This article is about spring cleaning your coding and billing! There are a few concerns coming to light that need tidying up. These include the following:
Inconsistent documentation will draw denials if the documentation impacts the reimbursement. Some examples include aspiration pneumonia versus pneumonia, unspecified; chronic diastolic congestive heart failure versus acute-on-chronic diastolic congestive heart failure; and sepsis.
Another issue that may draw a denial is when the documentation does not support the payer’s payment policies. Here are examples:
The Centers for Medicare & Medicaid Services (CMS) has published a fact sheet about the end of the PHE. It is important for your revenue cycle to understand how this change will impact your facility – and not just from a CMS perspective. From a coding perspective, update your facility-specific coding guidelines so that you document the expected changes.
There are proposed changes for MS-DRGs as well as New Technology Add-On Payment (NTAP) items. Make plans to become educated, and communicate those changes.
The Healthcare Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes update on a quarterly basis. It is important to stay on top of the changes to reduce claim rejections or missed revenue. The end of the PHE will impact the chargemaster and revenue integrity as well.
This issue recently came up during a coding review. There was a difference of opinion regarding the coding of Crohn’s disease and its manifestations. According to the coding instruction under K50, an additional code should be assigned to specify the manifestation. The Coding Clinic from the fourth quarter of 2012 also provides the guidance that the manifestation may be separately reported to provide specificity.
Spring always brings with it activity. It may be new codes, new payment rules, or changes in reimbursement methodology. It is important to discuss such changes, develop an action plan, and complete the actions. As healthcare becomes more complicated, communication will be important to be successful.
Programming note: Listen to Laurie Johnson’s live coding report every Tuesday on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer, 10 Eastern.
While underdosing is no longer a new concept in coding it remains a common area of confusion. Underdosing is when a patient takes less of
This a heads-up on a definitional change coming our way. There will be the launching of a new framework for obesity in mid-January, per a
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