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ICD-10: are you ready for a brave new world? NEPHROLOGY NEWS & ISSUES 2014; 28:26-29. [PMID: 25306846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The ICD-10 transition will be an evolutionary process. Relying on the EHR or certified coding staff alone will not be sufficient. The EHR can facilitate easy search tools that assist the provider in selecting a diagnosis. Billing staff are an invaluable resource to help validate that coding and documentation are in sync but the burden will clearly rest on the provider. The provider will be juggling a new code structure, drilling down to new levels of complexity and ensuring their documentation supports the specificity of the new codes selected, all while managing a full patient schedule. Education for the provider will be of paramount importance as they navigate this brave new world.
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Billing for ICD-10: be prepared. NEPHROLOGY NEWS & ISSUES 2014; 28:27-28. [PMID: 25306847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Mapping medical records of gastrectomy patients to SNOMED CT. Stud Health Technol Inform 2011; 169:764-768. [PMID: 21893850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this study is to explore the ability of SNOMED CT to represent narrative statements of medical records. Narrative medical records of 281 hospitalization days of 36 patients with Gastrectomy were decomposed into single-meaning statements, and these single-meaning statements were combined into unique statements by removing semantically redundant statements. Concepts from the statements describing patients' problems and treatments were mapped to SNOMED CT concepts. A total 4717 single-meaning statements were collected and these single-meaning statements were combined into 858 unique statements. Out of 677 unique statements describing patients' problems and treatments, about 85.5% statements were fully mapped to SNOMED CT. The rest of the statements were partially mapped. This mapping result implies that physicians' narrative medical records can be structured and used for an electronic medical record system.
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SNOMED CT implementation: implications of choosing clinical findings or observable entities. Stud Health Technol Inform 2011; 169:809-813. [PMID: 21893859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Internationally, it is a priority to develop and implement semantically interoperable health information systems.[1] One required technology is the use of standardised clinical terminologies. The terminology, SNOMED CT, has shown superior coverage compared to other terminologies in multiple clinical fields. The aim of this paper is to analyse SNOMED CT implementation in an Electronic Health Record (EHR). More specifically, differences and consequences of applying clinical findings (CFs) as an alternative to observable entities (OEs) is analysed. Results show that CFs represents the content of the templates with better coverage, with more parent concepts and with a higher degree of fully defined terms than the OEs. We discuss the possibility to further evaluate the observable entity hierarchy to overcome a potential overlapping use of the two hierarchies.
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Technology. Hospitals urged to plan now for shift to ICD-100. HOSPITALS & HEALTH NETWORKS 2008; 82:12. [PMID: 19031832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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6
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Deciphering dialysis access maintenance coding. JOURNAL OF AHIMA 2008; 79:70-72. [PMID: 18512433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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7
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Hospitals' code blues. MS-DRG switch may initially delay pay. MODERN HEALTHCARE 2007; 37:18-19. [PMID: 18161426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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8
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CODE your way to better reimbursement. MEDICAL ECONOMICS 2007; 84:48-54. [PMID: 18075058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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9
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Extra training needed for DRGs. Concerns arise on coding, payment issues for system. MODERN HEALTHCARE 2007; 37:8-9. [PMID: 17960717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Internationale Ausbildungsinhalte zum medizinischen Kodierer der ICD. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:962-8. [PMID: 17629767 DOI: 10.1007/s00103-007-0286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nationally collected data for mortality and morbidity are coded according to the International Classification of Diseases (ICD). From the coded data international statistics are compiled. Due to national variations in coding, data are not always comparable. With the development of core curricula for mortality and morbidity coding, the Education Committee of the WHO Family of International Classifications Network developed an entry level standard for the education of medical coders. Through this enhanced and internationally consistent level of education the quality of the collected data can be increased.
