Not all new technologies are created equal.
Facility-specific coding guidelines are key to code hospital visits and encounters consistently. Another role that facility-specific guidelines play is to capture all possible reimbursement that is due to an organization.
Every Oct. 1, the MS-DRGs and ICD-10-CM/PCS are updated. In addition to the MS-DRGs, the New Technology Add-On Payments (NTAPs) are updated as well. It is important not to confuse the NTAPs with the New Technology section in ICD-10-PCS. Not all the codes in the New Technology section are NTAPs. The NTAP provides additional reimbursement on top of the MS-DRG payment. The additional payments are usually triggered by the associated ICD-10-PCS code(s).
Coders must be aware of the NTAPs that are possible for their organization. Additionally, they must understand where the corresponding documentation can be found and how it appears. For the 2021 fiscal year, the following NTAPs are available:
In addition to these, NTAPs with alternative pathway have been added. These include:
Facility-specific coding guidelines should be updated to identify which of the above substances, devices, or tests are provided or performed by each facility. The result is additional reimbursement for the facility.
NTAPs are not the only updates to facility-specific coding guidelines. Each facility should consider the additional data needs in the context of quality, state reporting requirements, and facility reporting requirements. Some topics that have been in the news include social determinants of health (SDoH) and Hierarchical Condition Categories (HCCs), both of which should be addressed in facility-specific coding guidelines. SDoH codes fall in categories Z55-Z65. The guidelines should address which of these diagnosis codes are assigned and where the documentation is. For HCCs, each facility should address in their guidelines if they utilize them.
To promote coder productivity and efficiency, facility coding guidelines should address the coding of family history, past medical history, tobacco status, allergies, long-term drug use, external cause codes, and procedure status codes. Facility guidelines would also address the resolution process when there are situations that conflict with patient safety indicators (PSIs), hospital-acquired conditions (HACs), and other quality programs. The facility guidelines should address physician queries and how they are created, the follow-up process for unanswered queries, and an escalation process for unanswered queries. Discharge status is another topic that is strictly related to coding, but does impact reimbursement. Frequently, there is conflicting information regarding discharge status. The guidelines should include documentation for the discharge status. For example, the physician may say that the patient was discharged to a skilled nursing facility (SNF). The social worker may document that the patient was discharged to the acute rehabilitation unit within an SNF. If the social worker documentation is accurate, then the coder would identify that the patient was discharged to the acute rehabilitation unit. This internal guideline can avoid takebacks for inaccurate discharge statuses. See the Journal of the American Health Information Management Association’s (AHIMA’s) article, Developing Facility Specific Coding Guidelines, to assist your development.
Facility-specific coding guidelines are utilized by new coders as they become familiar with their new employers. They constitute a wonderful communication document. The bottom line is that this document can produce money for the facility and coder productivity for the department.
Programming Note: Laurie Johnson is a permanent panelist on Talk Ten Tuesdays. Listen to her live reporting on ICD-10 codes every Tuesday at 10 a.m. EST.
In ICD-10-CM, we have the ability to assign very specific external cause codes. As noted in Chapter 20, they allow us to classify environmental events
While it is not in the news on a daily basis any longer, COVID has not gone away. Since the start of the pandemic, we
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
