Reliable Telehealth Guidance

Featured coffee–Fireside Coffee

There are so many questions on social media sites from coders about how to code telehealth services since the Centers for Medicare & Medicaid Services (CMS)temporarily and emergently expanded benefits under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act for Medicare telehealth services.

My advice to coders, as always, is to go to the source.  If your providers participate with a payer, you can go to the carrier’s provider portal and review updated coding and payment policies for telemedicine.

CMS published a fact sheet that details coverage and payment of virtual services.  CMS also has an FAQ page that provides answers to most of the questions asked on social media sites.

American Medical Association (AMA) developed a Quick Guide that provides guidance for implementing and coding telemedicine services.  Also, AMA offers links to some payers, for updated payer-specific information on telehealth services.

AMA also provides a presentation that outlines special coding advice during Covid-19, with scenarios.

So, next time you’re on a social media site and someone posts a question about how to code telemedicine/telehealth services, share these links.  These are official sources.

 

 

 

Our New Normal

Featured coffee–Strawberry Cheesecake

I was talking to a friend who just started working from home.  Her entire department was sent home to work due to Coronavirus COVID-19.

I asked her if she was taking her breaks, eating lunch, and signing off at her scheduled time.  She said she forgot.

I’ll share with you the advice that I gave her:

• Unless your work schedule is modified by your employer, keep your scheduled hours. Your “commute” is short, so there’s no excuse for lateness.
• Unless you are requested to work overtime, stop working at your scheduled time. Of course, if you’re in the middle of coding a record, finish the record and then sign off.
• Your after-work “commute” is short, so you don’t have the drive time to decompress and leave work at work. Shut the system down and close the door.  Create an after-work routine that allows you to decompress.
• Unless instructed otherwise by your employer, turn the computer/laptop off (including extra monitors). Working from home, you’re going to see an increase in your electric bill.
• If you are allowed two 15-minute breaks in the office, take them at home too. Same with your scheduled lunch.  Remember to walk away from your home office during your breaks, and don’t forget to set your status to “be right back” or “away.”  If you’re required to sign out for your breaks and lunch, do the same at home.

 

Stay safe, and be well!

 

 

 

 

 

 

Documentation Improvement

Featured coffee – Mochadoodle 

We’ve always stressed the importance of coders giving feedback to providers when there are deficiencies in the documentation.  When coders are expected to code 100-150 notes in an eight hour day, when do they have time?

In the age of production coding, we (the industry) have become so focused on the number of encounters coded that we’re missing opportunities to assist providers in improving the quality of their documentation.

Many coding contractors are paid “per-piece.”  Hospitals and physician practices have daily, weekly, and monthly minimum budgets that are calculated according to charges and collections, and coders must meet daily production numbers.

Auditors review coders to determine if the coders correctly assign codes based upon the documentation.  Unfortunately, sometimes the documentation leads the coders to unspecified diagnosis codes.  For example, if the provider only documents pneumonia in the impression, the coder is correct to assign the unspecified code; however, if known but the provider did not document lobar pneumonia, this would negatively impact hierarchical condition categories (HCC) reporting.

Auditors should focus reviews on unspecified diagnoses.  These represent opportunities to provide feedback to the providers on the importance of specificity in their documentation.

In ICD-10-CM Official Guidelines for Coding and Reporting FY 2020, Section I.A.9b, “Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code.”  Section I.B.18 provides more detail.  “While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter.”

So, why is this important?

According to the World Health Organization (WHO), “ICD defines the universe of diseases, disorders, injuries and other related health conditions, listed in a comprehensive, hierarchical fashion that allows for:

• easy storage, retrieval and analysis of health information for evidenced-based decision-making;
• sharing and comparing health information between hospitals, regions, settings and countries; and
• data comparisons in the same location across different time periods.”

ICD-10-CM codes are not only used for processing health insurance claims. The codes are used to track epidemics, pandemics, factors that influence health status and external causes of diseases, and to compile worldwide mortality statistics.

These should be quick, focused audits and providers should be reminded to:

• Document all coexisting conditions that are related to the patient’s health status
• Document the current status of the condition
• Document anatomical site/location
• Document episode of care (specify if initial, subsequent, or sequela)
• Document laterality
• Document origin (etiology)
• Document complication/manifestation
• Document severity

 

 

 

CPT only copyright 2020 American Medical Association.

ICD-10 is copyrighted by the World Health Organization (WHO)