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Tag Archives: List

An HIM director’s holiday wish list

By Dom Nicastro
 
The last month of the year can be a bit stressful. Closing out the books on the prior year. Making sure you leave time for all the holiday get-togethers. The traffic. The lines. The people.
 
It adds up.
 
If you’re an HIM director, it can be hectic in your healthcare facility, too. Not that it’s smooth sailing the first 11 months of the year.
 
Either way, you deserve a few treats yourself this holiday season. Make a few wishes, and who knows?
In fact, we gave an HIM director just that – the platform to make a few wishes this holiday season.
 
So, the floor is yours, Marianne Durling, MHA, RHIA, CDIP, CCS, CPC, CIC, director of Health Information Management and privacy officer at Granville Health System in Oxford, North Carolina. What do you wish for?
 
I wish contract companies would quit poaching my coders.
Most contract companies allow remote work. They pay more than small, county-owned facilities like Durling’s can afford, she says.
 
“Most coders soon find out it isn’t what they expected and the work isn’t always guaranteed, but by then their job has been filled,” Durling adds. “As a manager, I feel bad when I can’t let an employee come back. Some also limit the notification time they will allow staff to give, which can make them ineligible for rehire.”
 
I wish I could implement a full CDI program.
What are the struggles here for HIM directors? What gets in the way of realizing a full program, and what can HIM directors do in light of not being able to have a full program? First, you must decide where CDI fits into your organization’s tree. Does it come under HIM and its coders or does it come under the revenue cycle and work with the utilization review/case management team?
 
“If leaders can’t agree on this aspect then they can’t agree on how to champion for the position,” Durling says. “I think CFOs don’t understand the role and the benefit to the organization and thus won’t approve the necessary funding for an experienced CDI specialist. Since this role is new, I see a lot of leaders making due with coders or clinical staff minimally trained in coding, which means you may be missing some important skills.”
 
I wish the CMS website was more user friendly.
Use professional organization websites and references relative to what you are reviewing, Durling says. When CMS releases a new regulation that will impact family practice physicians, wait a few days or a week then check the American Academy of Family Physicians website.
 
“They get their experts to review the new rulings and regulations,” Durling says, “and then they boil it down in terms that their members can understand and apply to daily practice. This usually works for any specialty. I also find that state Medicaid websites and some [Medicare Administrative Contractor] sites have more user-friendly search features to find what you need than the CMS website.”
 
I wish my staff knew how hard I champion for them with administration.
A good leader needs to spend their time educating the C-suite on what their department does and how it impacts the organization and community. Durling takes this seriously.
 
“While we all know HIM is responsible for producing the claims that brings in the money we are widely considered a non-revenue producing department,” she says. “I’ve worked to find ways to be innovative to cut costs and actually bring in some revenue. By doing this, it keeps HIM in the eye of the administration, and they can see the importance we play in all aspects of the daily operations and how we can be a valued community partner.”
 
I wish payers reimbursed more realistically so our salaries could be more competitive.
Coder salaries are often not truly competitive, and managers can be underpaid–and even overpaid at times. Some get lucky. They avoid the day-to-day operational work because they have other managers under them for each service area they supervise, while others are underpaid if they must do everything because they don’t have the same supervisors or managers.
 
“This is because smaller hospitals still have the same work requirements, but no funding to support extra staff,” Durling says. “If payers paid more realistically, I think it would greatly impact compliance and hospital care.”
 
I wish Santa would come and work for me a day!
“Since Dad is usually Santa, I think in our environment Santa would be the CEO,” Durling says. “I would have him do just what I do every day: on a day of back-to-back meetings, juggle a staff member calling out sick, and some ‘crisis’ from another hospital area, all while dealing with staff drama or conflict.” HIM can be the “forgotten department that everyone knows exists, but no one could tell you exactly what we do,” she says.
 
I wish more hiring managers thought outside the box when it comes to hiring coders instead of just focusing on the credentials.
What should hospitals focus on when hiring coders? Work experience, skills, and personality are far more important than focusing just on the credentials.
 
“I also think that some managers think one credential is better than another, when in reality you are going to train them to do things the way you want them to do it, regardless of their credentials,” Durling says. “I have been around since before coding credentials even existed and sometimes we forget that good policies, procedures, and training can allow anyone with some aptitude and a willingness to learn to be a great coder.”
 
Oftentimes, you’ll see a coder who has a long list of credentials who can’t do the day-to-day job. What does that tell Durling? Maybe they are good at taking tests or memorizing material, but not good at applying the material.
 