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Compliance with the NPI. TENNESSEE MEDICINE : JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 2007; 100:8-9. [PMID: 17542355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Practical issues in using SNOMED CT as a reference terminology. Stud Health Technol Inform 2007; 129:640-4. [PMID: 17911795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
SNOMED CT was created by the merger of SNOMED RT (Reference Terminology) and Read Codes Version 3 (also known as Clinical Terms Version 3). SNOMED CT is considered to be among the most extensive and comprehensive biomedical vocabularies available today. It is considered for use as the Reference Terminology of various institutions. We review the adequacy of SNOMED CT as a Reference Terminology and discuss the issues in its use as such. We discuss issues with content coverage of various clinical domains, data integrity and validity, and the update frequency of SNOMED CT, and why SNOMED CT alone is not adequate to serve as the Reference Terminology of a healthcare organization.
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Classifications used by Australian forensic odontologists in identification reports. THE JOURNAL OF FORENSIC ODONTO-STOMATOLOGY 2006; 24:32-5. [PMID: 17175833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Forensic odontologists are repeatedly called upon to assist in the identification of deceased persons. A great deal of information is available in the literature as to how and why comparative dental investigation of identification is performed but there is little information on the descriptive terms used in reporting these identifications. A forensic odontology report sets out the findings of a comparison between antemortem and postmortem evidence and indicates the odontologist's opinion on the identification. This opinion needs to be defendable in a court of law. This paper investigates the classifications utilised in the six states and two territories of Australia and reflects on the differences. Three states of Australia use American Board of Forensic Odontology classifications, whilst the remaining regions use a modified format. Since there are no significant legal, cultural or religious differences, and similar practitioners and clients, variation between regions within Australia would seem hard to justify. National standard terminology should be encouraged.
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Monitor observation status to make sure new codes are being used. HOSPITAL CASE MANAGEMENT : THE MONTHLY UPDATE ON HOSPITAL-BASED CARE PLANNING AND CRITICAL PATHS 2006; 14:49-51. [PMID: 16562573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Using SNOMED CT codes for coding information in electronic health records for stroke patients. Stud Health Technol Inform 2006; 124:815-23. [PMID: 17108614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
For a project on development of an Electronic Health Record (EHR) for stroke patients, medical information was organised in care information models (templates). All (medical) concepts in these templates need a unique code to make electronic information exchange between different EHR systems possible. When no unique code could be found in an existing coding system, a code was made up. In the study presented in this article we describe our search for unique codes in SNOMED CT to replace the self made codes. This to enhance interoperability by using standardized codes. We wanted to know for how many of the (self made) codes we could find a SNOMED CT code. Next to that we were interested in a possible difference between templates with individual concepts and concepts being part of (scientific) scales. Results of this study were that we could find a SNOMED CT code for 58% of the concepts. When we look at the concepts with a self made code, 54.9% of these codes could be replaced with a SNOMED CT code. A difference could be detected between templates with individual concepts and templates that represent a scientific scale or measurement instrument. For 68% of the individual concepts a SNOMED CT could be found. However, for the scientific scales only 26% of the concepts could get a SNOMED CT code. Although the percentage of SNOMED CT codes found is lower than expected, we still think SNOMED CT could be a useful coding system for the concepts necessary for the continuity of care for stroke patients, and the inclusion in Electronic Health Records. Partly this is due to the fact that SNOMED CT has the option to request unique codes for new concepts, and is currently working on scale representation.
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Problem list coding in e-HIM. JOURNAL OF AHIMA 2005; 76:68-70. [PMID: 16097128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Avoiding audits by benchmarking your E/M coding. THE JOURNAL OF MEDICAL PRACTICE MANAGEMENT : MPM 2005; 21:51-3. [PMID: 16206808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Providers are well aware that appropriate coding is the key to prompt payment of claims submitted for services. Payers do reserve the right to review payments at a later date, however. The auditing process is costly, time consuming, and often traumatic for practices. This article provides an overview of the coding and payment process. The author suggests that practices audit their own clinical records on a periodic basis and compare the distribution of their codes with national and/or specialty benchmarks. In addition, practices must weigh whether the coding level is supported by appropriate documentation.
