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Tag Archives: Christmas

Twelve Codes of Christmas: On the Seventh Day of the Coder’s Christmas (F40.00)

I have decided to start limiting my daily news intake to no more than 30 minutes per day.  This is mainly because the news has been so depressing lately and although I think it’s important to be informed, I think there comes a point when you just have to tune out before you decide to never leave your house again. 

I was looking through some old photos recently  and came across this old one of my dog Ginger.  Ginger is no longer with us, but I still have some great pics of her sweet little face.  This one struck me not only because of her expression, but also because of the bows.  No, I didn’t put bows in my dog’s ears on a regular basis.  I would take her to the groomer before the holidays and she always came back looking frilly and cute – with bows. It was always a test to see how long those bows would last before she shook her head enough or tried to pull them out with her paws.  Taking Ginger to the groomer was an event.  She was okay as long as we got in the car and headed north, because that meant she was on her way to see my parents and her favorite person – Grandpa.  But if we headed west, there were only two options: the vet and the groomer.  She wasn’t a fan of either.

So for the seventh day of Christmas, I dug out this picture of my Christmas pup for our daily carol and code:

  • I Heard the Bells on Christmas Day but Wouldn’t Leave my House (F40.00, Agoraphobia, unspecified).

Incidentally, Ginger was always up for leaving the house on Christmas if food was being carted to the car.  She always expected that once the food was packed up, she would be leashed up and we would join the party at a family member’s house!
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Twelve Codes of Christmas: On the Eighth Day of the Coder’s Christmas (F40.10)

What is Christmas – or any holiday celebration – like for you?  Is is a small intimate affair or is it a madhouse?  Do you get along with your family, or do you leave the celebration giving thanks for the fact that you didn’t choke anyone to death for another year?

I am blessed with a large and happy family.  A very loud and rambunctious group.  Our holiday traditions have undergone some adaptations over the years, but there are a few constants:  there will be lots of food; there will be many goofy white elephant gifts; and there most likely will be a pet or two present.

In case you can’t tell, I’m a bit of an animal lover.  And while looking through pictures to match my 12 Days of Codes, I found this gem.  This is Beau, my aunt’s cat.  And while I have a cat who is really more like a dog and can be found in the mix during family get togethers (and probably looking for a stationary lap to dominate), Beau has a tendency to do a cursory survey of the situation before retiring elsewhere.

So Beau, this carol and code are for you:

  • Have Yourself a Merry Little Christmas While I Sit Here and Hyperventilate (F40.10, Social phobia, unspecified)

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Twelve Codes of Christmas: On the Ninth Day of the Coder’s Christmas (F90.0)

Today is my last work day before Christmas.

I have Christmas baking to do.

I have shopping to do for Christmas dinner.

I can’t wait to see family – both those from in town and from out of town.

Don’t you love this time of year?

Don’t you feel like a little kid again as the clock ticks down to 5:00?

Maybe I’ll get off early today.

I wonder if it will snow.

Is that a squirrel sitting in a tree and staring in at me?

How do I get myself to focus on work today?!

Today’s carol and code?  Maybe you’ve already guessed:

  • We Wish You… Hey Look!  It’s Snowing!! (F90.0, Attention-deficit hyperactivity disorder, predominantly inattentive type)

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Twelve Codes of Christmas: On the Tenth Day of the Coder’s Christmas (Y93.G3)

Today is baking day.  I haven’t had a lot of time in the last few years to do any holiday baking, but I decided to take a day to get some goodies baked up for “dessert” on Christmas Day.  We’ll see how many of these cookies make it all the way until Tuesday.

There will be my mom’s famous cut-out cookies, which are now my famous cut-out cookies – the recipe having been stolen by a homemaker friend with a passion for decorating cookies.  The true secret to the cookies is to roll them out using confectioners sugar instead of flour (diabetics beware!). 

