News
Prevent costly healthcare-associated infections (HAIs) with robust CDI, coding practice
By Brian Murphy In 2015, 1 in 31 hospital inpatients developed a healthcare-associated infection (HAI) according to a recently released AHRQ report. These include but are not limited to: Central line-associated bloodstream infections (CLABSI) Catheter associated urinary tract infections (CAUTI) Ventilator-associated pneumonia (VAP) Non-ventilator hospital-acquired pneumonia (NVHAP) Surgical site infections (SSI) MRSA and…
Read MoreWatch for these common patterns of error in physician E/M leveling
By Joanne Wilson, RN, ADN, CCDS, Senior Director, Solutions Challenges with accurate E/M level code assignments remain a persistent problem for providers. In my recent experience auditing across various specialties including behavioral health, critical care, internal medicine, and gastroenterology, I’ve found some consistent patterns emerge and am sharing with you. Key observations: …
Read MoreRemote patient monitoring opens up new opportunities for CHF diagnosis, CDI query
By Brian Murphy I have my moments of technophobia, but other days feel rather optimistic. As I am for example with remote patient monitoring (RPM). Patients spend 99% of their time out of the hospital, which makes it very difficult to ensure medication or diet adherence, monitoring of vital signs, etc. The result…
Read MoreCoded data alone cannot tell the story—human interpretation a must
By Brian Murphy A recent study blaming upcoding as the cause of high acuity DRG reporting has me thinking about data more broadly—and its limitations. A few weeks ago Health Affairs recapped a study in which researchers, using all-payer discharge-level data from five states, claimed that “upcoding” was the cause of a 41%…
Read MoreEase the transition from V24 to V28 by knowing ICD-10-CM codes that map to CMS-HCCs
By Brian Murphy CMS document provides comprehensive list of HCCs in V28 The ongoing transition from CMS-HCC Version 24 (V24) to V28 has introduced several notable ICD-10-CM codes that now map to HCCs. These are available in an excel file on the CMS website. I thought I’d share a few that stand…
Read MoreThe work of mid-revenue professionals always comes down to values and character
By Brian Murphy A reminder that in the end it really is all about values and character. And taking responsibility for your actions. This is admittedly an easy concept to grasp, easy to write on a low-key Wednesday morning. But can be extraordinarily difficult to implement in practice, when the heat is on and pressure…
Read MoreUHC’s medical loss ratio an eye-opening reminder of impact of V28 of CMS-HCCs—for payers and providers
By Jason Jobes, VP of Solutions You want to read something scary? UHC said their 2024 full year medical loss ratio (MLR) was 85.5% compared to 83.2% in 2023. That 2.3 percentage point increase is nearly the same percent as the V28 impact in 2024. For those who have been following me over…
Read MoreNew sepsis aftercare code fills needed gap in long term care rendered to recovering patients
By Brian Murphy A reminder that we now have access to a new ICD-10-CM code for sepsis aftercare. Effective October 1, 2024, coders can report Z51.A: Encounter for Sepsis Aftercare. Z51.A was long in the making, needed to fill a gap in post-sepsis care. Sepsis is nasty and can result in long-term…
Read MoreExperts pitch obesity diagnosis overhaul, could alter CDI and coding work
By Brian Murphy There’s a new international effort afoot to revise the way physicians diagnose obesity. A clinical study published in The Lancet Diabetes & Endocrinology Journal, “Definition and Diagnostic Criteria of Clinical Obesity,” posits that obesity should be more than just high BMI, and recommends other measures including waist circumference, direct fat…
Read MoreCommit to trying new things (even just one) in 2025
By Brian Murphy Happy New Year! What resolutions are you hoping to implement in 2025? If you’re looking for some inspiration and ideas I recommend listening to my current episode of Off the Record (see link below). I take the top five lessons culled from a great lineup of guests and share them…
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