1st Quarter 2018 I N S I D E T H I S CPT Refreshed I S S U E · By now, you’ve heard of the KRACK...
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CONNECT WITH US! www.rmcinc.org 800.538.5007 REIMBURSEMENT MANAGEMENT CONSULTANTS, INC. 12042 SE Sunnyside Rd #452 Clackamas, OR 97015 What’s New? 2017 Coding Clinic Updates 2 Wi-Fi Vulnerability & the KRACK Infiltration: Tips from Techs 2-3 Respiratory Failure: Clinical Criteria 3 RMC News 6-7 Vol.8 Issue 1 1st Quarter 2018 INSIDE THIS ISSUE: CPT Refreshed By Sarah Reed, RHIT, CCS I can’t believe spring is just around the corner! In the spirit of spring, let’s take a moment to refresh our memories of the CPT Manual. There is a lot of good information within the code book. Encoders are wonderful, but sometimes the answer you are looking for is right under your fingertips, within the hard copy. Personally, I love the additional notes and instructions found throughout the CPT Professional book. Guidelines – Yes please! Located at the beginning of each CPT section (i.e. Evaluation & Management, Surgery, Medicine etc.), the guidelines provide information that will help you with reporting procedures and/or services within that section. This may include topics such as the CPT Surgical Package and Separate Procedures. Additional guidelines and instructions can be found near codes within subsections and subheadings. For instance, detailed instructions can be found in Integu- mentary that will assist in the coding of lesion removal and repairs. Annually, new and updated instructions will appear in green throughout the CPT Professional Manual. Be on the look-out for those! Another place to find good information is within the table of contents in certain subsections. For instance, when looking in Musculoskeletal you can find definitions of fracture treatment modalities as well as information on soft tissue tumors. The Index – Many encoders are logic based. If you are having a hard time locating a code within your encoder decision tree, the CPT Index may be what you need. The index will give you a single code or code ranges to help you arrive at the correct code. You can look up codes by: Name of procedure or Service Organ or Anatomic Site Condition Synonyms, Eponyms, Abbreviations If your provider is performing a procedure that is considered an emerging medical technology, Category III codes may be helpful to you. Services and procedures in this section are awaiting FDA approval. These codes are updated twice a year and may or may not be changed into a Category I code within a five year period. Category III codes, when applicable, provide better detail than an unlisted code. Another area of CPT, that I have to admit I often overlook, are the appendices. There are 16 total. Here you can find expanded information on modifiers in Appendix A and some great E/M level examples in Appendix C. If you are looking for a familiar code and are unable to find it, see Appendix B. Here you will find code additions, deletions and revisions. Appendix J can assist in coding nerve conduction studies. It contains details on sensory, motor and mixed nerves and their associated CPT ranges. If you are doing cardiovascular coding, check out Appendix L which has a listing of vascular families and their branches. The Current Procedural Terminology code book may not have all the answers you need when trying to solve a coding problem, but it can be a good place to start. There are notes everywhere! Instructional, parenthetical, and within code descriptors; hopefully you will find what you are looking for. Happy Coding! Sarah Reed, RHIT, CCS is RMC’s Senior Outpatient Auditor. Sarah joined RMC in 2013, and has nearly 10 years of experience in the Health Information Management Field. She has a love for all Outpatient Coding, ER, Outpatient, Profee and specializes in SDS. Prior to joining RMC, Sarah’s past positions include Surgery Coding Specialist, Senior Coding Compliance Auditor and Revenue Integrity Failed Claims Specialist. She has worked in a variety of acute care hospitals, ranging from a 25-bed critical access hospitals to large multi hospital networks including trauma level 1 teaching hospitals. Sarah is a multi-talented coder, auditor, educator and trainer. Sarah has been actively involved with RMC’s ICD-10 Training and education program. Sarah resides in Oregon and can be reached at [email protected]
Transcript of 1st Quarter 2018 I N S I D E T H I S CPT Refreshed I S S U E · By now, you’ve heard of the KRACK...
