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FY 2007 IPPS Overview: Comprehensive Changes in Effect for Inpatient Prospective Payment System

Author: Johnson, Laurie M.; Garrett, Gail S.

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

Publication Date: November 2006


The Inpatient Prospective Payment System (IPPS) final rule for fiscal year 2007 will prove challenging for inpatient providers. The rule (published in the August 18 Federal Register and available at www.access.gpo.gov/su_docs/fedreg/a060818c.html) includes some of the most comprehensive changes....

IRF PPS Coding Challenges

Author: Trela, Patricia

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

Publication Date: May 2007


Inpatient rehabilitation facility (IRF) coding can be a challenge due to the Medicare Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS), which was implemented in 2002 to cover patients paid under Medicare Part A. IRF PPS requires completion of the IRF-Patient Assessment In....

Getting Quality Clinical and Coded Data: How UMHS's CDIP Improved Clinical Coded Data and Clinical Staff Relationships

Author: Blackford, Gwendolyn; Whitehouse, Rosanne

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

Publication Date: October 2007


Obtaining codeable clinical documentation at the point of care in a large teaching facility can be challenging. However, the HIM department at the University of Michigan Health System (UMHS) in Ann Arbor, MI, took on the task, implementing a clinical documentation improvement program (CDI....

Final Rule for FY 2008 IPPS: MS-DRGs and POA Top List in a Year of Major Change

Author: D'Amato, Cheryl; Garrett, Gail S.; Johnson, Laurie M.

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

Publication Date: November 2007



The final rule for the fiscal year 2008 inpatient prospective payment system (IPPS) went into effect October 1, 2007. The rule includes ICD-9-CM code changes, implementation of the new Medicare severity-adjusted (MS) DRG system, and a number of quality-related changes that affect how Medic....

Ensuring Proper Wound Care Service Coding: OIG Highlights Need for Organizations to Assess Wound Care Coding Practices

Author: Bryant, Gloryanne H.

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

Publication Date: November 2007



This year the Office of Inspector General (OIG) issued two reports relating to wound care services and Medicare payments. As the OIG has included wound care services as part of its 2007 work plan, coding and HIM professionals should review each report and re-assess their organization̵....

Coding Debridement Procedures

Author: McCullough, Dan

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2008


Coding debridement procedures can be difficult-even for the most experienced coding professional. Recent studies have documented inappropriate coding of debridement procedures that have resulted in millions of dollars in overpayments.

This article offers guidance on the app....

Home Health PPS Update

Author: Blevins, Ida K.

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2008


The long-anticipated update to the Home Health Prospective Payment System (PPS), released in the August 29, 2007, Federal Register, goes into effect January 1, 2008. The final rule encompasses a wide range of changes for home health agencies.
An Overview of the Final Rule
....

2008 CPT Coding Update

Author: Jorwic, Therese M

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2008


The new CPT codes took effect January 1, 2008. Changes include 244 additions, 314 revisions, and 50 deletions. A comprehensive list of changes can be found in appendix B of the CPT book. Highlights of the changes by section are outlined here.
Evaluation and Management

A revised....

Coding Preventive Care Services

Author: Wilkinson, Dianne

Source: Journal of AHIMA - Coding Notes

Publication Date: March 2008


According to the Partnership for Prevention—a program-based organization of businesses, nonprofits, and government agencies—“the U.S. health care system suffers a quality deficit in part because too many patients do not get the effective preventive care they need when they ne....

Clarifying Patient Status Code

Author: Bryant, Gloryanne H.

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2008


The patient status code reflects the level of care a patient was discharged or transferred to when leaving an acute care hospital as an inpatient or outpatient (i.e., emergency department or emergency room). A recent Centers for Medicare and Medicaid Services MLN Matters publication provides a....

FY 2009 Hospital IPPS Final Rule

Author: Schwab, Linda

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2008


The final rule for the FY 2009 hospital inpatient prospective payment system (IPPS) went into effect October 1, 2008. Although there are relatively few changes to MS-DRGs and the complication and comorbidity (CC) and major CC (MCC) lists, the final rule signals that the Centers for Medicare an....

ABCs of Medicare Advantage

Author: Hernandez, Jeannette

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2008


Although most Medicare beneficiaries receive their health coverage through the traditional Medicare Part A and B fee-for-service programs, more and more beneficiaries are enrolling in Medicare Part C, referred to as Medicare Advantage (MA), to manage their healthcare costs.

By June 2....

Coding Radiology Services

Author: Walk, Gerri

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2009


Because coding and radiology departments often share accountability for the quality of outpatient radiology coding, it is important that coding professionals share coding issues and charge capture expectations with radiology staff. This article outlines methods to improve the quality of coded....

2009 CPT Coding Update

Author: Majerowicz, Anita

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2009


Changes to CPT codes for 2009 include 293 additions, 133 revisions, and 92 deletions. This article highlights some of the more notable changes; a comprehensive list can be found in appendix B of the 2009 CPT code manual. The changes took effect January 1.

E/M Codes


Nu....