There will be molasses cookies from a family gingersnap recipe.  What makes them molasses cookies instead of gingersnaps, is an airtight container and a slice or two of fresh bread.  The cookies absorb the moisture from the bread leaving a super soft and spicy treat. 

There will be Mexican wedding cookies.  But we never called them that growing up – we called them Grandmother Stanton’s horseshoe cookies for their shape and the fact that I had never had this cookie anywhere else before.

And there will be oven mitts.  Lots of oven mitts. I’ve been a baker since I was a little girl – my mom and I used to bake around Christmas time and by the time I was a teenager, the job was all mine.  And even though I am no stranger to cooking or baking and I know my way around a kitchen pretty well, I burn myself at least once or twice a year while taking something out of the oven.  It’s so bad, my boyfriend has quipped that he’s going to get me welding gloves for Christmas. 

So today I’m going off script and taking a break from the Christmas Carols for the Psychologically Challenged to bring you this occasion-appropriate activity code:

  • Y93.G3, Activity, cooking and baking

If you are tackling this same task today, be sure to watch out for those hot ovens!
Coder Coach

All I Want for Christmas is Fewer RAC Denials

This December, coders across the country got the ultimate Christmas present: a bill passed the House and Senate without the addition of language that would further delay ICD-10 implementation.  As we breathe a sigh of relief and get ready for a worry-free Christmas (at least as far as coding is concerned), we aren’t fully exhaling until the end of March when the SGR bill comes up again for a vote.

But how many people are aware that there is another type of legislation at work that could cut down on the number of RAC denials we get?  Sounds almost too good to be true, doesn’t it?  While the legislation is real, it’s in very draft form right now.  Unfortunately, from where I sit, it also seems to be flying very low under the radar among my peers and I think it deserves some attention.
First of all, if you are not yet familiar with RACs, those are the Recovery Audit Contractors hired by Medicare to recoup improper payments to hospitals and physicians and return that money – with penalties – to the Medicare program.  The idea is great – run all the claims data through proprietary software and analyze it to see what looks weird.  This can be anything from improperly coded claims to admitting a patient to the hospital for a short stay rather than treating them as an outpatient.  Side note: contrary to what a lot of Medicare patients are told, hospitals do not get paid more for outpatient claims; they actually get paid less.  Medicare patients pay more out of pocket for hospital outpatient services and in most cases, hospitals get paid less than if patients were inpatient.  But if hospitals admit patients who could be treated as outpatients for short stays, they can have to pay the money back plus RAC penalties.
There are two types of RAC audits: automated and complex.  Automated reviews can be identified just by looking at data without reviewing the medical record.  Complex reviews require review of the medical record (e.g., for coding errors).  But the RACs don’t have the final say; there is a rather lengthy appeals process that providers can – and should – take advantage of because several RAC denials have been overturned.  The problem is, there are about eight levels of appeals that end with the administrative law judge and currently there is a backlog of appeals at the administrative law judge level.
Enter the Hospital Improvements for Payment (HIP) act of 2014 (don’t you just love that so many healthcare laws start with “hip?!”).  This is a draft proposal aimed at reducing RAC audit backlogs by creating a new Hospital Prospective Payment System (HPPS) for Medicare short stays (less than 3 days length of stay), including observation services.  In short, it calls for the following;
  • Creation of the new HPPS by the year 2020
  • Creation of an alternate reimbursement system for short stays from fiscal year 2016 to fiscal year 2019 as data is gathered for the 2020 system
  • Elimination of RAC reviews for short hospital stays until HPPS is implemented
By now, there may be a lot of people jumping up and down with joy, but of course there is a catch.  The proposal calls for dual submission of claims by hospitals in fiscal year 2016 in order to establish payments.  This means that hospitals would have to submit both ICD-10-PCS and CPT codes for short hospital stays for 2016.  Yes, the proposal assumes that we will be coding ICD-10-PCS in fiscal year 2016, which incidentally, begins on October 1, 2015.  The proposal would also implement an ICD-10-PCS to CPT crosswalk.  If the dual coding of claims didn’t make you nervous, the crosswalk should.  I’ve never met a crosswalk I trusted.  Let’s face it, if one coding system easily crosswalked to another, then we wouldn’t need two different coding systems, would we?  I can see lots of operational challenges starting with the productivity dive that would surely occur and ending with training challenges since it’s getting harder to find inpatient coders who code CPT and many facilities have decided not to train their outpatient coders in ICD-10-PCS.
Read All About It
This is just a small snipit of what HIP is about, but I encourage you to read up on it yourself, starting with information from the House Committee on Ways and Means and checking out the industry commentary to see where you stand.  Here are some links you should check out:
Let Your Voice be Heard

