FY10 CMS IPPS Update. Audio Seminar/Webinar. Practical Tools for Seminar Learning. September 15, 2009

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1 Audio Seminar/Webinar September 15, 2009 Practical Tools for Seminar Learning Copyright 2009 American Health Information Management Association. All rights reserved.

2 Disclaimer The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments. AHIMA 2009 Audio Seminar Series American Health Information Management Association 233 N. Michigan Ave., 21 st Floor, Chicago, Illinois i

3 Faculty Christina Benjamin, MA, RHIA, CCS, CCS-P Christina Benjamin, MA, RHIA, CCS, CCS-P, is an independent consultant and inpatient coder who provides specialized education and tools for inpatient coding, MS-DRGs, and documentation improvement and related concepts. Ms. Benjamin also hosts webinars and is a regular contributor to a coding newsletter. As an educator, she serves many entities by providing online instruction and developing or editing inpatient coding education programs. Kathleen Myrick, RHIT, CCS Kathleen Myrick, RHIT, CCS, is a senior technical business analyst for QuadraMed Corporation, where she develops HIM content software for coding and compliance products and services. Ms. Myrick has over 24 years of coding experience in a variety of capacities. She is also an HIM educational presenter and author, teaching coding at San Diego Mesa Community College. AHIMA 2009 Audio Seminar Series ii

4 Table of Contents Disclaimer... i Faculty... ii Objectives... 1 FY2010 MS-DRGs... 1 MDC 8 MS-DRG Code Reassignment... 2 MS-DRG Reassignmnet for Procedures & MDC 5 Diseases and Disorders of the Circulatory System... 3 Post-Acute Transfer Policy Complication & Comorbidity... 4 MCC Changes for FY Case Study Featuring New MCC Case Study Coding... 6 Case Study Featuring New MCC with MS-DRG Attributes... 7 CC Changes for FY Case Study Featuring CC Case Study Coding... 9 Case Study Featuring CC with MS-DRG Attributes CC Exclusions 5 Principles FY 2010 CC Excludes Relative Weight Tranistion Payment Rate & Wage Index DRG Relative Weight Most Remarkable MS-DRG Rate Decreases New Technology Add-on Payment New Technology Add-on Payment: CardioWest CardioWest Reimbursement New Technology Add-on Payment: Spiration IBV Valve System Spiration IBV Reimbursement New Technology Not Approved Applications Withdrawn Present on Admission Hospital Acquired Conditions Case Study: POA/HAC Example with Torus Fracture POA/HAC: Acute Ischemic Stroke w/use of Thrombolytic Agent Continuing HAC List for FY Case Study: POA/HAC Example with Acute Pulmonary Embolism POA/HAC: Major Joint Replace/Reattach Lower Extremity All HACs for FY 2009 Rolled Over to FY Medicare Code Editor (MCE) MCEs MCE Corrections for FY AHIMA 2009 Audio Seminar Series (CONTINUED)

5 Table of Contents New MCE! Wrong Procedure Performed Reportable Never Events OIG 3 Serious Reportable Events HACs versus Wrong Procedure Performed Documentation & Coding Adjustment American Reinvestment & Recovery Act Provisions Value Based Purchasing Add 15 New Quality Measures Minus 1 Quality Measure Now Totals to New measures w/financial Implications FY Charge Compression Cost Centers for Devices Other Regulatory Issues Resource/Reference List Thank You Audio Seminar Discussion Become an AHIMA Member Today! Audio Seminar Information Online Upcoming Audio Seminars Thank You/Evaluation Form and CE Certificate (Web Address) Appendix Resource/Reference List CE Certificate Instructions AHIMA 2009 Audio Seminar Series

6 Objectives Provide an overview of FY 2010 IPPS Final Rule Identify MS-DRG changes Understand Post-Acute Care Transfer Policy List MCC and CC changes Explain new Medicare Code Edit Identify Add-on Payments Review POA & HAC regulations Describe Quality Measures changes 1 FY 2010 MS-DRGs No new MS-DRGs No deleted MS-DRGs No change in MS-DRG descriptions Request for MS-DRG changes for consideration for FY 2011 IPPS Proposed Rule must be sent to CMS by December AHIMA 2009 Audio Seminar Series 1

7 MDC 8 MS-DRG Code Reassignment Arthrotomy for removal of prosthesis w/o replacement, hip From MS-DRGs to Arthrotomy for removal of prosthesis w/o replacement, knee From MS-DRGs to Rationale: clinically similar to cases of debridement for infection 3 MS-DRG Reassignment for Procedures & FY 2009 FY 2010 Hip & Femur Procedures Except Major Joint Local Excision & Removal Internal Fixation Device Except Hip & Femur Wound Debridement & Skin Graft Except Hand, for Musculo-Connective Tissue Disorder AHIMA 2009 Audio Seminar Series 2