CONNECT
WITH US!
www.rmcinc.org
800.538.5007
REIMBURSEMENT
MANAGEMENT
CONSULTANTS, INC. 12042 SE Sunnyside Rd #452
Clackamas, OR 97015
What’s New? 2017
Coding Clinic
Updates 2
Wi-Fi Vulnerability
& the KRACK
Infiltration: Tips
from Techs
2-3
Respiratory
Failure: Clinical
Criteria 3
RMC News 6-7
Vol.8 Issue 1 1st Quarter 2018
I N S I D E T H I S I S S U E :
CPT Refreshed By Sarah Reed, RHIT, CCS
I can’t believe spring is just around the corner! In the spirit of spring, let’s take a moment to refresh
our memories of the CPT Manual. There is a lot of good information within the code book. Encoders
are wonderful, but sometimes the answer you are looking for is right under your fingertips, within the
hard copy. Personally, I love the additional notes and instructions found throughout the CPT
Professional book.
Guidelines – Yes please! Located at the beginning of each CPT section (i.e. Evaluation &
Management, Surgery, Medicine etc.), the guidelines provide information that will help you with
reporting procedures and/or services within that section. This may include topics such as the CPT
Surgical Package and Separate Procedures. Additional guidelines and instructions can be found near
codes within subsections and subheadings. For instance, detailed instructions can be found in Integu-
mentary that will assist in the coding of lesion removal and repairs. Annually, new and updated
instructions will appear in green throughout the CPT Professional Manual. Be on the look-out for
those!
Another place to find good information is within the table of contents in certain subsections. For
instance, when looking in Musculoskeletal you can find definitions of fracture treatment modalities as
well as information on soft tissue tumors.
The Index – Many encoders are logic based. If you are having a hard time locating a code within your
encoder decision tree, the CPT Index may be what you need. The index will give you a single code or
code ranges to help you arrive at the correct code. You can look up codes by:
Name of procedure or Service
Organ or Anatomic Site
Condition
Synonyms, Eponyms, Abbreviations
If your provider is performing a procedure that is considered an emerging medical technology,
Category III codes may be helpful to you. Services and procedures in this section are awaiting FDA
approval. These codes are updated twice a year and may or may not be changed into a Category I code
within a five year period. Category III codes, when applicable, provide better detail than an unlisted
code.
Another area of CPT, that I have to admit I often overlook, are the appendices. There are 16 total.
Here you can find expanded information on modifiers in Appendix A and some great E/M level
examples in Appendix C. If you are looking for a familiar code and are unable to find it, see Appendix
B. Here you will find code additions, deletions and revisions. Appendix J can assist in coding nerve
conduction studies. It contains details on sensory, motor and mixed nerves and their associated CPT
ranges. If you are doing cardiovascular coding, check out Appendix L which has a listing of vascular
families and their branches.
The Current Procedural Terminology code book may not have all the answers you need when trying to
solve a coding problem, but it can be a good place to start. There are notes everywhere! Instructional,
parenthetical, and within code descriptors; hopefully you will find what you are looking for. Happy
Coding!
Sarah Reed, RHIT, CCS is RMC’s Senior Outpatient Auditor. Sarah joined RMC in 2013, and has nearly 10 years of experience in the Health Information Management Field. She has a love for all
Outpatient Coding, ER, Outpatient, Profee and specializes in SDS. Prior to joining RMC, Sarah’s past
positions include Surgery Coding Specialist, Senior Coding Compliance Auditor and Revenue Integrity Failed Claims Specialist. She has worked in a variety of acute care hospitals, ranging from a 25-bed
critical access hospitals to large multi hospital networks including trauma level 1 teaching hospitals.
Sarah is a multi-talented coder, auditor, educator and trainer. Sarah has been actively involved with RMC’s
ICD-10 Training and education program. Sarah resides in Oregon and can be reached at [email protected]
2017 brought us a flurry of Coding Clinics which ranged from clarifications to updates to new advice. From correctly coding and reporting
uncontrolled diabetes to emphysema and chronic obstructive pulmonary disease (COPD) exacerbation to therapeutic and diagnostic
paracentesis, AHA Coding Clinic™ clarified many coding conundrums this calendar year. One of the most significant coding changes was
coding gastrointestinal (GI) bleeding and a gastrointestinal condition such as gastric ulcer which are not linked in the chart documentation.
