Search results for "Clinical Documentation"
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Sort by: Relevance | Newest | OldestNurses turn evidence into action
A care management department at Mercy Medical Center in Cedar Rapids, Iowa, helps incorporate new evidence and guidelines into daily practice.
https://acphospitalist.acponline.org/archives/2011/10/success.htm
15 Oct 2011
Documenting and billing for critical care services
To avoid rejection of critical care codes, physicians must be familiar with coding definitions, and documentation must reflect the professional services that support the codes.
https://acphospitalist.acponline.org/archives/2010/03/coding.htm
15 Mar 2010
Documenting adverse drug reactions and poisonings
Adverse effects of a correctly administered drug or drugs must be coded and reported differently than the misuse of a drug, which is classified as “poisoning” in ICD-9-CM coding.
https://acphospitalist.acponline.org/archives/2010/01/coding.htm
15 Jan 2010
Walking the tightrope of medical necessity
Our columnist discusses key elements of deciding the appropriate level of care for a given patient (inpatient versus outpatient or outpatient with observation).
https://acphospitalist.acponline.org/archives/2009/12/coding.htm
15 Dec 2009
Using observation services
Hospitals often struggle to achieve compliance with CMS regulations for determining whether a patient should be classified as an inpatient or an outpatient with observation services.
https://acphospitalist.acponline.org/archives/2009/11/coding.htm
15 Nov 2009
CMS updates payments, quality measures for 2010
October 1 is an important time to evaluate coding changes because it's when CMS’ annual update to the inpatient prospective payment system (MS-DRGs) takes effect.
https://acphospitalist.acponline.org/archives/2009/10/coding.htm
15 Oct 2009
Accurate coding for transfer to post-discharge facilities
Accurate ICD-9-CM codes for diagnoses and procedures performed during a hospital stay will only partially determine payment. Discharge status codes must be given equal attention.
https://acphospitalist.acponline.org/archives/2009/09/coding.htm
15 Sep 2009
Accurate coding improves payments, quality ratings
Accurate coding has a significant impact not only on a hospital or practice’s finances but also on quality ratings, as Medicare’s new coding system increasingly is being used to profile hospitals and physicians.
https://acphospitalist.acponline.org/archives/2009/07/documentation.htm
15 Jul 2009
Coding cardiac conditions: Beyond acute coronary syndrome
Acute coronary syndrome is a very popular diagnosis frequently documented when a patient presents to the hospital with chest pain thought to be cardiac in origin. For accurate coding, physicians should document unstable angina or acute myocardial infarction.
https://acphospitalist.acponline.org/archives/2009/07/coding.htm
15 Jul 2009
acp-hosp0907
billing and clinical documentation improvement consultation for. hospitals throughout the U.S., including the state of New York’s. ... When cardiac biomarkers. are. elevated in the absence of clinical. evidence of ischemia, the provider.
https://acphospitalist.acponline.org/archives/2009/07/acph-200907-coding_t1.pdf
14 Jul 2009