CMS to Reinstate Inpatient-Only List – September 2021 Coding Tip
In an unprecedented move, CMS has proposed in the 2022 Outpatient Prospective Payment System Rule to put back on the inpatient only list all 298 services that they had previously removed from the IPO list in CY 2021.
ICD-11 Implementation Date
When will we implement ICD-11 for use on healthcare claims in the US? That’s a question everyone wants the answer to, but the true answer is – no one knows. However, when we know the answer on the following three key questions, we’ll be able to predict the implementation date in the US. Will the…
Top 10 Documentation and Coding Issues for Physician Practices in 2021
Make sure you are addressing these top documentation and coding compliance concerns. Risk-based review of evaluation and management codes (E/M): Appropriate application of FY21 E/M code guideline changes Telehealth visits (audio and visual vs. telephone only); Medicaid behavioral health telehealth Review providers with higher than 10% of visits in level 4 and 5, or outliers…
Top 10 Documentation and Coding Issues for Hospitals in 2021
Make sure you are addressing these top documentation and coding compliance concerns. Risk-based review of inpatient DRG cases, examples include: RAC DRG targets; PEPPER targeted DRGs COVID related inpatient discharges Clinical indicators, cases at risk for clinical denials (e.g. Sepsis, CHF, ARF, severe malnutrition, encephalopathy) IP cases with only 1 MCC/CC code or HAC/PSI cases…
Reporting Percutaneous Ventricular Assist Device Insertion – August 2021 Coding Tip
Learn more about codes 33995 and 33997, which are new to the 2021 Current Procedural Terminology (CPT).
FY 2022 IPPS MS-DRG Final Rule Updates
The annual final rule from the Centers for Medicare and Medicaid Services (CMS) regarding the Inpatient Prospective Payment System (IPPS) MS-DRGs was issued on August 2, 2021. [1] This final rule is effective October 1, 2021. [2] It was proposed in April that 3,490 unspecified diagnosis codes currently designated as either CC or MCC would…
CY 2022 OPPS Proposed Rule
On July 19th the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Outpatient Prospective Payment System (OPPS) proposed rule. [1] After a comment period, the final rule will be published in November 2021. Notable changes proposed for CY 2022 include: A net increase in OPPS payment rates of 2.3% over…
New FY22 Code: Non-Traumatic Cardiac Injury
With the current ICD-10-CM code set, there is no specific code corresponding to non-traumatic myocardial injury. Given the high severity of illness typical of patients with non-ischemic myocardial injury, appropriate classification of these patients is paramount in terms of aligning appropriate diagnostic and treatment strategies while avoiding inappropriate approaches that would otherwise be suggested by…
New FY22 Code: Gastric Intestinal Metaplasia
Intestinal metaplasia (IM) occurs when cells in the tissues of the upper digestive tract, often in the stomach or esophagus, change and become more like cells from the intestines. Intestinal metaplasia in the esophagus is also called Barrett’s esophagus. Intestinal metaplasia is more common in people who have chronic acid reflux or gastroesophageal reflux disease (GERD). The…
FY 2022 ICD-10-CM Updates
Abnormal Findings on Neonatal Screening Currently there is only a single code to capture any or all types of newborn screenings that may have positive or abnormal results. The American Academy of Pediatrics requested expansion of category P09 Abnormal findings on neonatal screening, to specifically show which screening categories were abnormal. Table 1 shows the…
Glasgow Coma Scale – July 2021 Coding Tip
The Glasgow Coma Scale (GCS) is a clinical scale used to measure a person’s level of consciousness after a brain injury. The scoring is determined by three factors: amount of eye opening, verbal responsiveness, and motor responsiveness. The Glasgow Coma Scale has an adult version and a pediatric version. The pediatric version is also composed…
New FY22 Code: Measurement of Flow in a Cerebral Fluid Shunt
There are currently no unique ICD-10-PCS codes to describe the noninvasive measurement of flow through a cerebrospinal fluid (CSF) shunt. Hydrocephalus is a debilitating neurological disorder that results from the overproduction and/or impaired reabsorption of cerebrospinal fluid (CSF) in the ventricles of the brain. Hydrocephalus affects over 1 million people in the United States alone….