Previous Coding Clinic advice stated that the coder should not assume a causal relationship between gastrointestinal bleeding and a single
finding such as a gastric ulcer, gastritis, diverticulitis, etc. The physician must identify the source of the bleeding and link the clinical findings
from the colonoscopy or upper endoscopy, since these findings may be unrelated to the bleeding. However, based on updated advice published
in Third Quarter 2017, page 27 the classification now presumes a causal relationship between the two conditions linked by these terms in the
Alphabetic Index or Tabular List due to the “with” guideline. Unless the provider documents a different cause of the bleeding or states that the
conditions are unrelated, it is appropriate to assign the combination code for these conditions.
As coders, it’s important for us to watch for those coding convention terms such as “with” or ‘in”. The “with” guideline does not apply to “not
elsewhere classified (NEC)” index entries that cover broad categories of conditions. For example diagnosis code E11.628 is provided when
indexing the following:
Diabetes
With
Skin complication NEC
However, the coder cannot assume that all documented skin complications, such as cellulitis, acne, etc. are linked to the diabetes codes. Per
AHA Coding Clinic™, Fourth Quarter 2017, page 101 In order to link diabetes and a specific skin complication, the provider would need to
document the condition as a diabetic skin complication. Each case is patient specific, and the relationship between diabetes and the skin
complication should be clearly documented. Therefore, query the provider about the linkage, and if diabetes caused the specific skin
complication. Coding professionals should not assume a causal relationship when the diabetic complication is "NEC."
AHA Coding Clinic™ also touched on many issues in PCS coding. From body part to root operation to intent of the procedure, Coding Clinic
did not disappoint! Coding advice states when then there is no body part available for the procedure performed, the coder should select the root
operation that is the closest available equivalent which has the body part in the root operation table. This is an important coding tip to
remember when coding procedures! Additionally, as many of you know the definition of the root operation of “Control” was changed in
October 1, 2016. The definition of “control” now includes stopping other acute bleeding. Effective October 1, 2017, the ICD-10-PCS guideline
B3.7 "Control vs. more definitive root operations" has been revised to clarify that the list of definitive operations (Bypass, Excision,
Detachment, Extraction, Reposition, Replacement, or Resection) listed in the guideline is not all-inclusive.
Coding professionals are charged to stay abreast of all coding changes especially those applicable to your specialty areas of coding! Happy
coding in 2018!
Reference:
AHA Coding Clinic, Third Quarter 2017 page 15
AHA Coding Clinic, Second Quarter 2017, page 16.
AHA Coding Clinic, Fourth Quarter 2017, page 101
AHA Coding Clinic, Third Quarter 2017, page 27
AHA Coding Clinic, Second Quarter 2007, page 13
2017 ICD-10 Official Coding Guidelines
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What’s New? 2017 Coding Clinic Updates By Marquita Rawlins, RHIA, CCS
REIMBURSEMENT MANAGEMENT CONSULTANTS, INC. Offering Comprehensive Compliance Review & Coding Services. Nationwide.
Coding Support
Coding Reviews
Compliance Consulting
HCC/Risk Adjustment
CDI Consulting
Education & Training
Marquita Rawlins, RHIA, CCS is RMC’s Senior Manager of Coding Review Services. Marquita joined RMC in 2015, bringing with her
over 12 years of experience in the Health Information Management field. She is a graduate of the University of Alabama in Birmingham, with a Bachelor’s of Science in Health Information Management. Marquita’s past positions include Coding Specialist, Manager of Audit
Services, DRG RAC Auditor, and ICD-10 Auditor for acute care facilities nationwide. Marquita he has worked in both small and large bed
hospitals prior to coming to RMC, and in her time with RMC has performed services for facilities ranging from small critical access hospi-tals to large multi-hospital networks including trauma level 1 medical centers. Marquita is an AHIMA approved ICD-10-CM and ICD-10-
PCS Train the Trainer, and has been actively involved with RMC’s ICD-10 Training and education program. Marquita resides in Georgia
and can be reached at [email protected]
By now, you’ve heard of the KRACK WPA2 infiltration of Wi-Fi. Basically, a vulnerability in the WPA2, the standard for most Wi-Fi
communications between your mobile phone, computer and anything else that connects to a wireless access point, is a wide-open door for
cyber attackers. When a cyber attacker exploits the Wi-Fi vulnerability, they can intercept any device using the Wi-Fi network. It affects
everyone.
