Home Town Health – Medicare Updates July Jenan Custer CPC, CCS, CDIP AHIMA Approved ICD-10-CM/PCS Trainer and Ambassador Director of Coding Healthcare Coding and Consulting Services (HCCS)

Agenda CMS/AHIMA Upcoming Events OPPS Proposed Rule Category III Code Updates: July AHA Coding Clinic: 2Q 2016

Home Town Health - July CMS Upcoming Conferences To view click here The HOP Panel is an expert outside advisory panel that provides technical advice regarding the clinical integrity of the Ambulatory Payment Classification (APC) groups, relative payment weights, and supervision levels. CMS considers the technical advice provided by the Panel as they prepare the proposed and final rules to update the hospital outpatient prospective payment system (OPPS). AVAILABLE TO STREAM ON DEMAND AFTER, THE AGENDA WILL BE AVAILABLE TO SEE IF IT INTERESTS YOU

Home Town Health - July AHIMA Call for Participation AHIMA is developing comments on the Centers for Medicare and Medicaid Services' (CMS) proposed revisions to the conditions of participation (CoPs) for hospitals and critical access hospitals, including medical record services. A meeting will be held via WebEx on July 19, noon–1 p.m. CT. The public comment period closes on August 15. To participate, please e-mail AHIMA's senior director of federal relations at Lauren.Riplinger@ahima.org. https://www.federalregister.gov/articles/2016/06/16/2016-13925/medicare-and-medicaid-programs-hospital-and-critical-access-hospital-cah-changes-to-promote

CMS Reveals Site-neutral Payment Provisions in 2017 OPPS Proposed Rule Home Town Health - July CMS Reveals Site-neutral Payment Provisions in 2017 OPPS Proposed Rule CMS is looking to implement the Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments by January 1, 2017, according to the 2017 OPPS proposed rule, released 7/6/2016. Fact Sheet released by CMS that covers all items can be located on here

Home Town Health - July Source: http://www.medicarecompliancewatch.com/news-analysis/cms-adds-category-iii-codes-july-update?utm_source=edit&utm_medium=ENL&utm_campaign=ENL_ERCDA_070616_MCW&spMailingID=9160268&spUserID=MTMyMzM3NzkzNDk1S0&spJobID=960423562&spReportId=OTYwNDIzNTYyS0 Source: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3523CP.pdf

Home Town Health - July Coding Clinic, Second Quarter ICD-10 2016 Pages: 36-37 Effective with discharges: May 27, 2016 The AHA Central Office has received several questions requesting clarification of the advice published in the First Quarter 2016 issue regarding diabetes and associated conditions. The published advice is based on Guideline Section I.A.15 which says: The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular.

Home Town Health - July The following example from the Alphabetic Index for the main term "Diabetes" and the subterm "with" demonstrates this linkage: Diabetes, diabetic (mellitus) (sugar) E11.9 with amyotrophy E11.44 arthropathy NEC E11.618 autonomic (poly) neuropathy E11.43 cataract E11.36 Charcot's joints E11.610 chronic kidney disease E11.22

Home Town Health - July The subterm "with" in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word "with." The physician documentation does not need to provide a link between the diagnoses of diabetes and chronic kidney disease to accurately assign code E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease. This link can be assumed since the chronic kidney disease is listed under the subterm "with." These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated and due to some other underlying cause besides diabetes. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related."

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