Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...
Author Archives: proedge
Inpatient Prospective Payment System (IPPS) FY 2020 Proposed Rule Highlights
The IPPS FY 20 was released on April 24, 2019. Below are the highlights of the proposed changes. CC/MCC Summary – Over 1000 codes that are currently CCs will become non-CCs in the proposed rule Proposed Shifts # Non-CC to CC 183 CC to non-CC 1,148 CC to MCC 8...
National Physician Query Survey
Provident recently invited over 25,000 healthcare professionals to participate in a short survey regarding their experience with the process for clinical documentation improvement and coding queries. The objective of the survey was to establish an independent industry baseline after the widespread adoption of EHR systems. Although the results of the...
Coding Clinic 1st Quarter 2019 – Key Highlights
Below are highlights from Coding Clinic 1st Quarter 2019 – effective with discharges starting March 20th. Human Immunodeficiency Virus and Related Conditions • Code B20, HIV disease, may be reported for cases when AIDS is documented, the patient is treated for any documented HIV-related illness or is described by the...
DRG Audit Target Area – Diabetic Complications
Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...
DRG Audit Target Area – Multiple Significant Trauma (MST)
Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...
Coding Clinic – 4th Quarter 2018- Key Highlights
Coding Clinic 4th Quarter 2018 had an extensive question and answer section seeking to clear up any confusion regarding BMI coding. Much of the information was a reiteration of what has already been published in prior Coding Clinic issues and the Official Guidelines for Coding and Reporting. Below is a...
ICD-10 DRG Audit Target Area – Hypovolemic Shock
Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...
Proposed Model to Drive Down Prescription Drug Costs – the potential impact on providers and hospital billing
A recent proposal from the Department of Health and Human Services (HHS) is aimed at reducing prescription drug costs paid under Medicare Part B. The proposed pricing model would gradually shift Part B payments for delineated outpatient drugs to international prices in late 2019/early 2020, starting with providers in randomly...
AHA Coding Clinic 3rd Quarter 2018 – Key Highlights
Below are highlights from Coding Clinic 3rd Quarter 2018 (effective with discharges starting September 24th). Diabetes with necrotic pressure ulcer, diabetic peripheral vascular disease and neuropathy If a provider documents an association between diabetes and a pressure ulcer due to gangrene, the principal diagnosis is gangrene The “code first”...