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Inpatient Facility Coding & Compliance Alert

Compliance/Reimbursement:
OIG 2016 Work Plan Moves the Dial on HIPAA Enforcement
Get ready for scrutiny regarding your ePHI, EHR compliance, and more. This New Year, t... Read more
ICD-10 update:
Identify the Body System and Begin Building the PCS Code
Familiarize yourself with the 28 possible numbers and letters. Still facing the added... Read more
Reimbursement:
Get Ready For the New Joint Replacement Payment Demonstration for Hospitals
Hospitals to get incentive/ penalty as per the quality outcomes. Your joint replacemen... Read more
Reader Question:
Tackle Coding for Hypertensive Heart Disease with Chronic Bronchitis
Question: A 69- year-old with a mild acute exacerbation of obstructive chronic bron... Read more
Reader Question:
Check Out CMS' Policy on Coumadin
Question: Where do Coumadin and amiodarone fall in the E/M medical decision making ... Read more
You Be the Coder:
Hit the Right DRG for Pyelonephritis
Question: A patient is admitted with complaints of left flank pain and fever. He is... Read more
Reimbursement/Policy:
Know the New POS Modifiers Hospital-Based Off-Campus Clinics for 2016
OIG asks CMS to gather data for analyzing differential payments. Beginning Jan.1, 2016... Read more
Policy:
Get Ready for Patient Centered Discharge Planning in 2016
You will need to conform to CMS standards, and share quality data. Give way, for your ... Read more
ICD-10 Update:
Take the Guesswork out ICD-10 Flexibilities: What the Guidance Does and Does Not Cover
Go by the specificity NCDs and LCD require; turn to Ombudsman for help, and more. As y... Read more
Reader Question:
"X" Won't Just Mark a Spot in ICD-10-PCS
Question: In ICD-10-CM we use “X” as a way to show that codes need an a... Read more
Reader Question:
Use the "Other" Codes With Caution
Question: If I find that a common ICD-9 code that I used until September doesn&rsqu... Read more
Reader Question:
Expect No SSN on Future Medicare Insurance Cards
Question: Is it true that Medicare is removing the patient’s SSN from their M... Read more
Reader Question:
Know When to Use Condition Code 44
Question: What is condition code 44 and how what are the guidelines to apply it for... Read more
You Be the Coder:
Assign a DRG Code For Prostatectomy
Question: A morbidly obese patient is due for a prostatectomy. Which DRG should he ... Read more
Reimbursement/Policy:
Take Note of NOTICE, the New Law for Observation Care
Notify the patients under observation for more than 24 hours, in 2016. If you thought ... Read more
CPT® Update:
Start Thinking Now About New Codes for 2016
Plus, watch injection changes for pain management. It’s that time of the year wh... Read more
ICD-10 Tutorial:
Refresh Your ICD-10-PCS Coding with 3 Examples
Grab these must know facts on inpatient coding October is here, and so is ICD-10, fina... Read more
Reader Question:
Know the Correct POS code for Partial Hospitalization
Question: Our psychiatrist performed group psychotherapy for Medicare patients who ... Read more
Reader Question:
Know the New Rules for Opting Out of Medicare
Question: Our surgery practice has chosen to opt out of Medicare. I heard that ther... Read more
Reader Question:
Crack the Rehabilitation MS-DRGS In Sync With ICD-10
Question: Can you explain how inpatient admissions are assigned to Medicare Severit... Read more
Reader Question:
Choose Specific Codes for Radiculopathy in ICD-10
Question: What ICD-10 codes can we submit to report the diagnosis of lumbar radicul... Read more
Reader Question:
Fix the Fracture Codes Right with 18 Seventh Character options
Question: The code M84.551A has a seventh character of A. Another code S82.852K h... Read more
You Be the Coder:
Capture the ICD-10 Code for Herpes Zoster Myelitis
Question: A 40-year-old male with a history of shingles, presents to his physician&... Read more
Policy/Reimbursement:
Fine Tune Your Observation Services With the 2-Midnight Rule and More
Wipe out your woes with this package of 5 tips and 3 examples. The order to admit a p... Read more
Reimbursement/Policy:
Don't Miss 3 Important Changes in the SNF PPS Final Rule
Good news: Expect a boost in your payment rate for FY 2016. The three new standardized... Read more
ICD-10 Update:
Draw on ICD-10 Flexibility to Code for Symptoms
Make the grade in symptoms coding with these 4 tips. The clock is ticking, so are you ... Read more
Reader Question:
Go By Patient's Status to Determine the POS
Question: A pediatrician admitted and discharged a patient to observation status fo... Read more
Reader Question:
Conquer the Combination Codes
Question: A 56-year-old patient presents with chest pain. He is diagnosed with athe... Read more
Reader Question:
Beware of PHI Breach Within the Facility
Question: An employee at our hospital accessed records for which he had no legitima... Read more
Reader Question:
Use This Quick Guide to Pinpoint POS Codes
Question: I have heard according to a recent OIG audit, incorrect coding for place ... Read more
You Be the Coder:
Assign the Correct DRG for Pneumonia With Acute Respiratory Failure
Question: A patient is admitted with pneumonia. She also has acute respiratory fail... Read more
Policy/Reimbursement:
Get a Foothold on the Over 2-Midnight Rule
Guard yourself from RACs with this expert advice. Got the RACs knocking at your door? ... Read more
Privacy:
Is Someone Eyeing Your Medical Identity?
