Insights + Education

COVID-19 Booster and Third Shot Vaccinations – November 2021 Coding Tip

By Marcy Blitch / November 18, 2021

Currently there is no specific device value for the COVID-19 booster and or third COVID-19 vaccination. Assign the sixth character device value “U,” COVID-19 vaccine, when the additional dose is provided to the patient. A proposal for a new ICD-10-PCS code was presented by the Centers for Medicare and Medicaid at the September 2021 ICD-10…

Neurogenic Shock and Spinal Shock CDI Scenario – November 2021

By Staff / November 4, 2021

November’s CDI Scenario covers neurogenic shock and spinal shock. A 58 year old male enters the ER after hitting his head.

Two Important ICD-10 Guideline Changes for FY 2022 – October 2021 Coding Tip

By Marcy Blitch / October 21, 2021

Learn more about B3.7 (Control vs. More Specific Root Operations) and B4.1C as two important ICD-10 guideline changes for fiscal year 2022.

Pneumonia and COVID CDI Scenario – October 2021

By Staci Josten / October 11, 2021

October’s CDI scenario covers pneumonia and COVID-19. A 60 year old male patient presents with COVID and worsening hypoxia.

CMS to Reinstate Inpatient-Only List – September 2021 Coding Tip

By Marcy Blitch / September 22, 2021

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.

Medical Coding

ICD-11 Implementation Date

By Mary Stanfill / September 22, 2021
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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

By Staff / September 1, 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

By Staff / August 25, 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

By Marcy Blitch / August 18, 2021

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

By Mary Stanfill / August 9, 2021

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…