Inpatient coding woes? Well, there could be something amiss in your DRG process.
Every year thousands of dollars go down the drain because of poor Medicare Severity Diagnosis Related Groups Codes selection and under coding. One needs to understand the complete DRG process to figure out the ways to proper reimbursement. Spot on DRG assignment and auditing practices help you stay away from both up-coding and under-coding; in the process you'll save money and cut short the revenue cycle.
Changes to Medicare Severity Diagnosis Related Groups (MS-DRG)
Right from the time it was implemented in 2008, MS-DRG has witnessed documentation and coding adjustments made to the standardized amount to ensure budget neutrality. In FY 2011, Centers for Medicare and Medicaid mandated a non-cumulative 2.9% documentation and coding adjustments as part of a two-year process to get back overpayments ensuing from the conversion to the MS-DRG system.
As mentioned in the last IPPS Final Rule, an additional -2.9% adjustment is statutorily mandated for FY 2012. But then since the FY 2011 adjustment was non-cumulative, the net effect of the FFY 2012 adjustment resulted in no change as compared to the earlier adjustment.
In the end, the agency rejected the proposed implementation of another documentation and coding adjustment of 3.15 percent for FY 2012.
DRG codes & ICD-10 codes:
ICD-10 MS DRGs which are likely to go into effect in FY 2014 will be subject to notice and comment rulemaking. Meanwhile, the agency will provide extensive and detailed information on this activity by way of the ICD-9-CM Maintenance and Coordination Committee.
Version 28.0 of the ICD-10 MS-DRGs based on FY 2011 MS-DRGs is final and is available for public review on the CMS' website.
In the mean time the agency will continue to work with the public on the conversion and post drafts for updates. The final version of the ICD-10 MS-DRGs which will go into effect in FY 2014 will be subject to notice and comment rulemaking.
In the intervening time, the agency will provide extensive and detailed information on this activity through the ICD-9-CM Maintenance and Coordination Committee.
DRG Codes Lookup: For more MS-DGR updates, sign up for a good coding resource like SuperCoder. Such a site comes with Grouper-Procedure Code CrossRef, hospital coding datasets, average LOS look-up, MS-DRG to ICD-9-CM Vol. 1 CrossRef, a robust search engine, and more. Sign up today and see how it puts your inpatient coding on track.
Showing posts with label MS-DRG. Show all posts
Showing posts with label MS-DRG. Show all posts
Friday, September 23, 2011
Thursday, August 18, 2011
Hospital Coding Scenarios to Help You Avoid Denials
Hospital coding and billing mistakes can cost your hospitals thousands of dollars. Here are a couple of hospital billing & coding scenarios to help your understanding and save you from unnecessary denials.
Scenarios: After treating a patient in the office, our physician admitted her to the hospital later the same day. How should we go about this situation? Can we bill for the office visit and the first day of admission? Or do we just bill for the hospital stay?
Well, it all depends on whether your physician tends to the patient on the same day in the hospital.
Two face-to-face visits on the same date
If the physician tends to the patient in the hospital on the same day he saw her in the office, you are looking at two face-to-face visits on the same date. Go for only the proper initial hospital care code - (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ).
CPT coding guidelines ( Source "http://www.supercoder.com/cpt-codes/") lay down that all initial hospital care services that start in another place of location (say for instance the physician's office) should be combined and coded using the proper level of initial hospital care. As the 99221-99223 code will include the evaluation & management provided in the office, you will go for an initial hospital care code that includes the work done in both sites of the service.
Bill each encounter separately
However if your physician doesn't see the patient in the hospital until the next day, you should bill each encounter separately. Select the proper office visit code (99201-99205 or 99212-99215) for the visit on day one. After this add an initial hospital care code 99221-99223 for day two when the physician tends to the patient in the hospital for the first time.
Bear in mind: CPT uses initial hospital care codes to code the first hospital inpatient encounter by the admitting physician. Soon after that, you will report subsequent hospital care codes - 99231-99233 - until the date of discharge. After the physician discharges the patient, you will submit the proper hospital discharge day code (99238 or 99239, Hospital discharge day management ).
Scenarios: After treating a patient in the office, our physician admitted her to the hospital later the same day. How should we go about this situation? Can we bill for the office visit and the first day of admission? Or do we just bill for the hospital stay?
Well, it all depends on whether your physician tends to the patient on the same day in the hospital.
Two face-to-face visits on the same date
If the physician tends to the patient in the hospital on the same day he saw her in the office, you are looking at two face-to-face visits on the same date. Go for only the proper initial hospital care code - (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ).
CPT coding guidelines ( Source "http://www.supercoder.com/cpt-codes/") lay down that all initial hospital care services that start in another place of location (say for instance the physician's office) should be combined and coded using the proper level of initial hospital care. As the 99221-99223 code will include the evaluation & management provided in the office, you will go for an initial hospital care code that includes the work done in both sites of the service.
Bill each encounter separately
However if your physician doesn't see the patient in the hospital until the next day, you should bill each encounter separately. Select the proper office visit code (99201-99205 or 99212-99215) for the visit on day one. After this add an initial hospital care code 99221-99223 for day two when the physician tends to the patient in the hospital for the first time.
Bear in mind: CPT uses initial hospital care codes to code the first hospital inpatient encounter by the admitting physician. Soon after that, you will report subsequent hospital care codes - 99231-99233 - until the date of discharge. After the physician discharges the patient, you will submit the proper hospital discharge day code (99238 or 99239, Hospital discharge day management ).
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