by Cheryl Ericson, RN, MS, CCDS, CDIP and Cathy Farraher, RN, MBA, CCM, CCDS
Clinical validation is a process in which diagnoses already written in the chart are reviewed by a clinical documentation specialist to ensure the corresponding clinical indicators and treatment exist...Read More »
The third character of a procedure code is represented by the root operation. Definitions for the root operations are located in Appendix A and within the tables of the ICD-10-PCS manual.
When the same root operation is performed on different body parts represented by distinct characters...Read More »
by Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO
Similar to diagnosis coding, start in the Alphabetic Index using a main term when reporting in ICD-10-PCS. A main term is most commonly one of three types of terms:
With the advent of the Affordable Care Act in 2010, CMS announced that it would no longer reimburse hospital costs associated with preventable conditions such as mistakes in care or hospital-acquired infections. CMS began incentivizing eligible hospitals...Read More »
The question often surfaces regarding what to do with CDI queries once they have been issued. My best advice is keep them. Most facilities do not consider concurrent queries part of the permanent medical record because physicians respond...Read More »
CMS and the OIG will conduct a two-part study to assess inpatient hospital billing due to unspecified upcoding in hospital billing—either accidentally or intentionally reporting higher severity codes than supported by documentation to increase payment.Read More »
The federal government has intervened in a lawsuit against Sutter Health, taking the side of a whistleblower who claims the nonprofit health system inflated the risk scores of Medicare Advantage plan enrollees to secure higher risk-adjusted payments.Read More »