“I just think too many managers take the easy way out and think the credentials alone can allow them to find a successful coder, or because they had luck in the past with one type of credential they will only hire those with that same credential, which severely limits their pool of candidates,” she says. “Step outside your comfort zone and you may find a whole world of great employees you never saw before.”
 
I wish we could offer more services to help our patients be better stewards of their personal health information and healthcare in general.
Durling says she’d like to work with her marketing department to educate their community on the importance of accurate health information and why it’s important to protect that information. She would like to help educate local providers that are not fully complaint with HIPAA learn to be compliant, so everyone can provide the same protections. She’d liked to help create a database of verified patients where patients who don’t have any picture ID can be easily verified so they have alternative methods to service their needs and protect their information.
 
I wish I could pay my coders what I know they deserve.
Durling says her staff members multitask, but they are not being compensated for all those other duties.
“We lose good staff members to larger hospitals just because of the higher pay,” she says. “The other problem is location. Because we are rural, we have a smaller local pool of qualified candidates, which means that jobs are harder to fill. We also don’t have the ability to offer remote coding because the high cost of [electronic health record] integration causes us remain a hybrid record system with a lot of paper chart elements.”
 
Smaller hospitals struggle with a smaller candidate pool, broader job duties hybrid systems, and lower salaries.
 
“This is why so many small rural hospitals are merging with larger facilities or corporate healthcare agencies,” Durling says, “but if we lose that community attachment, will it truly benefit the community in the end?”
 
I wish I could win the lottery and afford to revamp and update my department like I want.
“I would do a major remodel to our work area to make it more user friendly for the way we work today, as well as upgrade equipment to reflect our changing tasks,” Durling says. “I would spend the necessary money to back scan all our old records and integrate all our service areas so we could truly be a fully electronic medical record.”
 
“I would also use some funding to create a group to champion for smaller, rural hospitals at the government level,” Durling adds.
 
I wish the hospital staff and community realized just how much HIM really does for the hospital, the community, and patients.
Often board members, like the hospital staff in general, don’t know exactly what HIM does.
 
“I would like to speak to them at each new board installation to talk about what we do and how we serve the facility, providers, and the community,” Durling says. “I would also wish to be able to talk to them about significant changes such as things like ICD-10, HIPAA, or even issues that impact our department such as identity theft. I normally don’t get asked to present to them on these types of topics, but I believe they need to know what to expect and the impact it will/could have on our facility and our community in order to make appropriate decisions moving forward.”

 

Email your questions to editor Steven Andrews at sandrews@hcpro.com.

HCPro.com – JustCoding News: Inpatient

2016 List of Not Otherwise Classified HCPCS Codes


A4335 Incontinence supply; miscellaneous

A4421 Ostomy supply; miscellaneous

A4641 Radiopharmaceutical, diagnostic, not otherwise classified

A4649 Surgical supply; miscellaneous

A4913 Miscellaneous dialysis supplies, not otherwise specified

A5507 For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

A6261 Wound filler, gel/paste, per fluid ounce, not otherwise specified

A6262 Wound filler, dry form, per gram, not otherwise specified

A6512 Compression burn garment, not otherwise classified

A6549 Gradient compression stocking/sleeve, not otherwise specified

A9152 Single vitamin/mineral/trace element, oral, per dose, not otherwise specified

A9153 Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified

A9279 Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified

A9280 Alert or alarm device, not otherwise classified

A9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml

A9580 Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries

A9698 Non-radioactive contrast imaging material, not otherwise classified, per study

A9699 Radiopharmaceutical, therapeutic, not otherwise classified

A9999 Miscellaneous dme supply or accessory, not otherwise specified

B9998 Noc for enteral supplies

B9999 Noc for parenteral supplies

C2698 Brachytherapy source, stranded, not otherwise specified, per source

C2699 Brachytherapy source, non-stranded, not otherwise specified, per source

E0446 Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories

E0625 Patient lift, bathroom or toilet, not otherwise classified

E0676 Intermittent limb compression device (includes all accessories), not otherwise specified

E0769 Electrical stimulation or electromagnetic wound treatment device, not otherwise classified

E0770 Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified

E1229 Wheelchair, pediatric size, not otherwise specified

E1239 Power wheelchair, pediatric size, not otherwise specified

E1399 Durable medical equipment, miscellaneous

E1699 Dialysis equipment, not otherwise specified

E2599 Accessory for speech generating device, not otherwise classified

G0235 Pet imaging, any site, not otherwise specified

G8701 Rehabilitation services were not ordered, reason not otherwise specified

G9055 Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project)

