On the horizon, looming like an ominous thunderhead, is ICD-11. But wait! There’s more: the expanding role of coding in big data, for example. The evolving healthcare IT, and how it will redefine the coding profession. All this and more is coming your way. That’s why ICD10monitor and Talk Ten Tuesdays invited senior healthcare consultant Angela Comfort, assistant vice president of revenue integrity at Montefiore, to take you on an exclusive trip into the future of ICD-11 and health informatics d...
Mar 19, 2024•27 min•Season 13Ep. 590
Code G2211 continues to be a gift disguised as something else. As many nuances surrounding the code continue to linger, there are still some areas that are not as clear-cut as many healthcare professionals would prefer. As a refresher, G2211 allows providers (primary care, as well as specialists) to bill for additional cognitive work effort that is not currently captured in the evaluation and management (E&M) codes typically billed for these services. One of the gray areas surrounding G2211 ...
Mar 12, 2024•32 min•Season 13Ep. 589
How many hospital star ratings does your facility have? Do you know? If you don’t, you’re not alone. Apparently, many coders and clinical documentation integrity specialists (CDISs) don’t know. But you should know. That’s why ICD10monitor and Talk Ten Tuesdays have invited Michelle Wieczorek, a registered nurse (RN) and a CDI authority, to explain what the hospital star rating means and how coders and CDISs impact those stars. Wieczorek, an independent revenue cycle consultant, will also explain...
Mar 05, 2024•31 min•Season 13Ep. 588
During the next live edition of Talk Ten Tuesdays, award-winning author H. Steven Moffic, MD, considered to rank among the world’s most renowned psychiatrists, will report on what he calls “social psychoexemplaries” – the other side of what he reported two weeks ago on social psychopathologies. Moffic, in his popular daily column in Psychiatric Times, recently mused on the notion of positive social psychiatry, writing “I have come to wonder if positive psychiatry can be expanded to positive soci...
Feb 27, 2024•30 min•Season 13Ep. 587
What are the “do’s” and “don’ts” for the safe handling of HCPCS code G2211, used to report payment to physicians and other qualified healthcare providers for the additional work required to adequately care for patients with serious or complex conditions? The code is now payable for the 2024 calendar year (CY). Not only has the code quickly become enigmatic, in the lexicon of medical record coding, but it also must be handled with care – as if operating a powerful band saw. On the surface, the co...
Feb 20, 2024•30 min•Season 13Ep. 586
Achieving high-performing revenue cycle management (RCM) begins with understanding where your healthcare organization falls on the RCM Maturity Framework, according to Matt Bridge, senior vice president for AGS Health. Bridge, who will be the special guest during the next upcoming edition of Talk Ten Tuesdays, says this four-stage framework informs a strategic roadmap designed for optimizing and digitally transforming revenue cycle performance and future proofing operations through a hybrid mode...
Feb 13, 2024•32 min•Season 13Ep. 585
We are all familiar with DSM-5 and ICD-10 for the classification of various mental disorders. Both, but especially ICD, also cover some of the social conditions needing medical attention that may or may not be connected to the primary disorder or illness. ICD does that in the Z codes. However, Z codes are used infrequently. Moreover, many social problems harmful to individuals, groups, and countries seem resistant to elimination – think racism, sexism, ageism, antisemitism, Islamophobia, cultish...
Feb 06, 2024•30 min•Season 13Ep. 584
New Condition Code 92 is here, and it’s effective now. The code outlines the billing requirement for intensive outpatient program services for hospital outpatient departments, critical access hospitals (CAHs), and community mental health centers (CMHCs). To explain what you need to know about correctly billing the new Condition Code 92 during the next weekly edition of Talk Ten Tuesdays will be Rose T. Dunn, past president of the American Health Information Management Association (AHIMA), and cu...
Jan 30, 2024•30 min•Season 13Ep. 583
Shrouded in controversy, the HCPCS code G2211 was released in 2021, proposed by the Centers for Medicare & Medicaid Services (CMS) to pay physicians and other qualified healthcare providers for the additional work required to adequately care for patients with serious or complex conditions. The code is now payable for calendar year (CY) 2024. The journey for this code to become payable has been fraught with obstacles. First, to financially support it, CMS slashed the conversion factor (CF). S...
Jan 23, 2024•30 min•Season 13Ep. 582
Last year, healthcare professionals saw many of the rules for evaluation and management (E&M) services that were implemented in 2021 now applied to 2023 E&M codes. This included codes representing services for hospital inpatient care (99221-99223 and 99231-99233), emergency department visits (99281-99285), nursing facility visits (99307-99210), and all consultation services. How are these changes likely to impact 2024 E&M coding? Senior healthcare consultant Frank Cohen, founder of t...