8 MDC 5 Disease & Disorders of the Circulatory System Proposed but not finalized Intraoperative Fluorescence Vascular Angiography (IFVA) procedure (code 88.59) did not have supporting data to move the procedure from MS-DRGs 235/236 (CABG w/o Cath) to MS-DRGs 233/234 (CABG w/cath) for increase in payment for the technology 5 Post-Acute Transfer Policy Subject to policy: Rehabilitation Facilities Skilled Nursing Facilities Home Health Psychiatric transfers OIG/RAC investigating that the hospital discharge disposition is accurately reported so that the reimbursement calculation is correct and overpayment was not made! 6 AHIMA 2009 Audio Seminar Series 3

9 Post-Acute Transfer Policy FY MS-DRGs 273 post-acute MS-DRGs All severity levels of a DRG are subject to policy 24 out of the 273 special pay MS-DRGs are eligible for increased payment for the 1 st day 7 Complication & Comorbidity A condition that arises during the hospital episode of care A pre-existing condition that will, because of its presence with a specific diagnosis will require additional care, resources, and may extend the length of stay FY 2010 count MCCs 1,602 CCs 3,464 8 AHIMA 2009 Audio Seminar Series 4

10 MCC Changes for FY Tumor lysis syndrome Puerperal sepsis (670.22, ) Puerperal septic thrombophlebitis (670.32, ) Other major puerperal infection (670.80, , ) 9 MCC Changes for FY Omphalocele Gastroschisis Severe hypoxic-ischemic encephalopathy Deleted due to code expansion Bilious vomiting in newborn 10 AHIMA 2009 Audio Seminar Series 5

11 Case Study Featuring New MCC Patient is admitted for a high-dose chemo regime with a recurrence of non- Hodgkin s lymphoma. Two days after admission, the patient went into acute kidney failure. A central venous catheter was placed and hemodialysis treatment was given. Final work-up revealed the cause of the acute kidney failure to be tumor lysis syndrome due to chemotherapy. 11 Case Study Coding Select the answer from the following choices: a. V58.11, , 584.9, E933.1; 99.25, 38.95, b. V58.11, , 584.9, , E933.1; 99.25, 38.95, c. V58.11, , , E933.1; 99.25, 38.95, d , ; 99.25, 38.95, AHIMA 2009 Audio Seminar Series 6

12 Case Study Featuring New MCC with MS-DRG Attributes MS-DRG 846 Chemo w/o acute leukemia as secondary Dx w MCC PDX V Y MCC N MCC N E933.1 N MS-DRG Tiers 846 RW RW RW PR CC Changes for FY Chronic pulmonary embolism Chronic venous embolism and thrombosis (lower) Venous embolism and thrombosis of superficial vessels of lower extremity Chronic venous embolism and thrombosis (upper) Acute venous embolism and thrombosis (upper) Deleted due to code expansion 14 AHIMA 2009 Audio Seminar Series 7

13 CC Changes for FY Secondary neuroendocrine tumor Pouchitis Other complications of intestinal pouch Puerperal endometritis (670.10, , ) Puerperal sepsis (670.20) Puerperal septic thrombophlebitis (670.30) 15 CC Changes for FY Hypoxic-ischemic encephalopathy, unspecified Mild hypoxic-ischemic encephalopathy Moderate hypoxic-ischemic encephalopathy Torus fracture of ulna (alone) Torus fracture of radius & ulna 16 AHIMA 2009 Audio Seminar Series 8

14 Case Study Featuring CC Patient was admitted for ORIF of a closed left intertrochanteric femur fracture. He missed a step and fell down the stairs at his home. Other significant problems include morbid obesity with a BMI of 39.8, Type II diabetes, and hypertension. Following the ORIF, the patient developed an acute venous thrombus in the left popliteal vein. This thrombus was successfully excised. With no further complications, the patient was discharged to home. 17 Case Study Coding Select the answer from the following choices: a , , V85.39, , 401.9; b , , V85.39, , 401.9, , E880.9, E849.0; 79.35, c , , , 401.9, , E880.9, E849.0; d , , V85.39, , 401.9, , E880.9, E849.0; 79.35, AHIMA 2009 Audio Seminar Series 9

