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jackson1

  1. Exclamation jackson1
    Medical Coding Books
    Medicare in-patient hospital ICD-9 codes are supposedly how payments are based and helps determine if the level of service is appropriate and the more specifity the more they will pay. Ex. Hypertension 401.9 vs 401.1, 401.0. Can anyone validate that the more specific an ICD-9 code is the more Medicare pays? Need help convincing manager/doctors

  2. #2
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    This may not be exactly what you are looking for but it reviews how ICD can increase payments. CMS site may have others that you can utilize.



    http://www.cms.hhs.gov/QuarterlyProv...s/cms1540p.pdf

  3. #3
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    Also, you may want to direct them to the ICD-9 coding guidelines in your book as it states there that we, as coders, are supposed to code to the most specific code for the condition documented. The providers should know this and it is their job to document it as such for the coders, we are not allowed to "lead" them in any way, but make sure to make them aware that coding higher just to get paid more is not good practice and fraud can be a very fine line so staying within the guidelines should be easy enough for them. It's all in their documentation. Good luck!

  4. #4
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    hosp inpateint is paid based on DRG. The diagnosis determines which DRG is utilized. One DRG can contain many dx codes. Also certain combinations of codes can determined the DRG, a CC can place a patient into a higher DRG for the same principle dx as a lower DRG. If you are going to be in the UR area for inpatient it is good to know the ins and outs of DRGs.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    Wow, well put, Deb! I code for a critical access hospital so our inpatient coding is way different then everyone elses.

    Jackson1, Deb is truly one of the best resources that I have come across in this entire forum so I would completely listen to and trust whatever advice that you get from her.

    Deb...I am not sucking up...haha(maybe a little)....just stating my experiences with you to date for someone that may be new to this site

  6. #6
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    Columbia, MO
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    Thanks Leslie now I am blushing! I hope you have had a great holiday so far. It is snowing here....again!

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    Too cold here to snow, 30 below with the windchill..bbrrrrr!

  8. #8
    Location
    Columbia, MO
    Posts
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    You Win!

    Debra A. Mitchell, MSPH, CPC-H

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  1. jackson1
    By jackson1 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 12-29-2009, 08:20 PM

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