G9213 Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified

G9282 Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons)

G9283 Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation

G9284 Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation

G9288 Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons)

G9289 Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation

G9290 Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation

G9291 Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos

G9418 Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation

G9419 Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of primary non-small cell lung cancer or other documented medical reasons) 

G9421 Primary non-small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation

G9422 Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma and not nsclc-nos)

G9424 Specimen site other than anatomic location of lung or classified as nsclc-nos

G9425 Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma) 

G9611 Order for anti-platelet agents or p2y12 antagonists was not documented, reason not otherwise specified

H0046 Mental health services, not otherwise specified

H0047 Alcohol and/or other drug abuse services, not otherwise specified

J0220 Injection, alglucosidase alfa, 10 mg, not otherwise specified

J0256 Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg

J0833 Injection, cosyntropin, not otherwise specified, 0.25 mg

J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg

J7192 Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified

J7195 Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified

J7199 Hemophilia clotting factor, not otherwise classified

J7599 Immunosuppressive drug, not otherwise classified

J7699 Noc drugs, inhalation solution administered through dme

J7799 Noc drugs, other than inhalation drugs, administered through dme

J7999 Compounded drug, not otherwise classified

J8498 Antiemetic drug, rectal/suppository, not otherwise specified

J8499 Prescription drug, oral, non chemotherapeutic, nos

J8597 Antiemetic drug, oral, not otherwise specified

J8999 Prescription drug, oral, chemotherapeutic, nos

J9020 Injection, asparaginase, not otherwise specified, 10,000 units

J9999 Not otherwise classified, antineoplastic drugs

K0108 Wheelchair component or accessory, not otherwise specified

K0812 Power operated vehicle, not otherwise classified

K0898 Power wheelchair, not otherwise classified

L0999 Addition to spinal orthosis, not otherwise specified

L1499 Spinal orthosis, not otherwise specified

L2999 Lower extremity orthoses, not otherwise specified

L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified

L3999 Upper limb orthosis, not otherwise specified

L5999 Lower extremity prosthesis, not otherwise specified

L7499 Upper extremity prosthesis, not otherwise specified

L8039 Breast prosthesis, not otherwise specified

L8499 Unlisted procedure for miscellaneous prosthetic services

L8699 Prosthetic implant, not otherwise specified

Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)

Q2050 Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg

Q2051 Injection, zoledronic acid, not otherwise specified, 1mg

Q4050 Cast supplies, for unlisted types and materials of casts

Q4051 Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies)

Q4082 Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap)

Q4100 Skin substitute, not otherwise specified

Q5009 Hospice or home health care provided in place not otherwise specified (nos)

Q9977 Compounded drug, not otherwise classified

S0590 Integral lens service, miscellaneous services reported separately

S4015 Complete in vitro fertilization cycle, not otherwise specified, case rate

S5130 Homemaker service, nos; per 15 minutes

S5131 Homemaker service, nos; per diem

S5181 Home health respiratory therapy, nos, per diem

S5199 Personal care item, nos, each

S5497 Home infusion therapy, catheter care / maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem 

S8189 Tracheostomy supply, not otherwise classified

S8301 Infection control supplies, not otherwise specified

S9379 Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem 

S9445 Patient education, not otherwise classified, non-physician provider, individual, per session

S9446 Patient education, not otherwise classified, non-physician provider, group, per session

S9542 Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem 

S9810 Home therapy; professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour (do not use this code with any per diem code)

S9976 Lodging, per diem, not otherwise classified

S9977 Meals, per diem, not otherwise specified

T1505 Electronic medication compliance management device, includes all components and accessories, not otherwise classified

T1999 Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in “remarks”

T2025 Waiver services; not otherwise specified (nos)

T2028 Specialized supply, not otherwise specified, waiver

T2029 Specialized medical equipment, not otherwise specified, waiver

T2032 Residential care, not otherwise specified (nos), waiver; per month

T2033 Residential care, not otherwise specified (nos), waiver; per diem

T5999 Supply, not otherwise specified

V2199 Not otherwise classified, single vision lens

V2799 Vision item or service, miscellaneous

V5090 Dispensing fee, unspecified hearing aid

V5267 Hearing aid or assistive listening device/supplies/accessories, not otherwise specified

V5274 Assistive listening device, not otherwise specified

V5287 Assistive listening device, personal fm/dm receiver, not otherwise specified

V5298 Hearing aid, not otherwise classified

V5299 Hearing service, miscellaneous


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