Following up on the November CodeWrite article on this topic, this article looks at three common myths that have surfaced regarding these new discharge status codes.
When Guidelines Depend on the Setting: This article outlines the differences in guidelines between the two coding types. This guideline is true for certain settings such as acute care facilities, short-term facilities, long-term care, and psychiatric hospitals. However, a coder coding a physician service may not apply this rule, even if a physician provides the service to an inpatient admission.
Take for example a patient admitted to a facility with a first progress note diagnosis of shortness of breath, rule out pneumonia. The coder reporting the professional fee would not be able to code the diagnosis of pneumonia, but he or she would need to code shortness of breath. Shortness of breath is the sign or symptom known.
The diagnosis of pneumonia could be coded by the hospital inpatient coder, as long as the diagnosis was not ruled out throughout the hospitalization. If this same documentation was applied to a hospital outpatient setting, such as a patient in observation, then the diagnosis of pneumonia would not be coded by either the coding professional reporting the professional fee or the hospital outpatient service.
Professional fee coding and reporting follow the established documentation guidelines set forth by the Centers for Medicare and Medicaid Services CMS.
There are two sets of documentation guidelines a physician may follow, the or guidelines. Both sets are similar in requirements with the exception of the examination section, and as coding professionals know, physicians may use either set.
Facilities may report the same evaluation and management codes but are not required to follow the same documentation guidelines that have been established for professional fee coding. While CMS is working on establishing facility guidelines to report evaluation and management codes, the codes should be reported based on facility-developed guidelines while physicians use the or guidelines.
It is important that coding professionals know the type of setting i. Modifier Usage Modifier usage also differs for professional fee coding and facility coding. Certain modifiers only apply to hospital outpatient settings, such as 73, Discontinued outpatient procedure prior to anesthesia administration, and 74, Discontinued outpatient procedure after anesthesia administration.
Professional fee coding would report modifiers 52, Reduced services, or 53, Discontinued procedure, for the same service in which the hospital would report 73 or 74 depending upon the documentation. Modifier use also differs in evaluation and management codes.
For example, necessary professional services may report modifiers 21, Prolonged evaluation and management services, and 24, Unrelated evaluation and management service by the same physician during a postoperative period.
Facilities may not report either modifier.
The postoperative period is defined differently for facilities and professional services. Most third-party payers define postoperative days for providers as 0, 10, or 90 days; facilities only have to be concerned with outpatient visits that occur on the same day.
V Codes Reporting V codes to third-party payers is a common challenge in both facility and professional fee coding. V codes, however, are valid codes, and when used correctly they result in paid claims. The ICDCM Official Guidelines for Coding and Reporting feature a table that describes when V codes should be used as the first listed diagnosis only, an additional diagnosis only, or a combination of both first listed or additional diagnosis.
For instance, if a patient is seen on an outpatient basis in follow-up for a knee replacement, the code V This encounter should be covered by the third-party payer. Coding professionals thus must be acutely aware of the setting they are coding for, as the guidelines differ from setting to setting.
And, of course, no matter the setting, good documentation and ongoing education are essential to good coding. Documentation must support all diagnosis and procedure codes reported.
Continuing education for coders is a must, as new codes and guidelines are created every year. Coding professionals should take the time to review the established coding guidelines and familiarize themselves with new ones. Education is never wasted and could save valuable time correcting errors on the back end.
References Centers for Medicare and Medicaid Services. National Center for Health Statistics.Welcome to CodeWrite Welcome to CodeWrite, AHIMA's monthly e-newsletter created exclusively for coding professionals..
If there is an individual whom you feel would benefit by receiving this e-newsletter, please forward this to him or her to ashio-midori.com for the next issue of CodeWrite in September. NEW READMISSION PATIENT DISCHARGE STATUS CODES: FOLLOW-UP. By Tedi Lojewski, RHIA, CCS, CHDA.
The National Uniform Billing Committee (NUBC) approved 15 new "readmission" patient discharge status codes (81–95) for use with inpatient discharges, effective October 1, NEW READMISSION PATIENT DISCHARGE STATUS CODES: FOLLOW-UP.
By Tedi Lojewski, RHIA, CCS, CHDA. The National Uniform Billing Committee (NUBC) approved 15 new "readmission" patient discharge status codes (81–95) for use with inpatient discharges, effective October 1, AHIMA's HIM Body of Knowledge™ provides resources and tools to advance health information professional practice and standards for the delivery of quality healthcare.
Welcome to CodeWrite Welcome to CodeWrite, AHIMA's monthly e-newsletter created exclusively for coding professionals.. If there is an individual whom you feel would benefit by receiving this e-newsletter, please forward this to him or her to ashio-midori.com for the next issue of CodeWrite in September.
When Guidelines Depend on the Setting: Comparing, Contrasting Facility Reporting and Professional Fee Coding. by Kathy Arner, LPN, RHIT, CCS, CPC, MCS.