If you are aware of any opportunities, please reach out.
Jenna Seidlitz, CPC
If you are aware of any opportunities, please reach out.
Jenna Seidlitz, CPC
Internal auditing strategies for ongoing ICD-10 success
Editor’s note: This article was modified from HCPro’s latest long-term care title, ICD-10 Compliance: Process Improvement and Maintenance for Long-Term Care, written by Maureen McCarthy, BS, RN, RAC-MT, and Kristin Breese, BSN, BSed, RN, RAC-MT. The complete book helps facilitate ongoing ICD-10 success by arming SNF readers with information and strategies that target the preparation, implementation, and maintenance phases of the fast-approaching coding transition. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com.
With the October 1 implementation date of ICD-10 now on a fast track to fruition?and no further delays in sight?even the most committed holdouts in the provider community have kicked off initiatives to ensure staff, outside business partners, and workflows can withstand the major coding transition.
To ensure that preparations made over the past months (or years) ultimately pay off, SNFs should start laying the groundwork for regular facility-wide audits of ICD-10 systems in the aftermath of implementation?a proactive approach that can help providers verify the strength of ongoing transition efforts and catch any snags before they disrupt essential facility processes.
Thus, although the word "audit" can provoke fear and anxiety in providers?often connoting scrutiny and penalties when administered by Medicare contractors?facilities can head off these unsavory external audits, or at the very least reduce negative outcomes, by conducting their own internal varieties.
In a broader sense, frequent self-audits can promote overall business vitality by facilitating the development and maintenance of sustainable processes across the facility, particularly in the face of the impending overhaul to coding methodology and practice.
The scope of self-audits
The Office of Inspector General (OIG) considers ongoing monitoring and evaluation important elements of a healthcare organization’s compliance program and identifies two overarching types of reviews:
1.Standards and procedures reviews, which measure whether internal standards are current and complete, or are in need of an update to reflect regulatory changes
2.Claims submission audits, which gauge whether coding, billing, and documentation are in compliance with payer and government contractors, as well as whether services performed are reasonable and support medical necessity
The OIG states that self-audits, which generally fall into the second category of reviews, can accomplish an array of verification processes. More specifically, the agency explains that these audits can be used to determine whether:
The baseline audit
SNFs should launch a baseline audit after the first three months of ICD-10 implementation. This initial evaluation will help providers identify areas that need improvement or education. To shape baseline (and subsequent) audits, facilities should consider the following list, which identifies key aspects of major operational areas the ICD-10 transition is likely to affect:
2.Coding/billing in the electronic health record system
Once SNFs have completed their baseline audits, they should analyze the outcomes to develop an auditing compliance plan, which can function as staffs’ blueprint for future documentation, coding, and billing.
The ICD-10 task force, or transition team, should appoint a post-ICD-10 committee to review initial implementation results, evaluate success against established criteria, and identify what works and doesn’t work, especially in the revenue cycle, health information management, and IT realms.
Prior to the October 1 kickoff, this committee should determine which measures will be tracked and collect related preliminary data.
Following the go-live date, this committee?and the facility at large?must be on the lookout for significant post-implementation issues, including claims denials and rejections or coding backlogs. The committee must quickly identify such issues, create feedback loops, and follow the established solution path to remediation?a task that’s best facilitated by routine auditing of both claims and supportive documentation in a patient’s medical record.
Facilities should track all ICD-10 submissions and receipts for 3?6 months after the transition. Quality assurance monitoring should focus on ensuring proper receipt of ICD-10 codes by vendors and payers. Providers should also be sure to address all communications from these sources, as well as trading partners and CMS.
Routine review of ICD-10 coding will soon become an essential function of all facilities’ quality monitoring systems and resulting performance improvement plans. Auditing documentation for sufficient data to support specificity in ICD-10 diagnosis coding should begin 2?3 months prior to the transition and continue well after October 1. Conducting ongoing auditing is crucial to update or solidify processes that underlie, facilitate, and support ICD-10 coding and claim submission, thereby ensuring a hassle-free conversion to the new system.
I am having a hard time finding a CPT code for this. Has anyone seen this done in the past?
1. Left foot hallux abductovalgus deformity.
2. Left fifth digit adductovarus hammertoe deformity.
3. Left first metatarsophalangeal joint gouty tophi.
1. Left foot Austin bunionectomy with screw fixation and
2. Left fifth digit skin plasty for adductovarus deformity
3. Left first metatarsophalangeal joint excision of gouty
PATHOLOGY: Left first MPJ gouty tophi.
ANESTHESIA: MAC sedation with IV anesthetic of 1% lidocaine
plain, 20 mL.
