by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: How would you recommend the facility coding for coronary intravascular lithotripsy (Shockwave) with a drug-eluting stent? We would bill C9600 for the stent, but how can we capture the intravascular lithotripsy (IL)? We are being told to add modifier 22 to C9600, but I […]

by Nirmala Sivakumar, CCS, CDIP Question: Should Z codes be recorded under comorbid conditions (item 24) on the IRF-PAI (Inpatient Rehabilitation Facility – Patient Assessment Instrument)? Answer: The IRF-PAI training manual defines a comorbid condition as a secondary condition a patient has in addition to the primary diagnosis for which the patient was admitted to […]

by Gail I. Smith, MA, RHIA, CCS-P If you have watched an episode of the reality show “Botched,” you have seen how the surgeons reverse the damage of previous cosmetic surgery. It is not uncommon to have a patient with severe pain due to breast augmentation that requires surgical intervention. This show popped into my […]

By Gail I. Smith, MA, RHIA, CCS-P January 1, 2021 ushered in the biggest change in E/M coding since the 1990s. The new Office/Outpatient code descriptions, definitions and time as a key component were added to the code set. On March 9, 2021, AMA published an additional set of definitions and clarifications to the guideline […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA The pandemic has affected every sector and population category across the US (and the world). Some business sectors thrived (Amazon, pizza delivery services, plexiglass manufacturers, and mask producers to name a few), but as we know, the healthcare industry took a big hit. When I say […]

by Stacy Swartz, RHIA, CCS, CPC In healthcare, an industry of constant evolution, there is absolutely no way to succeed without ongoing, continuous education. Coders require yearly training to remain current with annual changes to the coding systems and coding advice, changes to what is captured by coders (data for quality measures, risk adjustment, etc.) […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Would Z45.2 – Encounter for adjustment and management of vascular access device be an appropriate ICD-10 code for the placement of central line – 36556 or arterial line – 36620? One source says that these are appropriate while another one does not define this […]

by Cari A. Greenwood, RHIA, CCS, CPC, CICA The Office of Inspector General (OIG) recently issued a report on the findings of a study they conducted on trends in billing for inpatient hospital stays for Medicare beneficiaries from FY 2014 through FY 2019. The report, “Trend Toward More Expensive Inpatient Hospital Stays in Medicare Emerged […]

by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA No one wants to make mistakes. We never want to find out later that we did something wrong. This is especially challenging when a coder feels there was no resource available for finding the answer when the question came up. They did their best under the circumstances. Libman […]

by Richard D. Pinson, MD, FACP, CCS Q: A patient with a personal medical history of congestive heart failure (CHF), myocardial infarction (MI), coronary artery disease with three stents, ischemic cardiomyopathy, and chronic kidney disease (CKD) is admitted for acutely decompensated chronic systolic CHF. She had no chest pain or other ischemic symptoms. The initial […]