Key Issues in the 2009 OPPS Final Rule

Author: Clark, Andrea

Source: Journal of AHIMA - Coding Notes

Publication Date: March 2009


The final rule for the 2009 Outpatient Prospective Payment System (OPPS) includes multiple revisions that hospitals must address in their practices, policies, and operations. Hospitals should develop strategies for analyzing the financial impact and operational challenges by reviewing the foll....

ICD-10 Reimbursement Mappings: New Mappings from CMS Help Organizations in the Transition to ICD-10

Author: Butler, Rhonda R.; Mills, Ronald E

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2009


Starting October 1, 2013, healthcare claims will be submitted to payers using ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes. Some payers such as the Centers for Medicare and Medicaid Services (CMS) are converting their reimbursement systems to use ICD-10 codes directly. However, som....

ICD-10-CM Official Coding Guidelines

Author: Barta, Ann

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2009


One of the keys to a successful transition to ICD-10-CM/PCS is a thorough understanding of the ICD-10-CM Official Coding Guidelines, which were posted to the National Center for Health Statistics Web site in January 2009. Similar to the ICD-9-CM coding guidelines, the ICD-10-CM guidelines are....

Understanding National Coverage Policies: Navigating the Maze of HACs, Serious Reportable Events, and Wrong Surgical Sites

Author: Cook, Jane; D'Amato, Cheryl; Garrett, Gail S.; Ruhnau-Gee, Becky; Hyde, Linda A.; Novak, Natalie

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2009


Present on admission indicators, hospital-acquired conditions, serious reportable events, and “wrong” surgical events are each hot topics. However, they also can be a hot topic together, because a number of these reporting requirements are interrelated. HIM professionals must under....

New Guidance for Home Health Coding

Author: Blevins, Ida K.

Source: Journal of AHIMA - Coding Notes

Publication Date: July 2009


Sweeping PPS changes for home health went into effect January 2008, making much of the prior coding guidance issued by the Centers for Medicare and Medicaid Services (CMS) incompatible with changes in the revised data collection set. Home health coding professionals anxiously awaited further i....

FY 2010 Changes to the Hospital IPPS

Author: DeVault, Kathryn

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2009


The final rule for the FY 2010 Hospital Inpatient Prospective Payment System was released on July 31, 2009. Changes in the rule went into effect with inpatient discharges of October 1, 2009, and are reflected in Grouper Version 27.0.

The changes to MS-DRGs and the complication and co....

Coding in Critical Access Hospitals

Author: Kostick, Karen M.

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2009


National health policy has been increasingly responsive to the healthcare needs of rural residents and providers. Rural America has a large percentage of the nation’s Medicare population, and this percentage continues to grow as residents born in the Baby Boomer generation begin to retir....

ICD-10-PCS Root Operation Guidelines

Author: Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2010


ICD-10-PCS has a completely different structure than ICD-9-CM. Each ICD-10-PCS code consists of individual values rather than lists of fixed codes and text descriptions, with each value containing a unique definition. The objective of the procedure is identified in the third character, the roo....

2010 CPT Coding Update

Author: DeVault, Kathryn

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2010


Changes to CPT codes for 2010 include 219 additions, 141 revisions, and 63 deletions. This article highlights some of the more notable changes; a comprehensive list can be found in appendix B of the 2010 CPT coding book. The changes took effect January 1.
Resequencing

The most n....

ICD-10-PCS Root Operation Groups

Author: Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: March 2010

Root Operations that Take Out Some or All of a Body Part

The medical and surgical procedure section of ICD-10-PCS contains most, but not all, procedures typically reported in the hospital inpatient setting. As with all codes in ICD-10-PCS, the medical and surgical procedure codes contain....

ICD-10-PCS Root Operation Groups, Part 2

Author: Barta, Ann

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2010


Root Operations that Take Out Solids, Fluids, Gases from a Body Part, Involve Cutting or Separation Only, and Put In OR put Back or Move Some OR All of a Body Part

The medical and surgical procedure section of ICD-10-PCS contains most, but not all, procedures typically coded and repor....

Obstetric Coding in ICD-10-CM/PCS

Author: Barta, Ann

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2010


ICD-10-CM/PCS will capture a greater level of specificity for obstetric coding. This article highlights some of the new features in coding obstetric cases with ICD-10-CM/PCS.
OB Diagnoses Coding with ICD-10-CM

Obstetric cases require diagnosis codes from chapter 15 of ICD-10-CM,....

Coding Hip Fractures

Author: Endicott, Melanie

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2010


Hip fractures are most commonly seen in elderly patients. They are a serious concern for this population because they can lead to a decreased quality of life, extended hospitalizations, or admission to nursing facilities.

Two of the most common causes for fractures are falls and ost....

Establishing a CDI Program: How One Organization Leveraged Nursing and Coding Skills to Improve Clinical Data

Author: Lopez, Barbara A

Source: Journal of AHIMA - Coding Notes

Publication Date: July 2010


Establishing a clinical documentation improvement (CDI) program is an organization-wide, transformational process that affects a hospital’s culture, reaching across all disciplines and touching every colleague and the way they perform their jobs. Many factors can lead healthcare organizations....

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