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Demystifying Nonphysician Practitioner Billing

Author: Lich, Denisha

Source: Journal of AHIMA

Publication Date: February 2000


To address today's financial challenges, healthcare facilities are increasing their use of nonphysician practitioners, such as nurse practitioners, clinical nurse specialists, and physician assistants, to provide patient care. As a result, providers need to pay close attention to the employmen....

Defining Difficult Modifiers

Author: Endicott, Melanie

Source: CodeWrite | AHIMA newsletter article

Publication Date: April 2011



The assignment of modifiers is often an area of frustration for outpatient coders. The purpose of this article is to help define some of those difficult modifiers and provide examples of appropriate modifier usage.


Modifiers are used to indicate any of the following situatio....

Data Warehousing: Myths, Pitfalls, and the Secret Weapon

Author: Moyer, Rich

Source: Journal of AHIMA

Publication Date: November 2003


Is your organization using its data warehouse to its fullest potential? The author provides some pitfalls to avoid and some tips that may help improve care and use resources more efficiently.
Most healthcare organizations have invested in building a data warehouse. But once the warehouse....

Data Standardization in the Veterans Health Administration

Author: Weems, Shelley

Source: AHIMA Convention

Publication Date: October 21, 2005


The Data Standardization Program is the cornerstone of the Department of Veterans Affairs (VA) plan to share computable health information between its medical care facilities. Data standardization establishes a consistent way of defining data, thereby enabling all sites in the VA health system....

Data Abstraction Unplugged: Taking Trauma Registry to the Point of Care with Wireless Technology

Author: Eisenhower, Cynthia; McElwee, Karen; Wargo, Christina; Woodruff, Tracy

Source: Journal of AHIMA

Publication Date: July 2005


Central to Geisinger Medical Center’s success with concurrent abstraction is wireless technology that enables registrars to work at the point of care.
Registry abstraction can have trouble keeping up with technology. Often located away from IT-intensive clinical departments and oper....

CY 2017 OPPS Update

Author: Comfort, Angie

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: February 2017



As last year drew to a close, facilities began the looming task of reviewing the Hospital Outpatient Prospective Payment System (OPPS) final rule to ensure their chargemaster and systems were up-to-date with the 2017 changes. The final rule for calendar year (CY) 2017 was released on Novem....

CY 2013 OPPS Update

Author: Comfort, Angie

Source: Journal of AHIMA - Coding Notes

Publication Date: March 2013



As 2012 drew to a close, US healthcare facilities began the daunting task of reviewing the Centers for Medicare and Medicaid Services’ (CMS) hospital outpatient prospective payment system (OPPS) update to ensure their chargemaster and systems were up-to-date with the 2013 changes. Th....

CY 2012 OPPS Update

Author: Rihanek, Theresa

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2012


The final rule for calendar year 2012 Hospital Outpatient Prospective Payment System (OPPS) was released on November 30, 2011. The rule went into effect for outpatient hospital-based services January 1, 2012.

This article outlines the updates in the final rule.
Financial Impact....

CY 2011 Changes to the Hospital OPPS

Author: Karban, Karen M

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2011


The final rule for the calendar year 2011 Hospital Outpatient Prospective Payment System (OPPS) was released November 24, 2010. Changes in the rule went into effect with January 1, 2011, outpatient hospital-based services.

The changes to OPPS continue to reflect packaging adjustments....

Crystal Ball for Coding

Author: Johns, Merida L.

Source: Journal of AHIMA

Publication Date: January 2000


What will the future of coding look like? A special AHIMA task force has several ideas. What will really happen depends on how coders choose to respond. Here's an overview of the task force's findings, plus suggestions on how readers can make the most of possible career opportunities.
It....

Crossing the Rubicon: Developing a Strong Inpatient/Outpatient Coding Structure at Duke

Author: Stone, Fabian; Wooley, Barbara; Egan, Jeanne M.; Gallagher, Timothy

Source: AHIMA Convention

Publication Date: October 10, 2007

Overview

Duke University Health System (DUHS), based in Durham, NC, consists of Duke University Hospital, Duke Health Raleigh Hospital, Durham Regional Hospital, Duke University Affiliated Physicians (DUAP), Private Diagnostic Clinic (PDC), and the Patient Revenue Management Organization....

Crossing the Bridge to ICD-10: Using the General Equivalence Mappings (GEMs) to Create a ICD-10 Ready Workplace. Applied Mapping Case Study: The GEMs and MS-DRG Conversion

Author: Butler, Rhonda R.

Source: AHIMA Convention

Publication Date: October 17, 2008

Introduction

ICD-9-CM (referred to hereinafter as I-9) codes are the present basis for many critical healthcare transactions in the U.S.: reimbursement, healthcare quality, and morbidity reporting, to name a few. When the U.S. updates its code set to ICD-101, all systems and applications....

Critical Success Factors in Establishing the Electronic Health Record: the Experience of St. Michael's Hospital, Canada

Author: Wegener, John; Woodman, Anna Jane

Source: IFHRO Congress | AHIMA Convention

Publication Date: October 15, 2004

Overview

This presentation will provide insight into planning, implementing, and managing the transition of a health records department, moving from an overburdened and inefficient paper environment toward an automated electronic setting. This success story will look at how staff, work pr....

