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Observation Services Present Compliance Challenges

Author: Prophet-Bowman, Sue

Source: Journal of AHIMA

Publication Date: March 2003


Observation services have been a top fraud and abuse target of the Office of Inspector General (OIG) of the Department of Health and Human Services, primarily due to the complexity of the Medicare billing regulations and the potential for abuse. New regulations regarding reimbursement for thes....

Major Changes for Heart Failure Codes in 2003: New Codes Put Sharper Focus on Diagnosing, Preventing Heart Failure

Author: Casey, Patricia E.; Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2003


Are you up to date with the latest revisions to the heart failure codes? A revision of the heart failure codes, effective October 1, 2002, was originally presented at the May 2001 ICD-9-CM Coordination and Maintenance Committee meeting. At that meeting, representatives from Kaiser Permanente e....

ICD-9-CM Coordination and Maintenance Committee Discusses Code Proposals for FY2004

Author: AHIMA Policy and Government Relations Team

Source: AHIMA Advocacy and Policy

Publication Date: December 13, 2002


The ICD-9-CM Coordination and Maintenance Committee, cosponsored by the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS), met on December 5-6, 2002 in Baltimore, MD. Donna Pickett, RHIA, from NCHS, and Patricia Brooks, RHIA, from CMS, cochair....

Analysis of Final Rule for 2003 Revisions to the Medicare Hospital Outpatient Prospective Payment System

Author: AHIMA Policy and Government Relations Team

Source: AHIMA regulation analysis

Publication Date: November 24, 2002

The final rule regarding calendar year 2003 revisions to the Medicare hospital outpatient prospective payment system (PPS) was published in the November 1, 2002 issue of the Federal Register.   This rule becomes effective on January 1, 2003.   This analysis will cover significant....

Web FAQ

Author: AHIMA Coding Team

Source: AHIMA Q and A

Publication Date: October 2002

What Documentation Source Is Used to Assign Diagnosis Codes for Outpatient Testing?
A completed medical record is the best source of diagnosis coding, without regard to setting. However, recently there was confusion concerning whether the reason for testing found on a requisition for the test....

Web FAQ

Author: AHIMA Coding Team

Source: AHIMA Q and A

Publication Date: October 2002

Where Can I Find a Sample Job Description and the Standard Productivity Rate for a Coder?

Because of the wide variety of duties included in the tasks for a coding professional, AHIMA does not publish a standard job description and has found it impossible to create meaningful coding produ....

Web FAQ

Author: AHIMA Coding Team

Source: AHIMA Q and A

Publication Date: October 2002

Where can I find the APC regulations?

The HCFA regulations are found in the November 13, 2000 Federal Register, Vol. 65. No.219 pp.67798-68005. Go to http://www.access.gpo.gov/su_docs/fedreg/a001113c.html, and scroll down to Health Care Financing Administration.

HCFA has impleme....

Web FAQ

Author: AHIMA Coding Team

Source: AHIMA Q and A

Publication Date: October 2002

Who Has the Official Guidelines for Interpretation of Coding Guidelines or Appropriateness of Code Assignment?
For ICD-9-CM coding questions and guidelines we look to Cooperating Parties for ICD-9-CM. The National Center for Health Statistics and the Health Care Financing Administration receiv....

Web FAQ

Author: AHIMA Coding Team

Source: AHIMA Q and A

Publication Date: October 2002

Where Can I Find Coding Guidelines for Use in Long Term Care or for Skilled Nursing Facility Reporting?

The official coding guidelines (see earlier question regarding who has the official guidelines for code assignment) are applicable in long term care. These guidelines have been develope....

Communicating with Physicians: Something to Talk About

Author: Dunaway, M. Tray

Source: Journal of AHIMA

Publication Date: September 2002


Ask a physician: "Doctor, are your detailed history and physicals comprehensive?" Now ask: "Doctor, are your comprehensive history and physicals detailed?" Chances are, you'll get two affirmative replies. To a physician, detailed workups are comprehensive, and comprehensive workups are detaile....

New ICD-9-CM Committee Presents New Codes, Changes

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: September 2002


This is part 1 of a two-part summary of proposals from the April 2002 ICD-9-CM Coordination and Maintenance Committee meeting and includes procedure proposals. Part 2 will include diagnosis proposals and will be published in the October Journal of AHIMA.
The ICD-9-CM Coordination and Main....

Analysis of Final Rule for FY 2003 Revisions to the Medicare Hospital Inpatient Prospective Payment System

Author: AHIMA Policy and Government Relations Team

Source: AHIMA regulation analysis

Publication Date: August 02, 2002


The final rule regarding FY 2003 revisions to the Medicare hospital inpatient prospective payment system (PPS) was published in the August 1, 2002 issue of the Federal Register.



