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OIG Workplan: Review Medicare Inpatient Hospital Billing for Sepsis The OIG will be reviewing Medicare claims to assess patterns in the inpatient hospital billing of sepsis in 2023 and describe how the billing of sepsis varied among hospitals. The definition of and...
Dural Tear Clarification Per Coding Clinic, First Quarter 2024: A dural tear is clinically significant and should always be reported when documented by the provider. G97.41, accidental puncture or laceration of dura during a procedure is a CC...
Atrial Fibrillation (AF) Paroxysmal AF Definition: Episodes terminate either spontaneously or with treatment within 7 days; may recur Persistent AF Definition: AF is continuous and lasts > 7 days, fails to terminate spontaneously Long-standing Persistent AF...
Myocardial Infarction with Angina Per Coding Clinic, First Quarter 2024: Is it appropriate to assign a code for CAD with angina for the severe native multi-vessel disease that resulted in the MI? Examples: Assign code I21.4: Non-ST elevation (NSTEMI) myocardial...
UnderdosingPer Coding Clinic, First Quarter 2024: Underdosing when a PRN medication is not taken Example: Documentation states: A patient presents to the ED with shortness of breath due to an exacerbation of asthma. The patient did not take his PRN medication,...
Debridement Excisional Debridement Definition: The surgical removal or cutting away of devitalized tissue, necrosis, and slough. Non-Excisional Debridement Definition: The nonoperative brushing, irrigating, scrubbing, or washing of devitalized tissue, necrosis,...
ComaDefinition: Deep state of unconsciousness where patients are unable to move or be aware of or respond to their surroundings with loss of thinking abilities however retain non-cognitive function and normal sleep patterns.Diagnostic CriteriaA comprehensive...
New Codes for Sickle Cell Disease with Dactylitis (Valid for October 1, 2023 discharges)• D57.04 Hb-SS disease with dactylitis• D57.214 Sickle-cell/Hb-C disease with dactylitis• D57.414 Sickle-cell thalassemia, unspecified, with dactylitis• D57.434 Sickle-cell...
Complication Comorbidity UpdateSocial Determinants of Health (SDOH) codes Z59.00, Homelessness unspecified, Z59.01, Sheltered homelessness and Z59.02, Unsheltered homelessness will be considered CC’s (complication/comorbidity) beginning with October 1, 2023...
Pathological FracturesDefinition: A bone fracture that occurs without adequate trauma, caused by an underlying disease.Diagnostic CriteriaIdentified in Radiology/Diagnostic Imaging such as X-Ray, CT, MRI, or bone scans. There are various underlying causes for...
New Code for Resistant Hypertension (Valid for October 1, 2023 discharges)I1A.0 Resistant hypertension May be documented as: Apparent treatment resistant hypertension, Treatment resistant hypertension, True resistant hypertension. The ICD-10-CM Tabular instruction...
Hypertensive CrisisDefinition: HTN: Systolic blood pressure (SBP) of 130mm Hg or more and/or diastolic blood pressure (DBP) of more than 80mm Hg HTN Crisis: Generic term to describe hypertensive urgency or hypertensive emergency, typically seen with elevated blood...