Critical Expeditions

Author: AHIMA

Source: AHIMA

Publication Date: August 2001


With the action items of Vision 2006 largely met and the image marketing campaign well underway, the Association is poised to undertake its next strategic venture—expeditions.

Through a series of critical expeditions, AHIMA will explore new ground for the HIM profession—from....

CPT Updates for CY 2015

Author: Buttner, Patty

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: February 2015



On January 1, 2015, the updates to the American Medical Association’s Current Procedural Terminology (CPT) went into effect. The updates include 276 new codes, including three new Category II codes and 39 new Category III codes. There are a total of 129 revised codes and 137 deleted codes....

CPT Update 2011

Author: Smith, Gail I.; Endicott, Melanie

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2011


Each year CPT adds codes to reflect new procedures and surgical techniques. For example, new codes were added in the surgical section to identify procedures performed using balloon catheters.

In addition, CPT continues to make editorial changes and add coding guidelines within the t....

CPT Receives Update for 2014

Author: Endicott, Melanie

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2014



On January 1, 2014, the American Medical Association’s Current Procedural Terminology (CPT) was updated with additions, revisions, and deletions. In total, 175 new codes were added, 107 codes were revised, and 47 codes were deleted. In addition, editorial changes and coding guideline addi....

CPT "Monopoly" To Be Examined

Author:

Source: Journal of AHIMA

Publication Date: October 2001


Senate Minority Leader Trent Lott (R-MS) has forwarded a letter to HHS Secretary Tommy Thompson criticizing the American Medical Association's "statutory monopoly" on current procedural terminology (CPT) codes. Lott said that Congress will look at the CPT issue when it considers....

CPT Debridement Coding

Author: AHIMA Staff

Source: CodeWrite | AHIMA newsletter article

Publication Date: January 2011


CPT provides a variety of codes to reflect the treatment of damaged or infected tissue. A good coding practice is to review a selection of codes and identify the unique characteristics. For example, scan the codes in the following list and differentiate each.


11000:  This co....

CPT Code Updates for 2013

Author: Miller, Jackie

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2013



The CPT code set has undergone extensive revisions for 2013, with codes, guidelines, and modifiers being revamped and updated. HIM coding professionals should download and review the CPT 2013 errata on the AMA website before starting to use the new codes. This download can be accessed at w....

CPT Code Updates for 2012

Author: O’Hara, Karen

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2012


The 2012 updates to the CPT code set include 278 new codes, 139 code revisions, and 98 code deletions. This brings the total number of CPT codes to 9,641.

All major sections of the CPT code set, as well as the introduction and appendix A, have undergone changes. Beginning with the i....

CPT Changes for 2002

Author: O'Hara, Karen

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2002


Coders need to keep their resources current—including updating the Current Procedural Terminology (CPT) codes every year with the annual CPT book. This article provides a brief summary of the changes made to the CPT 2002 code set. The complete list of changes can be found in Appendix B of....

CPT Changes for 2001

Author: O'Hara, Karen

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2001




CPT 2001 Professional Edition (CPT® 2001) is complete and should be landing on your desk soon. As an introduction to the new book, this article provides a brief summary of the changes in 2001. A complete listing of the code and guideline changes can be found in CPT Changes 2001:....

CPT Category III Codes Cover New, Emerging Technologies: New Codes Developed to Address Issues in Light of HIPAA

Author: Beebe, Michael

Source: Journal of AHIMA - Coding Notes

Publication Date: October 2003


In 1998, the American Medical Association (AMA) initiated the CPT-5 Project. This project was a broad-based and comprehensive effort to make needed and practical enhancements to the CPT code set that would address challenges presented by emerging user needs and HIPAA. One of the initiatives tha....

CPT 2013 Changes In Nerve Conduction Studies

Author: Huey, Kim

Source: CodeWrite | AHIMA newsletter article

Publication Date: April 2013



In recent years, many changes to the Current Procedural Terminology (CPT) have made coding of certain procedures less complicated. This is true this year for the coding of nerve conduction studies. The codes have been restructured to reflect the number of studies performed as the unit of s....

CPR in Long Term Care

Author: Schoenfelt, Suzanne

Source: Journal of AHIMA

Publication Date: February 1999


Throughout the healthcare industry, the computer-based patient record (CPR) is in various stages of development. This article assesses the progress long term care facilities are making in moving toward the CPR. The article also suggests some ways HIM professionals can devel....

Covering the Bases of Coding Compliance

Author: Hapner, Peggy

Source: Journal of AHIMA - Coding Notes

Publication Date: May 2001




As HIM professionals already know, data quality-one of the basic tenets of compliance-depends on comprehensive documentation and accurate code assignments. Because coding plays a major role in payment, reporting data accurately, managing data flow and data collection, and training st....

Countdown to HIPAA Claims Attachments

Author: Giannangelo, Kathy

Source: Journal of AHIMA

Publication Date: October 2005


With the clock ticking down to the HIPAA national provider identifier compliance deadline, HIM professionals should start thinking about the next HIPAA standard on the horizon, claims attachments. While not one of the original eight administrative transactions approved for use in the healthcar....