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Coordinating SNOMED-CT and ICD-10. JOURNAL OF AHIMA 2005; 76:60-1. [PMID: 16097126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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19
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Documentation in medical practice. THE JOURNAL OF MEDICAL PRACTICE MANAGEMENT : MPM 2005; 21:54-7. [PMID: 16206809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Effects of form length and item format on response patterns and estimates of physician office and hospital outpatient department visits. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2001. VITAL AND HEALTH STATISTICS. SERIES 2, DATA EVALUATION AND METHODS RESEARCH 2005:1-32. [PMID: 15984725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This report describes effects due to form length and/or item formats on respondent cooperation and survey estimates. METHODS Two formats were used for the Patient Record form for the 2001 NAMCS and OPD component of the NHAMCS: a short form with 70 subitems and a long form with 140 subitems. The short form also contained many write-in items and fit on a one-sided page. The long form contained more check boxes and other unique items and required a two-sided page. The NAMCS sample of physicians and NHAMCS sample of hospitals were randomly divided into two half samples and randomly assigned to either the short or long form. Unit and item nonresponse rates, as well as survey estimates from the two forms, were compared using SUDAAN software, which takes into account the complex sample design of the surveys. RESULTS Physician unit response was lower for the long form overall and in certain geographic regions. Overall OPD unit response was not affected by form length, although there were some differences in favor of the long form for some types of hospitals. Despite having twice the number of check boxes on the long form as the short form, there was no difference in the percentage of visits with any diagnostic or screening services ordered or provided. However, visit estimates were usually higher for services collected with long form check-boxes than with (recoded) short form write-in entries. Finally, the study confirmed the feasibility of collecting certain items found only on the long form. CONCLUSION Overall, physician cooperation was more sensitive to form length than was OPD cooperation. The quality of the data was not affected by form length. Visit estimates were influenced by both content and item format.
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Psychiatry Billing for Nursing Home Services: Understanding Coding Options. J Am Med Dir Assoc 2005; 6:209-14. [PMID: 15894252 DOI: 10.1016/j.jamda.2005.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article reviews information on coding options, documentation, and payment for both initial and follow-up visits in the nursing home setting. Specific information is provided for both the psychiatry as well as the Evaluation & Management (E&M) code series. Payments are compared for comparable services in order to provide the nursing home psychiatrist with an understanding of the options available. Documentation, background information, and proposed note formatting are also provided. Proper use of the E&M series can provide valuable coding options.
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Competent coding for residents. CURRENT SURGERY 2005; 62:33-4. [PMID: 15708140 DOI: 10.1016/j.cursur.2004.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Challenges in coding and classification: what's new? HEALTH INF MANAG J 2005; 34:25-26. [PMID: 18239210 DOI: 10.1177/183335830503400202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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25
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Coding for split visits for Medicare patients: preventive medicine and office visit on the same day. THE JOURNAL OF MEDICAL PRACTICE MANAGEMENT : MPM 2004; 20:97-9. [PMID: 15523776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Billing for psychiatric evaluations: options for coding and reimbursement. Gen Hosp Psychiatry 2004; 26:296-301. [PMID: 15234825 DOI: 10.1016/j.genhosppsych.2004.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Accepted: 02/19/2004] [Indexed: 11/22/2022]
Abstract
The complexity of the current practice environment challenges clinicians to master complicated billing and coding regulations. Failure to properly bill and code can result in reduced potential revenue for services providers and, if improperly done, could lead to paybacks or penalties for the clinician. The purpose of this article is to assist psychiatrists in choosing the optimal coding for new evaluations and to understand the documentation requirements. Comparisons are provided between the "psychiatry codes" and the "evaluation and management" series. Details of required history, examination, and medical decision-making are listed in order to provide the tailed knowledge necessary to appropriately utilize some higher paying evaluation and management coding options for psychiatric evaluations.