This rule becomes effective on October 1, 2002.This analysis will cover changes to DRG classificat....

New PPS Proposed for LTC Hospitals

Author: Dougherty, Michelle

Source: Journal of AHIMA

Publication Date: July 2002


In the past 10 years, the number of new long-term care hospitals (LTCHs) in the United States has tripled. Because of this growth, LTCHs are the newest post-acute settings to face a change in the reimbursement system.


While there are only about 270 LTCHs in the United States, t....

ICD-10 on the Horizon

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: July 2002


ICD-10 has taken hold around the globe, so why is the US still using ICD-9-CM? This article reviews the history of ICD-10 in the US.


Other countries are using it. Why aren't we? Coding professionals across the country and around the world are wondering why ICD-10-CM hasn't been....

Constructing a Coding Compliance Plan

Author: Hanna, Joette

Source: Journal of AHIMA

Publication Date: July 2002


The government has turned its attention to coding compliance. Do you have an effective program in place? Use the steps in this article to build a coding compliance program that protects your organization.


Coding compliance has become an integral part of every HIM department....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on ICD-10-CM

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: May 29, 2002

May 29, 2002
Opening Comments

Chairman Cohn, members of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security Subcommittee, ladies and gentlemen, good afternoon. I am Sue Prophet, director of coding policy and compliance of the American Health Informati....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on ICD-10-PCS

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: April 09, 2002


April 9, 2002

Opening Comments

Chairman Cohen, members of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security Subcommittee, ladies and gentlemen, good afternoon. I am Sue Prophet, director of coding policy and compliance of the American Hea....

Coding on the Home Front

Author: Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2002


Recently, a group of coders participated in a survey about their day-to-day experiences as remote, or at-home coders. The survey asked a series of questions related to the positives and negatives of coding at home versus coding in the more traditional office setting. Below is a summary of the....

Quality at the Core

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: March 2002


Is your hospital getting ready for the Joint Commission’s core measures project? Some hospitals are already transmitting the necessary data as part of the pilot project. Here’s how they are handling the challenges and deriving benefits.
If you’re an HIM director, you prob....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on Medical Code Sets

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: February 06, 2002

February 6, 2002
Opening Comments

Good morning Mr. Chairman, members and staff of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security subcommittee, ladies and gentlemen.   I am Sue Prophet, director of coding policy and compliance for the American Heal....

Medical Necessity under OPPS: a Look at the Challenges

Author: Carter, Darren

Source: Journal of AHIMA

Publication Date: February 2002


The outpatient prospective payment system (OPPS) has dramatically changed claims processing by introducing an automated system. Medical necessity validation has also been automated as a result, leaving hospitals with increased rejections. This article explores how OPPS impacts the medical nece....

Best Practices for Medical Necessity Validation

Author: Scichilone, Rita A

Source: Journal of AHIMA

Publication Date: February 2002


To protect the Medicare Trust Fund from being drained, government health plans must provide coverage restrictions for unnecessary health services in vulnerable patient populations. One restriction mechanism is the provision of edits that look for valid reason-for-visit codes for selected servi....

Closer Look at All-Patient Refined DRGs

Author: Averill, Richard F.

Source: Journal of AHIMA

Publication Date: January 2002


Are you fluent in DRG? This article takes a look at the evolution of the three distinct DRG systems and spotlights the most recent iteration, All-Patient Refined DRGs. It also sheds light on how this system, when codes are properly applied, can help an organization study morbidity and mortalit....

CPT Changes for 2002

Author: O'Hara, Karen

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2002


Coders need to keep their resources current—including updating the Current Procedural Terminology (CPT) codes every year with the annual CPT book. This article provides a brief summary of the changes made to the CPT 2002 code set. The complete list of changes can be found in Appendix B of....

Here Comes Rehab PPS!

Author: Grzybowski, Darice; Draper, Skeeter

Source: Journal of AHIMA

Publication Date: January 2002


Just when you thought it was safe to come up for air.


After Medicare’s introduction of the Outpatient Prospective Payment System (PPS, which brought us APCs), the Home Health PPS (with its HHRGs), and Skilled Nursing Facility PPS (with RUGS), another new reimbursement syst....

Anthrax: What Every Coder Should Know

Author: Stanfill, Mary H

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2002


The inhalation anthrax identified by a Florida physician in October 2001, during the recent series of bioterrorist attacks, was the first case of reported inhalation anthrax in the United States in more than 25 years.1 With the threat of anthrax as a biological weapon, correct coding could be....

ICD-9-CM Codes Ready for 2002

Author: Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2001


For those reporting ICD-9-CM codes for all diagnoses coding, and hospitals reporting ICD-9-CM volume III for procedures, fall is the time to review and implement the changes and revisions for fiscal year 2002.

The ICD-9-CM coding changes for fiscal year 2002 were released in the Augus....

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