Talk Ten Tuesdays

Fresh from her meeting last week at the World Health Organization (WHO) Morbidity Reference Group in Malmo, Sweden, Margaret Skurka returns to Talk Ten Tuesdays this Tuesday to report on ICD-11 – the new code set that is expected to be released next month by the WHO. Skurka reports on how countries are approaching the implementation of ICD-11. ( see ICD11 training videos ) Skurka is the past presi...

What’s next, when it comes to risk-adjusted reimbursement?   Home health is next. Just like diagnosis-related groups (DRGs) and hierarchical condition categories (HCCs), the patient-driven groupings model (PDGM) represents another tremendous opportunity for the health information management (HIM) professional because of the nationwide demands for ICD-10 expertise.   The Centers for Medicare &...

Clinical documentation integrity (CDI) is seen through an international lens as the contributions of the American Health Information Management Association’s (AHIMA’s) World Congress are recognized during this edition of Talk Ten Tuesdays. The broadcast will usher in the global celebration, coming just in advance of World Health Day on April 7. Joining the broadcast will be Alexandre Bouché, who c...

Surprise balance billing is an issue that is not only generating national interest but also legislative engagement on the state level. In Part I of this series, Holly Louie, past president of the Healthcare Business and Management Association, reported on such billing related to insurance company denials. For Part II, Matthew Albright, former Director of the Administrative Simplification Group at...

Imagine an almost seamless transition from ICD-10 to ICD-11, unlike the sturm and drang that characterized the transition from ICD-9 to ICD-10 – which, finally, after the dust settled, became effective in 2015.  Eliminating the speed bumps could happen. The National Committee for Vital Health Statistics (NCVHS) recently sent a letter to the Secretary of the U.S. Department of Health and Human Serv...

We are honored to welcome the President and Chair of the 2019 American Health Information Management Association (AHIMA) Board of Directors, Valerie Watzlaf, Ph. D. to this edition of Talk Ten Tuesdays.  Dr. Watzlaf is vice chair of education and associate professor within the Department of Health Information Management (HIM) in the School of Health and Rehabilitation Sciences (SHRS) at the Univer...

As the clinical documentation integrity (CDI) industry continues to grow beyond the traditional inpatient setting, the American Health Information Management Association (AHIMA) is working to provide best-practice resources to provider stakeholders from across the continuum of care. Sharing an update on AHIMA’s advocacy during this edition of Talk Ten Tuesdays will be Tammy Combs, the Association’...

Many procedures in the CPT® codebook are designated "separate procedures," but that doesn't mean you can report those procedures "separately" in every case, according to nationally recognized professional coding expert Terry Fletcher, who returns to Talk Ten Tuesdays to offer insight into this topic. Join Dr. Erica Remer and Dr. Juliet Ugarte Hopkins as they host the podca...

Knowing how to distinguish new patients from established patients, apart from ensuring that coding guidelines are being followed, enables you to be reimbursed for the additional work that new patient visits warrant. Moreover, in some cases, not distinguishing new patients from established patients can amount to shortchanging yourself, as you will learn during this edition of Talk Ten Tuesdays, whe...

Although still lingering on the horizon, much like a coming storm, ICD-11 is fast approaching – which is why the new code set is on the radar screen at the American Health Information Management Association (AHIMA). In fact, AHIMA reports that it has begun conducting research aimed at addressing coding in order to determine how productivity, accuracy, and quality can be improved across all setting...

The fallout continues over the recent announcement by UnitedHealthcare (UHC) that it would not use Sepsis-3 when reviewing claims to validate sepsis for payment from providers in the Empire State. New York state law defines sepsis with systemic inflammatory response syndrome (SIRS) criteria, otherwise known as Sepsis-2.  Reporting on Sepsis-3 during the next edition of Talk Ten Tuesdays will be br...

"The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis." — ICD-10-CM guideline I.A. 19 This guideline is frequently cited as the reason coders list diag...

Social determinants of health (SdoH) are swamping hospitals like rising rivers following a storm. A reported $1.7 trillion in healthcare costs are now attributed to 5 percent of the nation’s population, with a majority of that sum related to the SdoH.  And while the focus has been largely on the most vulnerable and disenfranchised members of populations, the new face of SDoH is evolving as a conse...