15 Case Study Featuring CC with MS-DRG Attributes MS-DRG 481 Hip and femur procedure except major joint w CC PDX Y Y V85.39 Y Y Y CC N E880.9 Y E PR MS-DRG Tiers 480 RW RW RW CC Exclusions 5 Principles Secondary diagnoses are not considered MCC/CC for the principal diagnosis when: 1. Chronic & acute manifestations are of the same condition 2. Specific & nonspecific diagnosis codes are of the same condition 3. Codes for the same condition that cannot logically coexist 4. Codes for the same condition that are in anatomically proximal sites 5. Closely related conditions 20 AHIMA 2009 Audio Seminar Series 10

16 FY 2010 CC Excludes Example of a closely related condition: New MCC, Tumor lysis syndrome is closely related to MCC codes Acute kidney failure When either or are assigned as principal diagnoses the addition of the syndrome or the acute kidney failure will not be considered a MCC for MS-DRG grouping 21 FY 2010 CC Excludes An example of chronic and acute manifestations of the same condition: New CC, Acute venous embolism and thrombosis of deep veins of upper extremity is an acute manifestation of the same condition new CC Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity. The same condition is the venous embolism and thrombosis which do not necessarily need to be of the same vessel and therefore will not be considered a CC for either PDX code. 22 AHIMA 2009 Audio Seminar Series 11

17 Relative Weight Transition 2-year transition to coincide with transition to cost-based RW FY blend of DRG and MS- DRG relative weight plus 2/3 cost-based with 1/3 charge-based RW FY % cost-based & 100% MS- DRG relative weight FY 2010 complete transition POA indicator resets to Y to calculate the RW to reflect the true costs 23 Payment Rate & Wage Index Final rates/indexes List of hospitals by provider # that received a special/reclassified wage index in table 9A (page of Final Rule) Tip: calculate/verify your expected payments to see if your MAC/FI is providing the correct new payments Outlier threshold FY10 $23,140 increased from FY09 $20,045 It is now more difficult to obtain an outlier payment 24 AHIMA 2009 Audio Seminar Series 12

18 DRG Relative Weight The average charge for each DRG recomputed (excluding statistical outliers) and divided by the national average standardized charge per case to determine the relative weight Recalculated and adjusted annually to account for changes in resource consumption 25 Most Remarkable MS-DRG Rate Decreases MS-DRG FY09 Final Rule Post- Acute DRG FY09 Final Rule Special Pay DRG TYPE Long MS-DRG Description Weights FY09 Weights FY10 Payment Change % Payment Change 423 No No SURG Other hepatobiliary or pancreas O.R. procedures w MCC Yes No SURG Cardiac valve & other major cardiothoracic procedures w cardiac cath w CC AHIMA 2009 Audio Seminar Series 13

19 Most Remarkable MS-DRG Rate Decreases MS-DRG FY09 FY09 Final Final Rule Post- Rule Acute DRG Special Pay DRG TYPE 224 No No SURG 005 No No SURG Long MS-DRG Description Cardiac defibrillator implant w cardiac cath w/o AMI/heart failure/shock w MCC Liver transplant w MCC or intestinal transplant Weights FY09 Weights FY10 Payment Change % Payment Change No No SURG Heart transplant or implant of heart assist system w/o MCC Most Remarkable MS-DRG Rate Increases MS-DRG FY09 Final FY09 Final Rule Rule Post- Special Acute DRG Pay DRG TYPE Long MS-DRG Description Weights FY09 Weights FY10 Payment Change % Payment Change 001 No No SURG Heart transplant or implant of heart assist system w MCC Yes No SURG 769 No No SURG Skin grafts & wound debridement for endocrine, nutritional, & metabolic disorders w MCC Postpartum & post abortion diagnoses w O.R. procedure AHIMA 2009 Audio Seminar Series 14

20 Most Remarkable MS-DRG Rate Increases MS-DRG FY09 Final Rule Post- Acute DRG FY09 Final Rule Special Pay DRG TYPE Long MS-DRG Description Weights FY09 Weights FY10 Payment Change % Payment Change 463 Yes No SURG Wound debridement & skin graft except hand, for musculoconnective tissue disorder w MCC No No SURG Craniotomy for multiple significant trauma No No SURG 010 No No SURG Other heart assist system implant Pancreas transplant New Technology Add-on Payment Ensures adequate payment for new medical services and technologies Must demonstrate that the new service or technology is shown to be a benefit to Medicare beneficiaries Time limits of 3 years Add-on payment discontinued DRG revision 30 AHIMA 2009 Audio Seminar Series 15

21 New Technology Add-on Payment: CardioWest Approved for FY 2009, CardioWest Temporary Total Artificial Heart system (TAH-t) continues to meet requirements for FY 2010 Billing requirements Device procedure code Clinical trial secondary diagnosis V70.7 Condition code CardioWest Reimbursement Add-on Payment Maximum $53,000 Pre-MDC MS-DRGs 001 Heart transplant or implant of heart assist system w MCC RW Heart transplant or implant of heart assist system w/o MCC RW AHIMA 2009 Audio Seminar Series 16