Safeguard your facility from medical identity theft with these 8 tips. How safe is yo... Read more
ICD 10 Update:
Rejoice With No ICD-10 Code Based Denials For One Year
CMS and AMA promise 4 concessions to ease the transition. Breathe easy, for CMS and th... Read more
Reader Questions:
Coding for Claims That Span the ICD-10 Implementation Date
Question: Is there any policy for processing split claims for certain institutional... Read more
Reader Questions:
Know POS For Inpatient Consultation Outside the Hospital
Question: We were asked to perform a consultation for a hospital inpatient who was ... Read more
You Be the Coder:
Assign the Correct DRG for Atrial Fibrillation With Decubitus Ulcer
Question: Mr. Michael, 55, was admitted to the hospital with acute atrial fibrillat... Read more
Reimbursement:
Pull the Plug on Short Hospital Stay Policy Issues
Get familiar with 5 MedPAC policy recommendations and more. The advancement in health ... Read more
Policy:
Ensure IRF Claims Coverage with 3 Simple Steps
Boost your bottom line with these IRF PPS requirements. If you are part of an Inpatien... Read more
ICD-10 Update:
Take a Giant Leap Forward With This CMS Advice
Ward off your ICD-10 fears with these 12 enlightening facts from CMS.  The ICD-10... Read more
Reader Questions:
Acute Neck Pain Coding in ICD-10
Question: A patient receives pain control measures for acute neck pain following an... Read more
Reader Questions:
Know More About 99218-99220 Observation Coding
Question: The pulmonologist admits a 55-year-old patient with mild chronic bronchit... Read more
Reader Questions:
Billing for Office Visit and Admission the Same Day
Question: We have several patients that we see in the office before they are admitt... Read more
You Be the Coder:
Assign the Correct DRG for Appendectomy with Peritoneal Abscess
Question: A patient is due for appendectomy. She also has a peritoneal abscess and ... Read more
Reimbursement/Policy:
Get a Foothold With the OIG Work Plan Mid-Year Update
Tune in to 6 additional watch items. On May 28, 2015, the Office of the Inspector Gene... Read more
Compliance:
Brace Yourself for the Meaningful Use Requirements
Stay away from the radar of payment penalties with these tips. Are you one of the 400,... Read more
Coding:
Stop Missing Out on Reimbursement in the Event of Patient's Demise
Discharge codes are appropriate, CMS advises. Is your hard work written off along with... Read more
ICD-10 Update:
Enjoy Extended Coverage as New Bill Proposes Transition Period
HHS to prove readiness and provide 18 months cover from denials. Get ready for the lat... Read more
Reader Questions:
Put the 99221/99211 Confusion Behind You With a Simple Query
Question: Our provider admitted a patient for observation, but documentation of ini... Read more
Reader Questions:
Add Modifier 59 for Control of Bleed of an Inpatient
Question: Our gastroenterologist just attended to a Medicare inpatient and performe... Read more
You Be the Coder:
Heed the POS for Inpatients
Question: One of our physicians was called and asked to do a consult on an inpatien... Read more
Reimbursement/Policy:
Know No Fear; the "Final Doc Fix" Is Here
Now you have a mixed bag of surprises to wade through to conclude the SGR impasse. Thi... Read more
Reimbursement:
Make Way for the 1.9 Percent Increase in Payments Next Year
CMS proposes new quality measures for hospitals. Your inpatient rehabilitation facilit... Read more
Documentation:
Documentation Holds the Key for Long-term Opioid Treatment
Draw on an impeccable strategy for reimbursement with the 4 A’s. Are you aware o... Read more
ICD-10 Update:
Breathe Easy With CVA Sequelae Codes
Get your feet wet in multiple code choices. Look no further for coding cerebrovascular... Read more
Reader Questions:
The 90-day Surgical Global Period Includes Hospital Visits as WelL
Question: If my doctor performs a procedure with a 90-day global period and he has ... Read more
Reader Questions:
Understand Limitation On Liability (LOL) and Refund Requirements
Question: What are “Limitation On Liability” and the “Refund Requ... Read more
Reader Questions:
Remember This When Reporting a Wrong Procedure
Question:  In an untoward incident, the provider performed the procedure on the wro... Read more
You Be the Coder:
Assign Correct DRG for Appendectomy with Morbid Obesity
Question: A morbidly obese patient is due for a major procedure involving the small... Read more
Reimbursement:
MedPAC Shares the Truth Behind the Declining Inpatient Occupancy, and More
Base payment rates for hospitals to rise by 3.25 percent in 2016. If you think your fa... Read more
Coding:
Twin Tips to Wade Through Inpatient Consult Coding
Ensure the “inpatient” status before billing. You cannot afford to do with... Read more
ICD-10 Update:
Grab the July ICD-10 Testing Opportunity by CMS
Gather tips on end-to-end testing before the official implementation date. Cash in on ... Read more
Reader Questions:
How Date of Service Affects the Patient
Question: Could you please explain the CMS date of service policy, especially the i... Read more
Reader Question:
Code Right For Extended Psychotherapy
Question: Our psychiatrist recently performed an extended psychotherapy session for... Read more
Reader Questions:
How to Report Subsequent Hospital Care
Question: The provider wants to bill for initial hospital care using 99221, as well... Read more
Reader Questions:
Fulfill ABN Readability Requirements
Question:  I recently heard another provider that there are certain readability sta... Read more
You Be the Coder:
Which MS DRG Goes In for Cardiac Pacemaker Revision?
