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Ins and Outs of HCCs

Author: Fernandez, Valerie

Source: Journal of AHIMA | Journal of AHIMA - Coding Notes

Publication Date: June 2017



A Hierarchical Condition Category (HCC) is defined as a risk adjustment model that is used to calculate risk scores to predict future healthcare costs. The Centers for Medicare and Medicaid Services’ (CMS) CMS-HCC model is used to predict healthcare spending for Medicare Advantage Pl....

Evolving Roles in Clinical Documentation Improvement: Physician Practice Opportunities

Author: Barnette, Erin; Endicott, Melanie; Ericson, Cheryl E; Wieczorek, Michelle M.

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: May 2017


In order to effectively discuss clinical documentation improvement (CDI) opportunities in physician practices, it is important to first understand the drivers and goals of a physician practice CDI program. Historically, diagnosis codes have had little impact in regard to physician practice paym....

Back to Basics: APC Payment Methodology

Author: Tomak, Tracey

Source: CodeWrite | AHIMA newsletter article

Publication Date: April 2017



In August of 2000, the Centers for Medicare and Medicaid Services (CMS) introduced the Ambulatory Payment Classifications (APCs) under the Outpatient Prospective Payment System (OPPS). The objective of the APC payment system was to control costs and increase efficiencies for outpatient ser....

2017 CPT Coding Update

Author: Huey, Kim

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: March 2017



The 2017 update to the CPT code set brings fewer new codes than in previous years but more guideline changes and clarifications, as well as revisions in code description. One Appendix is deleted and a new one is created. There are a total of 149 new CPT codes, 498 revised codes, and 81 del....

New Study Illuminates the Ongoing Road to ICD-10 Productivity and Optimization

Author: Alakrawi, Zahraa M; Watzlaf, Valerie J.M.; Nemchik, Scot; Sheridan, Patty Thierry

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: March 2017



To quantify the impact of ICD-10-CM/PCS (ICD-10) on coding productivity, Ciox Health, in partnership with the University of Pittsburgh’s Department of Health Information Management, School of Health and Rehabilitation Sciences, conducted a previous study published in the August 2016....

Skilled Nursing Facility (SNF/NF) Clinical Documentation Improvement (CDI) Tip Sheets

Author: AHIMA Long Term Care CDI Workgroup

Source: AHIMA Task Force

Publication Date: February 2017

These tips focus on the language and/or wording that will garner greater details and specificity of the coded data for a given diagnosis, condition, and disease. In addition to the focus on coded data, these tips also include information to reflect quality care, frequency of documentation requirements, and documentation sources. These tips are meant to provide guidance in recognizing gaps in the clinical documentation.

CY 2017 OPPS Update

Author: Comfort, Angie

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: February 2017



As last year drew to a close, facilities began the looming task of reviewing the Hospital Outpatient Prospective Payment System (OPPS) final rule to ensure their chargemaster and systems were up-to-date with the 2017 changes. The final rule for calendar year (CY) 2017 was released on Novem....

Role of Coding and Documentation in the Quality Payment Program

Author: DeVault, Kathryn; Easterling, Sharon; Huey, Kim

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: January 2017



In the current era of healthcare transformation, the continuing importance of documentation and coding cannot be overstated. With the multitude of acronyms being added to the healthcare vocabulary, one may wonder where documentation and coding fits in. It’s important to remember that....

Provider’s Condensed Resource for Revenue Cycle, Coding Tools, and More

Author: Clack, Crystal; Freeman, Rae; Lewis, Laquette

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: January 2017


A cyclone of regulatory requirements for providers has officially touched down in the United States. The Affordable Care Act (ACA), Medicare Access and CHIP Reauthorization Act (MACRA), patient-centered medical home (PCMH), and value-based purchasing (VBP) initiatives are contributing to dramat....

Heart of the Matter: ICD-10-PCS Cardiac Coding

Author: Land, Daniel

Source: Journal of AHIMA

Publication Date: January 2017



A robust knowledge of anatomy and cardiac surgery techniques, a comprehensive understanding of coding guidelines, and an eye for precision are key components of correct ICD-10-PCS cardiac coding.


This article will review ICD-10-PCS Official Guidelines for Coding and Reportin....

Investigative Approach: How Clinical Documentation Teams Improve Communication, Documentation Outcomes and Patient Care

Author: Robinson, Steven

Source: Journal of AHIMA - website

Publication Date: December 29, 2016



Clinical documentation programs’ success is a result of the healthcare team keeping a constant vigil on communication while operationalizing outcomes and instilling provider support. Patient care is largely dependent on accurate communication among the healthcare provider team. In a....

Clinical Validation: the Next Level of CDI (December 2016 update)

Author: Denton, Debra Beisel; Endicott, Melanie; Ericson, Cheryl E; Love, Tammy R.; McDonald, Lori; Willis, Daphne

Source: AHIMA practice brief

Publication Date: December 2016


One of the more challenging tasks for both coding and clinical documentation improvement (CDI) professionals is clinical validation. This is a relatively new responsibility that has evolved as CDI programs mature and CDI and coding professionals advance their knowledge and collaboration on clin....

Hypertension Coding - Crisis Averted

Author: Lojewski, Tedi

Source: CodeWrite | AHIMA newsletter article

Publication Date: December 2016



Thanks to the recent publication of the ICD-10-CM Official Guidelines for Coding and Reporting FY 2017, the past controversy over the interpretation of the term "With" has been resolved.1 The revision of Section I.A.15, "With," now incorporates what was previously clarified in AHA Coding C....

Coding Viral Sepsis

Author: Sanvik, Gina

Source: AHIMA blog post | Journal of AHIMA - website

Publication Date: November 10, 2016




How to code viral sepsis has been a topic of discussion on AHIMA’s Engage Coding, Classification and Reimbursement community, and has be the subject of several inquiries to AHIMA’s Code-CheckTM coding question service.


The viral sepsis coding confusion may com....

ICD-10-PCS: An Applied Approach

Author: Kuehn, Lynn; Jorwic, Therese M

Source: AHIMA book

Publication Date: 2016

This comprehensive text, which uses the 2017 code set, is devoted to learning and mastering the process of building codes in ICD-10-PCS. All current coding professionals and students in academic programs must become and remain proficient in using this system for inpatient procedures.

FY 2017 Updates to ICD-10-PCS

Author: Ward, Maria

Source: Journal of AHIMA | Journal of AHIMA - Coding Notes

Publication Date: November 2016



Many changes come with the first update of the new ICD-10 Procedure Coding System (ICD-10-PCS) for fiscal year (FY) 2017. The higher-than-usual volume of changes was to be expected since the update system has been in a holding pattern for several years due to implementation delays. And al....

FY 2017 Updates to ICD-10-CM

Author: Rugg, Donna

Source: Journal of AHIMA | Journal of AHIMA - Coding Notes

Publication Date: November 2016



The ICD-10 Coordination and Maintenance Committee’s code freeze, first implemented after the October 1, 2011 annual update, has finally thawed. For fiscal year (FY) 2017 the ICD-10-CM classification is back on track with annual code and guideline updates. Due to the thousands of new/....

Tying Together CDI, ICD-10, and Healthcare Data Analytics: How CDI Programs and ICD-10 Are Impacting Data Analytics—and The Benefits Healthcare Organizations Are Seeing

Author: Bradley, Paul

Source: Journal of AHIMA

Publication Date: October 2016



A year in and ICD-10 is almost approaching the point of old news.


Of course—I’m kidding! Nothing could be further from the truth. From a data analytics perspective, the impact of ICD-10 is only beginning to be realized and understood.


For one, this first year....

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