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PPS brings change to inpatient psychiatric facilities. JOURNAL OF AHIMA 2004; 75:64-6. [PMID: 15141593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Coding and HIM in home care: up to the challenge. JOURNAL OF AHIMA 2004; 75:62-3; quiz 67-8. [PMID: 15141592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Finance. Code breakers. THE HEALTH SERVICE JOURNAL 2004; 114:44. [PMID: 15129644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Is your coding on target? MEDICAL ECONOMICS 2003; 80:84-6, 89-90, 93. [PMID: 14712587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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CPT category III codes cover new, emerging technologies. New codes developed to address issues in light of HIPAA. JOURNAL OF AHIMA 2003; 74:82-4, 86, 88. [PMID: 14571555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Disparity in coding concordance: do physicians and coders agree? JOURNAL OF HEALTH CARE FINANCE 2003; 29:43-53. [PMID: 12908653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Increasing demands for large-scale comparative analysis of health care costs has led to a similar demand for consistently classified data. Evidence-based medicine demands evidence that can be trusted. This study sought to assess managers' observed levels of agreement with physician code selections when classifying patient data. Using a non-sampled research design of both mailed and telephone surveys, we employ a nationwide cross-section of over 16,000 accredited US medical record managers. As a main outcome measure, we evaluate reported levels of agreement between physician and information manager code selections made when classifying patient data. Results indicate about 19 percent of respondents report that coder-physician classification disagreement occurred on more than 5 percent of all patient encounters. In some cases, disagreement occurred in 20 percent or more instances of code selection. This phenomenon shows significant variation across key demographic and market indicators. With the growing practice of measuring coded data quality as an outcome of health care financial performance, along with adoption of electronic classification and patient record systems, the accuracy of coded data is likely to remain uncertain in the absence of more consistent classification and coding practices.
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Benchmarking variation in coding accuracy across the United States. JOURNAL OF HEALTH CARE FINANCE 2003; 29:29-42. [PMID: 12908652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The objective of this study was to measure the consistency of coded medical data through information managers' reports of the overall coding error level in patients' medical records. Using a cross-sectional design, we examined the reported percent of records containing coding errors significant enough to change a diagnostic related group (DRG). Results indicate about 87 percent, 9 percent, and 5 percent of respondents reported that significant coding errors existed in less than 5 percent, 6-10 percent, and greater than 10 percent of the medical records in their institutions, respectively. Significant variation was found in the accuracy and consistency of coding practice and associated data quality across key demographic and organizational variables. Significantly large error rates in coded data exist in some organizations. Given variations across key demographic characteristics, providers may tend to distrust all coded data, when aggregated. As the United States moves toward an evidence-based medicine environment, the use of current patient data classification methods may be of limited value without increased attention to coding practices.
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Abstract
This analysis was performed to examine whether Medicare claims accurately document underlying rheumatologic diagnoses in total hip replacement (THR) recipients. We obtained data on rheumatologic diagnoses including rheumatoid arthritis (RA), avascular necrosis (AVN), and osteoarthritis (OA) from medical records and from Medicare claims data. To examine the accuracy of claims data we calculated sensitivity and positive predictive value using medical records data as the "gold standard" and assessed bias due to misclassification of claims-based diagnoses. The sensitivities of claims-based diagnoses of RA, AVN, and OA were 0.65, 0.54, and 0.96, respectively; the positive predictive values were all in the 0.86-0.89 range. The sensitivities of RA and AVN varied substantially across hospital volume strata, but in different directions for the two diagnoses. We conclude that inaccuracies in claims coding of diagnoses are frequent, and are potential sources of bias. More studies are needed to examine the magnitude and direction of bias in health outcomes research due to inaccuracy of claims coding for specific diagnoses.
