Changes to the Official Guidelines for Coding and Reporting 2017

Were We Asleep at the Wheel?

3461-3461-cms-logo-250x100_6zMZ22.png.jpgYesterday was certainly like any other, in the world of healthcare coding, clinical documentation improvement (CDI) and appeals. The work is intriguing, interesting, and certainly a learning experience every day. The only thing that made this day different was taking a look at the changes to the Coding Conventions for the 2017 Official Coding Guidelines for Coding and Reporting. Oddly enough, providers would think the updates could not be that bad after surviving ICD-10 but on the other hand, could they and did providers fall asleep or lose focus as we grappled with MACRA (Medicare Access and CHIP Authorization Act), IPPS (Inpatient Prospective Payment System) Final Rule, Quality Initiatives like PQRS (Physician Quality Reporting System), Readmissions, Value Modifier, Patient Safety Indicators, just to name a few and certainly providers probably deserve a nap. It has been a long couple of years and someone’s foot is still on the gas.

Providers utilize the Official Coding Guidelines for appropriate code assignment of ICD-10 diagnosis and procedure codes which ultimately leads to payment of a DRG for inpatient and can justify medical necessity for service within the outpatient arena. These guidelines are approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), Centers for Medicare and Medicaid Services (CMS), and National Center for Health Statistics (NCHS). As stated in the guidelines, “Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.” The guidelines go on to say, “Only this set of guidelines, approved by the Cooperating Parties, is official”, and become effective October 1 of every year coinciding with the IPPS Final Rule effective date…

Via:  Were We Asleep at the Wheel? Changes to the Official Guidelines for Coding and Reporting 2017

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