Cost of Converting Small Physician Practices to ICD-10 Much Lower than Reported

Author: Kravis, Thomas C; Belley, Susan; Smith, Donna; Averill, Richard F.

Source: Journal of AHIMA - website

Publication Date: November 2014




The controversial delay of ICD-10 implementation was based in part on the perceived time, cost and lost productivity for physician offices to perform the necessary assessment, training, software conversions, testing and “super bill” updates.1 Current evidence suggests that....

Constructing a Coding Compliance Plan

Author: Hanna, Joette

Source: Journal of AHIMA

Publication Date: July 2002


The government has turned its attention to coding compliance. Do you have an effective program in place? Use the steps in this article to build a coding compliance program that protects your organization.


Coding compliance has become an integral part of every HIM department....

Conduct is Their Business

Author: Byrd, Katherine

Source: Journal of AHIMA

Publication Date: March 2001




Suppose you were asked to do something unethical on the job. What if you were asked by your supervisor to hide delinquent charts just prior to a Joint Commission survey? What would you do?

As a profession, HIM professionals understand our moral obligation to the patient to p....

Computers, Coding, and Change

Author: Dimick, Chris

Source: Journal of AHIMA

Publication Date: January 2008


Computer-assisted coding won’t eliminate the profession, but it will change it dramatically.

Mythily Srinivasan thought she was out of a job. Out with human coders, in with computer-generated coding. At first that seemed to be her facility’s master plan.

Computer-assisted Coding Toolkit

Author: AHIMA Work Group

Source: AHIMA toolkit

Publication Date: May 2014

This toolkit provides many of the necessary tools and documents necessary for a successful implementation. It will be helpful to those who wish to plan and prepare for the implementation of CAC in ambulatory (including physician), acute care inpatient, or outpatient hospital settings.

Computer-Assisted Coding: A Year Later. Proof of Concept Pilot Results, The Department of Veterans Affairs

Author: Bebb, Jacki; Hanken, Mary Alice; Helbig, Susan; Longosky, Sean; Main, Renee; Wood, Shirley

Source: AHIMA Convention

Publication Date: October 05, 2009


Health Information Management, VHA Central Office and the VA Puget Sound Health Care System
Objective

Beginning in late 2008, the Veterans Health Administration (VHA) began a proof of concept project to determine if natural language processing (NLP) and computer assisted coding....

Computer-Assisted Coding and Beyond

Author: Eminger, Heather

Source: AHIMA Convention

Publication Date: September 28, 2010


Introduction to CAC

Whether you're a facility reviewing the Computer-Assisted Coding (CAC) technologies because of coding challenges such as the ever evolving CMS requirements and backlogs, or preparing for ICD-10 CM. You will learn there is much more that Computer-Assisted Coding....

Comprehensive CDI: Making it Happen

Author: Pinson, Richard D.; Tang, Cynthia L.

Source: AHIMA Convention

Publication Date: October 17, 2008

Introduction

MS-DRGs were introduced by CMS on October 1, 2007 in an effort to incorporate severity of illness in adjusting hospital reimbursement for inpatient acute care. In response, as CMS predicted, clinical documentation integrity (or improvement) programs [CDI] are springing up eve....

Compliance Efforts Get Some PEPP

Author: Bryant, Gloryanne H.

Source: Journal of AHIMA

Publication Date: September 1999


Earlier this year, the Office of the Inspector General (OIG) informed the Health Care Financing Administration (HCFA) that "the DRG system is vulnerable to abuse by providers who wish to increase reimbursement inappropriately through upcoding, particularly so within certain DRGs.&....

Comparative Data--Its Impact and Opportunities

Author: Bellile, Susan K.

Source: Journal of AHIMA

Publication Date: June 1998


A battle for control of medical management is now being waged among hospitals, managed care plans, insurers, employers, physician groups, and researchers—a battle in which data is the weapon of choice. Cumulative and comparative healthcare information is being used to eva....

Communication with a Side of Encouragement, Please: Effective Communication Strategies for a Smooth CDI Program implementation Transition

Author: Flood, Diana

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2012


Clinical documentation improvement (CDI) programs are spreading rapidly across the United States-and for good reason. They help facilities improve the level of documentation that goes into the patient medical record, leading to fewer errors and an overall improvement for continuity of care. Bu....

Communicating with Physicians: Something to Talk About

Author: Dunaway, M. Tray

Source: Journal of AHIMA

Publication Date: September 2002


Ask a physician: "Doctor, are your detailed history and physicals comprehensive?" Now ask: "Doctor, are your comprehensive history and physicals detailed?" Chances are, you'll get two affirmative replies. To a physician, detailed workups are comprehensive, and comprehensive workups are detaile....

Common E/M Documentation Issues

Author: Udell, Curtis

Source: Brief Encounter

Publication Date: July 02, 2001


One of the constant challenges facing managers today is evaluating physician documentation and then helping their physicians to improve the content of their patient notes, particularly for evaluation and management (E/M) services.

While physicians may have unique style or flair to t....

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