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Sepsis, related terms cause confusion for coders. JOURNAL OF AHIMA 2003; 74:81-3. [PMID: 12747157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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APCs: lack of knowledge can hurt your bottom line. ED MANAGEMENT : THE MONTHLY UPDATE ON EMERGENCY DEPARTMENT MANAGEMENT 2003; 15:53-5. [PMID: 12760153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Understanding pelvic adhesions. How to get up to date with procedures, codes. JOURNAL OF AHIMA 2003; 74:74-7; quiz 79-80. [PMID: 12747156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Monitoring improper Medicare payments. New CMS programs build on OIG methods to report errors. JOURNAL OF AHIMA 2003; 74:70-3. [PMID: 12747155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Retrospective investigation of dental records used in forensic identification cases. SADJ : JOURNAL OF THE SOUTH AFRICAN DENTAL ASSOCIATION = TYDSKRIF VAN DIE SUID-AFRIKAANSE TANDHEELKUNDIGE VERENIGING 2003; 58:102-4. [PMID: 12856402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The purpose of this paper was to investigate the standard of dental record keeping from a sample of forensic records retrieved from the Department of Oral Pathology and Oral Biology, School of Dentistry, University of Pretoria. Forty of the most recent cases in which ante-mortem information was required, were analysed. From the investigation it was clear that dentists did not comply with the requirements pertaining to dental charting and record keeping. A recommended code of abbreviations is proposed for use by dentists. It is concluded that until such time as charting is reinstituted as a legal requirement by the Health Professional Council of South Africa, dentists would not routinely chart their patients' dental status.
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Getting paid for house calls. MEDICAL ECONOMICS 2003; 80:24, 27. [PMID: 12688067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Multiple-cause coding of death from myocardial infarction: population-based study of trends in death certificate data. J Public Health (Oxf) 2003; 25:69-71. [PMID: 12669922 DOI: 10.1093/pubmed/fdg014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data on long-term trends in mortality are generally unavailable for multiple-cause coding of deaths. We wanted to know whether multiple-cause coding of deaths for myocardial infarction contributes much to the interpretation of death certificate data on mortality rates for this condition. METHODS We analysed all causes of death on death certificates in the former Oxford health service region from 1979 to 1998. RESULTS Of 69,333 death certificates that included myocardial infarction as a cause of death, it was the underlying cause of death in 93.6 per cent. The ratio of 'mentions' to 'underlying cause' was broadly similar over the study period, during which time there were substantial falls in mortality rates. There were significant changes to the ratios, associated with timing of changes to coding rules; but their effects were small. The ratio of mentions to underlying cause was similar in men and women and in different age groups. CONCLUSION The underlying cause of death was a robust and almost complete measure of certified deaths for myocardial infarction.
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Did we do it right?--an evaluation of the colour coding system for antenatal care in Malaysia. THE MEDICAL JOURNAL OF MALAYSIA 2003; 58:37-53. [PMID: 14556325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Identification of pregnancies that are at greater than average risk is a fundamental component of antenatal care. The objective of this study was to assess the level of appropriate management and outcomes among mothers with hypertensive disorders of pregnancy, postdates and anemia in pregnancy, and to determine whether the colour coding system had any effect on the maternal mortality ratios. A retrospective follow-through study confined to users of government health services in Peninsular Malaysia was carried out in 1997. The study areas were stratified according to their high or low maternal mortality ratios. The study randomly sampled 1112 mothers out of 8388 mothers with the three common obstetric problems in the selected study districts. The study showed that the prevalence of anemia, hypertensive disorders in pregnancy and postmaturity among mothers with these conditions were according to known international standards. There was no significant difference in the colour coding practices between the high and low maternal mortality areas. Inappropriate referrals were surprisingly lower in the areas with high maternal mortality. Inappropriate care by diagnosis and by assigned colour code were significantly higher in the areas with high maternal mortality. The assigned colour code was accurate in only 56.1% of cases in the low maternal mortality areas and in 55.8% of the cases in the high maternal mortality areas and these two areas did not differ significantly in their accurate assignment of the colour codes. The colour coding system, as it exists now should be reviewed. Instead, a substantially revised system that takes cognisance of evidence in the scientific literature should be used to devise a more effective system that can be used by health care personnel involved in antenatal care to ensure appropriate level of care and referrals.