This kind of widespread Wi-Fi vulnerability serves as a good reminder that we need to be especially careful using public Wi-Fi, like that at
your local coffee shop, or when traveling – at airports, hotels. As our virtual CIO / IT vendor recommends, “If you can use a Virtual Private
Network (VPN) vs public Wi-Fi, that’s a better option to help secure your communications.”
Over the weekend, we received several communiques from various IT vendors with whom we work. A partner of ours, Convergence
Networks, forwarded a great e-letter to me that shared the following excellent tips.
Who does the KRACK infiltration affect? If you use WPA2 encryption to secure your Wi-Fi communications (and you likely do), you’re probably affected. That said, Android devices
are the most widely exploited.
Does this mean someone can get my Wi-Fi password? No. The Wi-Fi vulnerability could allow an attacker to intercept Wi-Fi communications between a device and a wireless access point but
doesn’t compromise your Wi-Fi password.
How is the KRACK vulnerability being fixed? Vendors are working on or have already released patches to fix the vulnerability:
Microsoft has released patches for supported Windows operating systems (Windows 7 and higher).
Apple is working on a patch for MacOS and iOS devices, expected to be released in November.
Android vendors manage their own patching schedules. Google Pixel devices will receive updates by November 6. Other Android
vendors are expected to release patches later.
Fortinet firewall and wireless access point vendor has shown very limited exposure to this attack, but vendors are gathering
information on any devices affected.
Cisco has already released a patch for its Meraki wireless access points.
What should I do? If you have an IT vendor for your information systems support, check with them on their patch schedule for Windows systems. They should
automatically patch during the next maintenance window if not sooner.
As an individual, it’s strongly recommended that you immediately apply software and security updates to your mobile devices – particularly
Android devices. Do so as soon as you’re notified that an update is available – don’t swipe the notification away!
For businesses using off-the-shelf consumer level Wi-Fi like Linksys or Netgear, look into business-class wireless. You’ll get better timing on
security updates.
Home-based Wi-Fi? Call your ISP provider or the company that makes your wireless access point (router, firewall, etc.) to if they updated the
firmware.
This is an excellent time to be sure that your wireless devices are updated, too. If your devices are so old that there’s no fix available, it’s time
to part ways.
Particularly check your IoT devices – don’t forget wireless home security cameras!
Should I not use Wi-Fi? Good question. Convergence Networks had this advice: “While the KRACK Wi-Fi vulnerability is serious, it requires an attacker to be in range
of your wireless device to execute it, it requires time, and is not yet an easy vulnerability to exploit. While the vulnerability affects most Wi-Fi
devices, the overall risk to a device is not high, and in most cases, Wi-Fi can still be safely used. If you’re an Android user, consider disabling
Wi-Fi on the device, limiting connectivity to cellular service, until security patches have been applied to your device.”
Chris Apgar, founder of Apgar & Associates is a Certified Information systems Security Professional (CISSP). He is one
of the country’s foremost experts and spokespersons on healthcare privacy, security, regulatory arriafs, state and federal
compliance and secure and efficient electronic health information exchange. Chris has more than 19 years of experience in
regulatory compliance and is a leader of regional and national privacy, security and health information exchange forums. As
a member of Workgroup for Electronic Data Interchange, and serving on the Board of Directors since 2006, Chris is an
honest, reliable, trustworthy expert in the field of privacy and security.
Email [email protected] for more details.