Jan 09, 2024•28 min•Season 13Ep. 581
Codes for split (or shared) evaluation and management (E&M) services for 2024 have been revised, simplified, and aligned by the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS). During the next live edition of the long-running Talk Ten Tuesdays broadcast, 3M Senior Consultant Colleen Deighan-Ejak will report on the revised guidelines for determining who performed the substantive portion of a given service. She will also discuss the Medicare payment ...
Dec 05, 2023•35 min•Season 13Ep. 580
There’s a new code in town. It’s an add-on code, HCPCS Code G2211. And its effective date is Jan. 1, 2024. The new code is associated with the continuing focal point for all needed medical services that are part of ongoing care related to a patient’s single, serious condition, or complex condition. The Centers for Medicare & Medicaid Services (CMS) will be implementing this separate add-on payment code to be reported with evaluation and management (E&M) categories Office and Other Servic...
Nov 28, 2023•29 min•Season 13Ep. 579
There are substantial new changes to the minimum data set (MDS) assessment, including how functional abilities and goals are scored, the introduction of tracking of indications for medication use, and the addition of new measures for tracking communication of transfer-of-health information. The recent changes became effective Oct. 1, the start of the government’s fiscal year. The MDS assessment is a standardized assessment used in skilled nursing facilities (SNFs) and some swing beds to capture ...
Nov 21, 2023•31 min•Season 13Ep. 578
MINOCA (myocardial infarction with non-obstructive coronary arteries) and INOCA (ischemia with non-obstructive coronary arteries) pertain generally to coronary artery disease. During the next live edition of the long-running and popular Internet broadcast Talk Ten Tuesdays, Pam Scott will take you on a coding journey into these conditions and the microvasculature of the heart – located downstream from the epicardial vessels and featuring structures as small as a human hair, which cannot be asses...
Nov 14, 2023•29 min•Season 13Ep. 577
With thousands of followers on social media, Dr. Robert Oubre, aka “The Doctor of Documentation,” will make his Talk Ten Tuesdays debut on Tuesday, Nov. 7, when he will be the broadcast’s special guest. Dr. Oubre will be reporting on what documentation considerations should be given when patients are reading physician notes appearing on the monitor screen of the electronic medical record (EMR). He is expected to cite the 21st Century Cures Act, which went into effect April 5, 2021, mandating tha...
Nov 07, 2023•24 min•Season 13Ep. 576
Like autumn leaves, new codes and guidelines are raining down on hospitals and physician practices, impacting coders, clinical documentation integrity specialists (CDISs), and professionals managing the revenue cycle. And while there appears to be no respite, the weary can take comfort during the next live edition of the long-running and popular Talk Ten Tuesdays Internet broadcast, produced by ICD10monitor. That’s when the legendary Rose Dunn, past president of the American Health Information M...
Nov 01, 2023•28 min•Season 13Ep. 755
As the demand for telehealth services has surged, the nuances of coding and documentation for virtual visits present unique challenges and opportunities. During the next live edition of Talk Ten Tuesdays, Angela Comfort will delve into the specifics of coding for telehealth, including the evolving Centers for Medicare & Medicaid Services (CMS) guidelines, and the importance of accurate documentation to ensure compliance and proper reimbursement. Also, during her segment, Comfort is expected ...
Oct 24, 2023•29 min•Season 13Ep. 754
A must-have resource for any coding or clinical documentation integrity specialist (CDIS) is the American Hospital Association (AHA) Coding Clinic. Each quarterly issue provides official guidance for ICD-10-CM and ICD-10-PCS coding for all healthcare settings. The third-quarter issue covers a variety of topics, from prescribed marijuana use for chronic pain during pregnancy to subcapsular hematoma, epidural hematoma, and several ICD-10-PCS procedures – Hemospray, HeRO® Graft, and NAVA among them...
Oct 17, 2023•28 min•Season 13Ep. 573
The nation’s healthcare spotlight will shine on the American Health Information Management Association (AHIMA) during the organization’s live AHIMA23 Conference, gaveling to order Oct. 8 through Oct. 10 at the Baltimore Convention Center. During the next live edition of Talk Ten Tuesdays, the legendary Rose Dunn, former AHIMA president and CEO, will be the broadcast’s special guest. She will report on activities taking place there, as several thousand HIM and other healthcare professionals gathe...
Oct 10, 2023•29 min•Season 13Ep. 572
The Centers for Disease Control and Prevention (CDC) has released the ICD-10-CM code updates for the 2024 fiscal year (FY), which will be effective starting Oct. 1. The update includes more than 433 diagnosis code changes, including 395 code additions, 25 code deletions, and 13 code revisions. It is essential for coding professionals to stay up-to-date with these annual code changes, and to understand how to apply them. It is also important that all applicable team members, including coders, phy...