MATERIALS: Stryker 3.0 headed screw, 2-0 Vicryl, 3-0 Vicryl, and
INJECTABLES: 1 mL of dexamethasone given postoperatively as
well as 10 mL of 0.5% Marcaine plain.
TECHNIQUE: The patient presented to the preoperative holding area having been n.p.o. past midnight. All preoperative studies were reviewed and discussed with the patient as well as the risks and benefits. The patient wished to proceed with the proposed procedure. The left lower extremity was marked with indelible ink. The patient received preoperative IV antibiotic of 2 g Ancef.
The patient was then transported to the operating room and placed on the operating room table in supine position. Following this, a time-out was then called between myself, anesthesiologist, surgical nurse, and surgical tech about the procedure to be performed as well as the location of the procedure. All were in agreement. Following IV sedation, the left pneumatic ankle tourniquet was then placed to a well padded area above the ankle joint. A Mayo block was then performed over the left first ray as well as reverse Mayo block for the fifth digit. The foot was then scrubbed, prepped and draped in the usual aseptic manner.
Attention was then directed to the left foot hallux abductovalgus deformity. An incision was made medial to the extensor hallucis longus tendon, contouring this to the deformity itself. The incision was then brought through skin into the subcutaneous tissue. Care was taken to retract any neurovascular structures. Upon doing so, a linear capsulotomy was then performed over the left first metatarsophalangeal joint. The head was then fully exposed and noted to have 1 x 1 cm gouty tophi medial to the metatarsophalangeal joint. This was resected in total and separate from the surrounding bone and soft tissue. The specimen was then passed from the operative field and sent to Pathology for further analysis. Attention was then directed back to the incision site within the left first interspace. The adductor conjoined tendon was then released. Attention was then directed
back to the left metatarsal head. The medial eminence was then slightly dissected to create a flat surface. After this, an Austin bunionectomy was then performed with a sagittal saw with a through-and-through cut through the head of the metatarsal with dorsal arm slightly longer. The capital fragment was then shifted laterally and temporarily fixated with a K-wire from the Stryker screw set. Under fluoroscopic guidance it was noted to be in excellent alignment. A Stryker 3.0 screw was then placed through the cannulated wire into the area under Stryker manufacturer guidelines. Noted in excellent compression and alignment well stable. K-wire was then removed. Further medial eminence was then resected as such to create a smooth surface as well as a barrel bur to smooth out any rough edges. The capsulotomy was then sutured closed with 2-0 Vicryl, but upon doing so it was decided to do a medial capsulorrhaphy to help bring the hallux in a more corrected position, thus a wedge capsulorrhaphy was then removed from the medial side of the left first metatarsophalangeal joint and was sutured/tightened closed, noting the hallux in a more corrective alignment. The rest of the capsule was then closed with 2-0 Vicryl. A wet sponge was then placed in the area.
Attention was then directed to the left fifth digit, where an adductovarus hammertoe deformity was noted. Upon mapping out the skin edges, a semi-elliptical incision was made about the proximal interphalangeal joint. By doing so, a wedge of skin was removed, and by holding the 2 skin edges together it was noted to bring the toe itself in a more corrective rectus position. Thus the area was sutured closed with 4-0 nylon.
All areas were then reevaluated under fluoroscopic guidance and noted to be in excellent alignment. Attention was then directed back to the left first metatarsophalangeal joint of the hallux abductovalgus deformity. A running subcuticular stitch with 3-0 Vicryl was then performed. Mastisol was placed about the area. Steri-Strips were then placed around the skin edges to help keep closure. One mL of dexamethasone as well as 10 mL of 0.5% Marcaine plain was then injected about the region. Areas were then dressed with Betadine-soaked Adaptic, 4 x 4’s, gauze and Kling. Tourniquet was then deflated and immediate hyperemia returned to all digits of the left foot. The left foot was then placed in a slipper cast for added protection. The patient was then transferred to the postoperative holding area with vital
signs intact as well as vascular structures intact to the left foot.
I am in search of a CPT (if one exists) that would be suitable to use for the application of a cryotherapy device for the following reasons:
Improve recovery time after intense activity or exercise
Increase energy and metabolism
Decrease inflammation in the body (arthritis and other chronic pain conditions etc.)
Faster recovery post-surgery – combined with physical therapy
Increase range of motion
The unit being used is made by cryousasolutions
I’ve searched via google and bing trying to find a CPT…I myself am leaning towards 97010 as the only option but upper management believes that there may be another applicable code so that we may receive reimbursement. We are not a DME vendor (so no HCPCS).
I think the cryotherapy devices for PT services, unfortunately, fall under the cold pack therapy which most insurance carriers will not pay.
Any feedback will be helpful.