For more information from the House Ways and Means Committee, including information on submitting comments, click here.  This proposal has the potential to rock the world of hospital reimbursement (again) and has some definite pros and cons.  While it’s still only a draft and is not a done deal, it’s time to take the opportunity to let our voices be heard and submit comments.

Coder Coach

Twelve Codes of Christmas: On the Tenth Day of the Coder’s Christmas (Y93.G3)

Today is baking day.  I haven’t had a lot of time in the last few years to do any holiday baking, but I decided to take a day to get some goodies baked up for “dessert” on Christmas Day.  We’ll see how many of these cookies make it all the way until Tuesday.

There will be my mom’s famous cut-out cookies, which are now my famous cut-out cookies – the recipe having been stolen by a homemaker friend with a passion for decorating cookies.  The true secret to the cookies is to roll them out using confectioners sugar instead of flour (diabetics beware!). 

There will be molasses cookies from a family gingersnap recipe.  What makes them molasses cookies instead of gingersnaps, is an airtight container and a slice or two of fresh bread.  The cookies absorb the moisture from the bread leaving a super soft and spicy treat. 

There will be Mexican wedding cookies.  But we never called them that growing up – we called them Grandmother Stanton’s horseshoe cookies for their shape and the fact that I had never had this cookie anywhere else before.

And there will be oven mitts.  Lots of oven mitts. I’ve been a baker since I was a little girl – my mom and I used to bake around Christmas time and by the time I was a teenager, the job was all mine.  And even though I am no stranger to cooking or baking and I know my way around a kitchen pretty well, I burn myself at least once or twice a year while taking something out of the oven.  It’s so bad, my boyfriend has quipped that he’s going to get me welding gloves for Christmas. 

So today I’m going off script and taking a break from the Christmas Carols for the Psychologically Challenged to bring you this occasion-appropriate activity code:

  • Y93.G3, Activity, cooking and baking

If you are tackling this same task today, be sure to watch out for those hot ovens!
Coder Coach

Twelve Codes of Christmas:On the Eleventh Day of the Coder’s Christmas (F60.2)

Yep. You guessed it.  Another animal picture.  This is the last one, though.  I think.

Pets are better than TV and in since the news is so depressing lately, I highly suggest turning the tube off and tuning in to the closest animal.  It’s even better when you have a camera.

This little picture was captured one Christmas when I was snapping pictures of my Christmas decorations – something I often do to either remember how I decorated or to keep a record of Christmases past since I have a tendency to change decor colors every couple of years.  Yes, I’m one of those.  But I think I’ve already mentioned my affinity for Christmas decorations.

This is a picture of my sweet kitty, Mandy, pondering pouncing on Ginger, the dog.  Ginger was raised by cats and actually liked cats better than dogs.  So the cats pretty much had the rule of the roost and there wasn’t a lot Ginger ever did about it.  But this picture looks a little sinister, so here’s our carol and code for this eleventh day of the coder’s Christmas:

  • Thoughts of Roasting You on an Open Fire (F60.2, Antisocial personality disorder)

Coder Coach

Twelve Codes of Christmas: On the Twelfth Day of the Coder’s Christmas (F42)

Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells!!!

  • F42, Obsessive-compulsive disorder

Happy Holidays!!!
Coder Coach