Oct 03, 2023•30 min•Season 13Ep. 571
There’s a new ICD-10 code presenting a new challenge for facilities, physicians, clinical documentation integrity specialists (CDISs), and coders: E88.A, muscle wasting due to underlying conditions. This new code represents an opportunity to identify, document, and report the frequent and too-often unrecognized undernutrition, sarcopenia, and cachexia disorders associated with muscle wasting, along with their underlying causes. During the next live edition of Talk Ten Tuesdays, James S. Kennedy,...
Sep 26, 2023•29 min•Season 13Ep. 570
Artificial intelligence (AI) is what many in healthcare will come to remember about the closing years of this decade in healthcare – a decade of unprecedented technological changes, ranging from telehealth to algorithms. And now AI is becoming an accepted technology for evaluation and management (E&M) coding. The results appear to be dramatic in terms of remarkable speed and extraordinary accuracy. Join us during the next live edition of Talk Ten Tuesdays, when Angela Jordan, executive vice ...
Sep 19, 2023•28 min•Season 13Ep. 569
A reported 700,000 suicides worldwide annually are the impetus for the World Health Organization (WHO) to recognize what it has called a major public health problem ahead of World Suicide Prevention Day on Sept. 10. In recognition of this global issue, during its next edition, Talk Ten Tuesdays will feature world-renowned psychiatrist and award-winning author H. Steven Moffic as the program’s special guest. Dr. Moffic will report on how to detect early-warning signs of potential self-harm. Dr. M...
Sep 12, 2023•30 min•Season 13Ep. 568
Despite their advanced capabilities, artificial intelligence (AI) tools can occasionally misinterpret ambiguous documentation or lack the nuance necessary for complex decision-making. And that is why coders must continue to exercise their expertise and judgment when reviewing AI-assisted code assignment. This level of vigilance is crucial for ensuring that AI-assisted coding assignment meets stringent standards of quality and compliance – as you’ll learn during the next live edition of Talk Ten ...
Aug 30, 2023•34 min•Season 13Ep. 567
The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) affect Leapfrog’s ubiquitous reputation scores and contribute approximately 15 percent to the Centers for Medicare & Medicaid Services (CMS) Hospital-Acquired Condition (HAC) penalty determinations of 1 percent of a hospital’s total inpatient reimbursement. AHRQ finally released its PSI methodology for the 2023 fiscal year (FY) on Aug. 14, and it involves a significant expansion of the risk-adjusted univer...
Aug 22, 2023•30 min•Season 13Ep. 566
The Centers for Medicare & Medicaid Services (CMS) has released the finalized 2024 Part C risk adjustment model, which goes into effect Jan. 1, 2024. This revised model, V28, comes with substantial changes to the current V24 model, starting with using the ICD-10-CM classification system – which aligns with the rest of the healthcare system that has been using ICD-10 codes since 2015. Comparing CMS V24 to V28, there is an increase in the number of Hierarchical Condition Categories (HCCs) and ...
Aug 15, 2023•31 min•Season 13Ep. 565
Start unpacking. The 2024 Inpatient Prospective Payment System (IPPS) Final Rule by the Centers for Medicare & Medicaid Services (CMS), plus half a dozen other final payment rules have arrived. To help you and your team prepare for the onslaught of new codes, Leigh Poland, vice president of coding service line for AGS Health, will offer practical tips and best practices so you can effectively adapt to the final rule’s coding changes, thus helping to ensure compliance, and optimizing reimburs...
Aug 08, 2023•33 min•Season 13Ep. 564
The 2024 Inpatient Prospective Payment System (IPPS) Final Rule by the Centers for Medicare & Medicaid Services (CMS), plus half a dozen other payment rules, will all require new codes and fresh new thinking. And that is why ICD10monitor is producing an exclusive national coding update broadcast on Talk Ten Tuesdays. All this and more will be covered during the next live edition of the weekly Internet radio broadcast, which will feature these outstanding segments and thought leaders: Coding ...
Aug 01, 2023•29 min•Season 13Ep. 563
Could clinical documentation improvement specialists (CDISs) be at risk as a profession, with the growing acceptance of automated query solutions? And what is driving the demand for them? Today, with the advent of “smart hospitals,” automated query solutions are being used by providers and CDISs in capturing acute and chronic diagnoses, as specified by ICD-10. With this rapidly developing technology, real-time documentation prompts and automated queries are assisting providers as they are writin...
Jul 25, 2023•31 min•Season 13Ep. 562
Revenue leakage presents a huge challenge for healthcare organizations. According to a study by the Healthcare Financial Management Association (HFMA), it can account for up to 5 percent of a healthcare organization’s net revenue – potentially making the difference between an entity being profitable or not profitable. Fear not, however – there are solutions to tackle revenue leakage. One effective strategy is strong denial management. In fact, the Medical Group Management Association (MGMA) foun...
Jul 18, 2023•31 min•Season 13Ep. 561