Page 3 C O M P L I A N C E C O N N E C T I O N S
Wi-Fi Vulnerability & the KRACK Infiltration: Tips from Techs By Chris Apgar CISSP
How does your facility stand with overturning denials for respiratory failure? Respiratory failure is a MCC (Major comorbid condition), and is
often under close scrutiny by payers. ACDIS’s CDI Strategies, Volume 12, Issue 1 addresses this problem. Payer denials will often state these
denial reasons:
Arterial blood gas (ABG) not obtained
Need for low dose supplemental oxygen is clinical manifestation expected with pneumonia
No need for assistive ventilation devices such as bi-level positive airway pressure support or mechanical ventilation
Oxygen supplementation via nasal cannula is often provided in the home setting and is not considered, in of itself, a treatment for acute
respiratory failure
According to the 2018 CDI Pocket Guide from ACDIS: “For a patient to have acute respiratory failure, it must be symptomatic and meet
diagnostic criteria based on arterial blood gas (ABG), P/F ratio, or pulse oximetry readings (SpO2).” In addition, the “diagnostic criteria for
hypoxemic respiratory failure are pO2 < 60 (SpO2 < 91%) on room air, or a P/F ratio < 300 on oxygen.”
There are several clinical considerations to take into account to support this diagnosis:
Increase in treatment: What is the patient’s baseline function? For example, is the patient on home oxygen? What level of oxygen
delivery is baseline? An increase in oxygen delivery from a baseline home oxygen of 2/LPM to 5/LPM, or even BiPAP, is a
significant increase in treatment.
Acute impairment in gas exchange: Patient’s with underlying lung diseases, such as COPD, often have low Sp02 levels as baseline. It is
important to discern the patient’s baseline function to compare a worsening of gas exchange.
Clinical assessments of respiratory failure: Is the patient showing clinical signs of distress such as accessory muscle use, retractions, or
tripoding? What are the recorded respiratory rates in the medical record?
While mechanical ventilation and ABGs are not required to support the diagnosis of respiratory failure, clinical evidence of an impaired gas
exchange, worsening from baseline function and an increase in treatment intensity are necessary to successfully support this diagnosis.
Reference: CDI Strategies, Volume 12, Issue 1.
Page 4 C O M P L I A N C E C O N N E C T I O N S
Respiratory Failure: Clinical Criteria By Barb Brant, MPA, BSN, RN, CCS, CDIP, CCDS
Barb Brant, MPA, BSN, RN, CCS, CDIP, CCDS is RMC’s Senior Clinical Documentation Specialist and Auditing Consultant, joining RMC in 2016. Barb received her BS in Nursing at York College of PA, and her Master’s in Public Administration at Pennsylvania State
University. In addition to her nursing background, Barb has extensive experience in Clinical Documentation Improvement. Barb has lead in
the development, implementation, auditing and performance improvement efforts of numerous CDI programs. Additionally, Barb assisted health systems with ICD-10 Gap Analyses by creating and presenting ICD-10 CM educational materials for physicians, coders and CDI
specialists. For RMC Barb has provided CDI services, chart documentation analyses, and clinical direction for coding reviews. Barb re-
sides in Camp Hill, PA and can be reached at [email protected].
Page 5 C O M P L I A N C E C O N N E C T I O N S
Yep. You read that right. Totally free.
Visit our website: www.rmcinc.org to submit your questions today!
Our new website features a “Coding Questions” button. Submit your question, and one of our
RMC coding experts will reply.
*Also - don’t forget to follow RMC on Facebook, LinkedIn and Twitter. We post coding tips, reminders and updates weekly!
Page 6 C O M P L I A N C E C O N N E C T I O N S
Camille Walker: [email protected] or Kristin Gibson: [email protected]
RMC is currently looking for experienced, credentialed, hard-working coding experts to join our team.
Positions are all remote, and all RMC staff are issued a company laptop.
Qualified candidates:
Must have a minimum of 5 solid years of coding experience
Must be AHIMA/AAPC credentialed
Must pass RMC's coding test
Must be reliable, friendly and flexible
Full-time AND part-time positions available! Some positions qualify for sign-on bonus!
If you want to join our team and LOVE your job, please send your resume to [email protected]
