What Happens on October 1st this year?!?!

END OF MEDICARE ICD10 "GRACE PERIOD".

https://youtu.be/Lp9a-SGZVm4

Do NOT use unspecific ICD10 codes!

Your diagnosis codes will start affecting payment January 1st!

Going forward, CMS & the third-party payers are "matching" your CPT codes with ICD10 codes
to build payment policies for the future.

The codes you submit now will affect current reimbursement & FUTURE reimbursement.

Check out this video -- very interesting!

RN-Coder Compliance Question of the Week

Respiratory

For the Week of September 19, 2016

Can you provide some examples of chest manipulations and the documentation required to report the applicable codes?
Chest manipulations are described in CPT with examples such as cupping, percussing and vibration to facilitate lung function by mobilization of sputum. These services must be documented as reasonable and necessary to be covered, and there must be evidence of the following:

• Consistent with the nature and severity of the individual’s symptoms and diagnosis
• Reasonable in terms of modality, amount, frequency and duration of treatment
• Generally accepted by the professional community as being safe and effective treatment for the purpose used.

RN-Auditor COMPLIANCE Question of the Week

For the Week of September 12, 2016

I have heard that the Medicare “ICD-10 flexibilities” will expire on October 1, 2016. What does this mean exactly?

According to the Centers for Medicare & Medicaid Services (CMS), ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud. 

As you say, these ICD-10 medical review flexibilities will end on October 1, 2016, and providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. 

Note, however, that providers should already be coding to the highest level of specificity as this is not a new requirement.

RN-CDS Compliance Question of the Week

For the Week of September 5, 2016

What is the difference between “history of” and “follow-up” in physician documentation?

Using “history of” and “follow-up” as if they are the same is a common documentation mistake.

“History of” is often used to indicate the current clinical indication. However, in ICD-10-CM, “history of” means that the patient has a past medical condition that no longer exists and is not receiving any treatment, but has the potential for recurrence.

“Follow-up” goes along with “history of” because follow-up codes indicate continued surveillance following a completed treatment of a condition, not follow-up during treatment.