The mystery continues.  At the time of this report there were a reported 116 confirmed cases of acute flaccid myelitis (AFM) across 31 states, with the most cases reported in Colorado (15) and Texas (14). Plus, there are another 170 possible cases that haven’t been confirmed.  AFM is similar to polio and leads to a sudden onset of paralysis. This condition mostly affects children younger than 4. T...

Never before has the responsibility of an organization to provide clear, facility-specific guidelines and in-depth training for coders been more apparent than it is today – especially now with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) poised to conduct diagnosis-related group (DRG) validation audits. Reporting our lead story during this edition of Tal...

Are you experiencing this dilemma at your facility? You ask your physicians to add linking verbiage to their documentation for accuracy, which in turn has a negative impact on their publicly reported scores regarding complications and other metrics. Should physicians exclude the linking verbiage? Should they enter “as expected,” or should they simply avoid addressing these issues? Reporting on thi...

When it comes to defining sepsis, who wins? Is it providers, who rely on the current definition of sepsis as “life-threatening organ dysfunction caused by a dysregulated host response to infection?” Or do payers prevail – the ones who control the reimbursement? And under what circumstances would you ever side with a carrier that has denied a claim of sepsis? Reporting our lead story during this ed...

The tragic events that shocked the nation’s collective conscience on an otherwise peaceful recent Saturday morning call to mind the intersection of physician burnout and post-traumatic stress syndrome. With physician burnout reported to be widespread and suicides among physicians escalating at an alarming rate, do disasters – both natural and manmade – disproportionately impact the profession? Or...

The FY 2019 Official Guidelines for Coding and Reporting versus the American Hospital Association (AHA) third-quarter Coding Clinic: when it comes to coding body mass index (BMI), there’s a contradiction. The Guidelines say BMI codes should only be assigned when the associated diagnosis meets the definition of a reportable diagnosis. AHA guidance states that obesity is always coded, even without s...

UnitedHealthcare (UHC) has thrust Sepsis-3 into the national healthcare conversation with its recent announcement that come Jan. 1, 2019 it use the SEP-3 definition to determine if a diagnosis of sepsis is clinically validated, advising that the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score is to be used to determine if sepsis is present.  Although the definition of Sepsis-3 wa...

The third-quarter 2018 issue of AHA’s (the American Hospital Association’s) Coding Clinic for ICD-10-CM/PCS has been released, and during this edition of Talk Ten Tuesdays, Gloryanne Bryant will report on its significance. Other segments to be featured on the broadcast include: News Desk: Daniel Zirkman, MD, anchors the Talk Ten Tuesdays News Desk with the very latest news on hospitals in the disa...

Medical marijuana allows chronically ill patients to relieve painful, often debilitating symptoms legally instead of taking pills that many claim are mostly unhelpful. So why are there are no valid codes for submission for payment in the Current Procedural Terminology® (CPT), Healthcare Common Procedural Coding System (HCPCS), or National Drug Code (NDC) for medical marijuana? The current state of...

Twenty-nine new ICD-10 codes that are expected to leverage the ability of providers to document clients who might be at risk of sex and labor exploitation go into effect Oct. 1. Reporting on this developing story during this edition of Talk Ten Tuesdays is Nelly Leon-Chisen, the director of coding and classification for the American Hospital Association (AHA). The new codes will serve as the offic...

During this edition of Talk Ten Tuesdays, the fourth universal definition of myocardial infarction (MI) is reported on from two perspectives: the cardiologist and the coder. Joining the broadcast to offer the cardiologist perspective is Dr. Geoffrey Rose, division chief of adult cardiology with the Sanger Heart and Vascular Institute at Atrium Health. Nationally recognized coding authority Terry F...

In this edition of Talk Ten Tuesdays Chuck Buck and Holly Louie, RN welcome special guest Dr. Emmel Golden, a physician associate and medicine lead for Enjoin. Dr. Golden, board-certified in internal medicine and pulmonary disease, will report on, among other topics, those associated with major disease category 18, including the confusing aspects of coding systemic inflammatory response syndrome,...