By Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS
At the 2017 ACDIS conference in May, Nelly Leon Chisen, RHIA, director of coding and classification, the executive editor of the American Hospital Association’s (AHA) Coding Clinic ...Read More »
By Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS
The 2017 Official Guidelines for Coding and Reporting, effective October 1, 2016, contained a new, perplexing, and problematic section I.A.19 titled “Code Assignment and Clinical Criteria,” which states:...Read More »
Q: We use an electronic system at our hospital, and find it is difficult to query a physician since we all have our own processes. Would you recommend having a set format for a query that is used electronically?
A: This is going to be contingent on the system your...Read More »
Nursing notes cannot be used for coding and billing purposes. This does not mean, however, that they’re worthless for CDI purposes. Often times, CDI specialists neglect reviewing this documentation because they know it can’t be coded. This is a mistake.
Physicians often ask why documentation matters to them. Last week, CMS sent out a reminder regarding the importance of complete and accurate documentation related to physician evaluation and management (E/M) codes.Read More »
When ICD-10-CM was launched last year, CMS said it would allow providers billing Part B physician fee schedule codes a one-year grace period to fully ramp up. During the grace period, the agency would not deny physician claims as long as the codes on the claim were from the correct “family of...Read More »
At this time last year, many CDI specialists, providers, and coders worried about the arrival of ICD-10; some spoke of doomsday scenarios with mountains of claim denials and delayed payments. One year later, the debut of ICD-10 is earning widespread comparisons to Y2K, the turn-of-the-century...Read More »