Question: A 55-year-old male undergoes Cardiac pacemaker revision only. His reports... Read more
Reimbursement:
Rejoice With No Change in MS-DRG Reporting This October
Prepare for the new MS-DRGs to evolve by 2018.  Your MS-DRGs will stay the same f... Read more
Compliance:
Brace Yourself for the 2015 Inpatient Payment Updates
Grab the mixed bag of these six opportunities. Here is your peek at some really dynami... Read more
Compliance/Documentation:
Get a Foothold on Incentives by EHR Participation in 2015
Act in time to reap benefits in 2016. The clock is ticking -- have you begun your part... Read more
ICD-10 Update:
Pursue the Most Definitive Diagnosis in ICD-10
Capture the exact code, or else use “unspecified.” Have you made up your m... Read more
Reader Question:
Know the Rules for Urban To Rural Classification
Question: How can we apply for a reclassification of our facility from urban to rur... Read more
Reader Question:
Which MS DRG Goes In for Prostatectomy
Question: A 60-year-old male undergoes prostatectomy. His reports do not reveal the... Read more
Reader Question:
Are Hospital Visits Included in the 90-day Surgical Global Period?
Question: If my doctor performs a procedure with a 90-day global period and he has ... Read more
Reader Question:
Know When to Bill EEG Reading With Hospital Visit
Question: Can we bill for an EEG when our physician reads one in addition to a hosp... Read more
You Be the Coder:
Code Interoperative Consult as Inpatient
Question: Provider A was asked to provide an interoperative consultation by Provide... Read more
Reimbursement:
Pump Up Your PAC Payments With Standardized Tool and Quality Reporting
Capture dollars with new quality measures that IMPACT Act brings in 2016. The Improvin... Read more
Accreditation:
Wield Your Imaging Edge With the New Diagnostic Imaging Standards
Get a quick scoop on 4 key areas for hospitals. Your long wait for diagnostic imaging ... Read more
ICD-10 Update:
Crack Appendicitis Coding With Numerous Site Based Options
Heed peritonitis while coding for acute appendicitis. As you explore ICD-10 options fo... Read more
Reader Question:
Know the Transfer DRGs
Question: What are transfer DRGs and how do they apply to acute care hospitals? M... Read more
Reader Question:
Crack the Code for White Coat Hypertension
Question: Our physician recently diagnosed a patient with “white coat hypertension... Read more
Reader Question:
Prove Medical Necessity for Unlisted Procedure Claims
Question: One of our physicians performed a colonoscopy on a Medicare patient with ... Read more
Reader Question:
Know the Rules for Geographical Reclassification
Question: Our facility receives patients from a nearby area and the wage index is q... Read more
You Be the Coder:
Assign Correct DRG for Appendectomy with Anemia
Question: A patient is due for appendectomy with peritoneal abscess. She also has a... Read more
Compliance:
Plan Ahead for the Issues Within the OIG's 2015 Work Plan
Address the changes that OIG wants to see with these five strategic tips. Short i... Read more
Reimbursement:
Prepare for Four New Alternatives to Modifier-59 in 2015
Precision is the key to using the “X” modifiers. Watch out for the new cod... Read more
Refresh Your Memory:
Modifier -59 Defined
Here’s the CPT® manual’s definition of this commonly-used modifier: &l... Read more
Reimbursement:
Here's the Truth Behind the Rise in Outpatient Services
Spearhead your work plan with these 3 foundational realities. So, you think your facil... Read more
ICD-10 update:
Celebrate the New Year With CMS's Positive Feedback on Claims Testing
Win the battle by setting right the invalid NPI’s and ICD-10 qualifier codes. If... Read more
Reader Question:
Know the Difference Between 'Unspecified' and 'Other Specified' in ICD-10
Question: Are there are some codes that don’t have a bridge between the curre... Read more
Reader Question:
Look for the New Chronic Care Payment Rate in 2015
Question: What is the final rule from CMS on the payment rate change for chronic ca... Read more
Reader Question:
Find Out the Effect of Readmissions on Reimbursement
Question: A patient who previously had pneumonia needed to be readmitted to the hos... Read more
You Be the Coder:
Know What Can Reduce the DRG Payment
Question: What are the factors that can reduce a MS-DRG payment? Illinois Subscri... Read more
Available Years:  2015  2014  2013  2012