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Variation in coding influence across the USA. Risk and reward in reimbursement optimization. JOURNAL OF MANAGEMENT IN MEDICINE 2003; 16:422-35. [PMID: 12534165 DOI: 10.1108/02689230210450981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent anti-fraud enforcement policies across the US health-care system have led to widespread speculation about the effectiveness of increased penalties for overcharging practices adopted by health-care service organizations. Severe penalties, including imprisonment, suggest that fraudulent billing, and related misclassification of services provided to patients, would be greatly reduced or eliminated as a result of increased government investigation and reprisal. This study sought to measure the extent to which health information managers reported being influenced by superiors to manipulate coding and classification of patient data. Findings from a nationwide survey of managers suggest that such practices are still pervasive, despite recent counter-fraud legislation and highly visible prosecution of fraudulent behaviors. Examining variation in influences exerted from both within and external to specific service delivery settings, results suggest that pressure to alter classification codes occurred both within and external to the provider setting. We also examine how optimization influences vary across demographic, practice setting, and market characteristics, and find significant variation in influence across practice settings and market types. Implications for reimbursement programs and evidence-based health care are discussed.
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What's the difference between these modifiers? MEDICAL ECONOMICS 2003; 80:16, 19. [PMID: 12557820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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45
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Where to find answers to your coding questions. JOURNAL OF AHIMA 2003; 74:84-6; quiz 87-8. [PMID: 12530353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Plenty of CPT changes for 2003. Latest on additions, revisions, and deletions. JOURNAL OF AHIMA 2003; 74:80-2. [PMID: 12530352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Improve compliance and financial performance at the same time. THE JOURNAL OF MEDICAL PRACTICE MANAGEMENT : MPM 2002; 18:155-8. [PMID: 12534261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Contrary to conventional wisdom, which holds that compliance is often a net negative to a practice's financial performance, the fact is that compliance, operations, and the financial performance of a medical practice can all be simultaneously improved. This article will illustrate that the basic drivers of effective compliance are often the same fundamental business principles that lead to outstanding operations and enhanced financial performance. The lesson for medical practice managers is that if you improve compliance, you should actually improve your bottom line, not harm it.
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Medicare cost controls and program compliance: the rationale of physician claims edits. THE JOURNAL OF MEDICAL PRACTICE MANAGEMENT : MPM 2002; 18:115-9. [PMID: 12534250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
This article attempts to demystify and create a context for the enactment of several Medicare cost control and compliance systems for physician reimbursement. The focus is on claims "edits" and Medicare compliance. Portions of Medicare, including health care provider reimbursement, remain fee-for-service programs that can be easily defrauded. To protect the Trust, the Centers for Medicare and Medicaid Services (CMS) has taken a multi-pronged approach, using program administration, enforcement, and rules-based claims editing systems. The Evaluation and Management codes, the Correct Coding Initiative (CCI), and medical necessity rules are claims edits that affect procedure codes. The Medicare program has a complicated system of billing procedures and an apparatus to enforce them. A solid compliance plan must incorporate proper claims editing, because consistent incorrect Medicare billing can be considered abuse. Many resources are available to aid physicians, including computerized tools, new CMS initiatives, and Internet materials.
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Coding for injuries and skin grafts. THE JOURNAL OF MEDICAL PRACTICE MANAGEMENT : MPM 2002; 18:146-7. [PMID: 12534257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Laboratory services regulations impact national coverage decisions, HIM. JOURNAL OF AHIMA 2002; 73:18-20, 22, 24. [PMID: 12371335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
This is Part 2 of a two-part article on laboratory services regulations. Part 1, which appeared in the September Journal of AHIMA, dealt with the administrative policies contained in these regulations. Part 2 addresses the specific national coverage decisions that were developed as part of this regulatory process. For more information on each coverage policy, review Addendum B of the regulations.
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