Physicians and mid-level providers are having some serious conversations with patients regarding advanced care planning (ACP) – meaning the discussion of a serious illness and the next steps they need to take regarding advanced directives, hospice, skilled nursing, pre, and post-death arrangements, and more. These discussions are now payable under most health insurance plans, including Medicare, but you need to be walked through the steps of these important conversations first, then consider the...
May 14, 2019•29 min
If there’s an industry buzzword that is heard most often in today’s healthcare discourse, it might be “artificial intelligence” (AI). And just as the advent of the computer presaged concerns about job loss, the same could be said today about AI, especially when it comes to coding. But before AI came into vogue, computer-assisted coding (CAC) and the use of natural language processing (NLP) appeared to be a potential job killer. Reporting on AI and CAC during this edition of Talk Ten Tuesdays is ...
May 07, 2019•30 min
Proposed changes to the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System were posted late Tuesday by the Centers for Medicare & Medicaid Services (CMS). And while the dust has yet to settle, the proposals are sending shockwaves through the coding and clinical documentation integrity (CDI) communities. Context, perspective, and analysis of the proposed IPPS rule will be provided during the next edition of Talk Ten Tuesdays. The live bro...
Apr 30, 2019•30 min•Ep. 367
The patient’s physician requests the treatment advice of another physician consultant, but without a face-to-face encounter with the patient and that consultant. Is this a billable situation? Traditionally No. But since 2018 and even now, more specifically, CPT® codes in 2019, "virtual" peer reviews are a covered benefit for most payers. This is new territory when it comes to insurance coverage, especially since these services are not subject to telehealth rules or restrictions Medicare has put ...
Apr 23, 2019•31 min•Ep. 366
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 president of the International Federation of Health Information Management Associations, IFHIMA, and the ...
Apr 16, 2019•31 min•Ep. 365
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 & Medicaid Services (CMS) is moving home health agencies away from a volume-based payment model and toward...
Apr 09, 2019•31 min•Ep. 364
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 created a new international arm of AHIMA –- the AHIMA World Congress (AWC) –- to help its members ach...
Apr 02, 2019•29 min•Ep. 363
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 the Centers for Medicare & Medicaid Services (CMS), reports on billing laws on the state level, ...
Mar 26, 2019•30 min•Ep. 362
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 Services (HHS), proposing that the massive agency use sub-regulatory processes to make version updates to...
Mar 19, 2019•29 min
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 University of Pittsburgh. She also holds a secondary appointment in the Graduate School of Public Health. In...
Mar 12, 2019•29 min•Ep. 360
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’s director of HIM practice excellence. The live broadcast will also feature these other segments: Th...
Mar 05, 2019•30 min•Ep. 359
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 podcast, which also features these other segments: The ICD-10 Coding Report: Nationally recognized coding authority Laurie Johnson...
Feb 26, 2019•30 min•Ep. 358
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, when Terry Fletcher returns to the broadcast to report on evaluation and management (E&M) coding. O...
Feb 12, 2019•29 min•Ep. 356
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 settings. Reporting on ICD-11 and how AHIMA is preparing its members for the next coding milestone during t...
Feb 05, 2019•30 min•Ep. 355
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 broadcast co-host Erica Remer, MD, founder and president of Erica Remer, MD, Incorporated. Dr. Remer wi...
Jan 29, 2019•29 min•Ep. 354
"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 diagnoses because the doctor said so. But is the doctor’s say-so enough? Reporting on this recurring issue during ...
Jan 22, 2019•29 min•Ep. 353
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 consequence of an increase of natural and manmade disasters, as well as new attention being given to longs...
Jan 15, 2019•28 min•Ep. 352
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. These patients experienced a viral illness with fever and cough 3-10 days prior to the paralysis onset....
Dec 12, 2018•30 min•Ep. 351
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 Talk Ten Tuesdays will be Cari Greenwood who will discuss how your team should intensify training –- pa...
Dec 04, 2018•30 min•Ep. 350
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 this complex issue during the next edition of Talk Ten Tuesdays will be Sharon Savinsky, clinical docum...
Nov 27, 2018•29 min•Ep. 349
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 edition of Talk Ten Tuesdays will be Roland Dale, responsible for denials prevention, for Hardin Medic...
Nov 13, 2018•29 min•Ep. 348
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 are there other conflicts endemic to healthcare that tear at the emotional and mental health of phys...
Nov 06, 2018•29 min•Ep. 347
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 supporting clinical significance. What’s a coder to do? During this edition of Talk Ten Tuesdays, Jam...
Oct 30, 2018•31 min•Ep. 346
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 was announced in February 2016, its acceptance has become more widespread as you learn when Dr. Edward ...
Oct 23, 2018•31 min•Ep. 345
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 disaster zone, coping with the aftermath of Hurricane Michael. Zirkman rode out Hurricane Florence from ...
Oct 16, 2018•29 min•Ep. 344
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 claims payments for medical marijuana clearly has yet to be defined. So, what is the answer? Report...
Oct 09, 2018•29 min•Ep. 343
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 official diagnoses used to describe diseases, causes of diseases, and deaths related to human trafficking...
Oct 02, 2018•27 min•Ep. 342
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 Fletcher joins the conversation to report on the new clinical concepts found in the fourth definition...
Sep 25, 2018•31 min•Ep. 341
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, or SIRS. Other segments to be featured on the broadcast include: News Desk: Knicole Emanuel, Esq, an...
Sep 18, 2018•30 min•Ep. 340
The next big milestone for ICD-10 is the 2018 Coordination and Maintenance Committee meeting in Baltimore. The two-day meeting covered the latest requests for diagnosis and procedure codes. Monitoring and reporting on the meeting during this edition of Talk Ten Tuesdays will be Laurie Johnson, senior healthcare consultant for Revenue Cycle Solutions, LLC and an ICD10monitor contributor. Other segments to be featured on the broadcast include: News Desk: Larry Field, DO, anchors the Talk Ten Tuesd...
Sep 11, 2018•30 min•Ep. 339