22 New Technology Add-on Payment: Spiration IBV Valve System Under bronchoscopic placement, small one-way valves are placed into selected small airways of the lung to limit airflow into selected portions of the lung experiencing prolonged air leaks following lobectomy, segmentectomy, or lung volume reduction surgery. Remove valve(s) no later than six weeks post implantation. 33 Spiration IBV Reimbursement Add-on Payment Maximum $3, MDC 4 Respiratory System Procedures MS-DRGs Major chest procedure 163 w MCC RW w CC RW w/o CC/MCC RW or in combination with one of the following lung surgeries: AHIMA 2009 Audio Seminar Series 17

23 New Technology Not Approved LipiScan Coronary Imaging System Procedure code Intravascular spectroscopy Intravascular Near Infrared Spectroscopy (INIRS) device used during an invasive coronary catheterization which scans the artery wall for plaque composition in areas shown to be more prone to rupture 35 Applications Withdrawn CLOLAR (clofarabine) Injection AutoLITT System Procedure code (10/1/09) Laser interstitial thermal therapy [LITT] of lesion or tissue of brain under guidance, for treatment of patients with glioblastoma multiforme brain tumors. TherOx Downstream System using SuperSaturatedOxygen Therapy 36 AHIMA 2009 Audio Seminar Series 18

24 Present on Admission No changes to POA indicators POA examples no longer in guidelines Diagnosis Code Indicator Categories: Y = Yes N = No U = Insufficient documentation W = Clinically undetermined 1 = Exempt (not applicable) 37 Hospital Acquired Conditions No HAC changes but the data will be monitored during FY new codes added to the injury list Revised existing code title Torus fracture of radius (alone) New codes Torus fracture of ulna (alone) Torus fracture of radius and ulna 38 AHIMA 2009 Audio Seminar Series 19

25 Case Study: POA/HAC Example with Torus Fracture Patient was admitted for an acute cerebral vascular infarction with left-sided hemiplegia which further led to an acute exacerbation of her COPD after admission. The patient was given thrombolytic infusion per protocol. While preparing for a brain CT scan, the patient tripped, braced herself and fell onto her outstretched arms resulting in a right torus radial fracture. Following closed reduction, she was discharged in good condition with no CVA residuals but with instructions to follow-up with the orthopedist for fracture aftercare. 39 POA/HAC : Acute Ischemic Stroke w/use of Thrombolytic Agent MS-DRG 062 w CC PDX Y CC N CC N E885.9 N E849.7 N RW MS-DRG 063 w/o CC/MCC PDX Y CC N E885.9 N E849.7 N RW AHIMA 2009 Audio Seminar Series 20

26 Continuing HAC List for FY 2010 Foreign object Air embolism Blood incompatibility Stage III & IV pressure ulcers Ulcer progression to these stages POA still Y Injuries Catheter-associated UTI 41 Continuing HAC List for FY 2010 Vascular catheter-associated infection Poor glycemic control Surgical site infections following CABG, certain orthopedic procedures, and bariatric surgery for obesity Acute deep vein thrombosis & Pulmonary embolism following certain orthopedic procedures 42 AHIMA 2009 Audio Seminar Series 21

27 Case Study: POA/HAC Example with Acute Pulmonary Embolism Patient was admitted for right hip replacement with ceramic on ceramic bearing for localized osteoarthritis of the right hip. The patient also has a past history of MI, native CAD which is medically managed, and hypertension. Following the procedure, the patient developed an acute pulmonary embolism. Thrombolysis treatment with TPA was administered and the patient was discharged in good condition. 43 POA/HAC : Major Joint Replace/ Reattach Lower Extremity MS-DRG 469 w MCC PDX Y Y Y MCC N RW MS-DRG 470 w/o MCC PDX Y Y Y MCC N (HAC) RW AHIMA 2009 Audio Seminar Series 22

28 All HACs for FY 2009 Rolled Over to FY 2010 DVT/PE Following Certain Orthopedic Procedures (CC) Acute venous embolism and thrombosis of deep vessels or lower extremity (MCC) Iatrogenic pulmonary embolism and infarction (MCC) Other pulmonary embolism and infarction and one of the following procedure codes Resurfacing hip Hip replacement Total knee replacement 45 Medicare Code Editor (MCE) Patient information is fed into the Medicare claims processing systems and subjected to a series of automated screens designed to identify cases that require further review by the MAC/FI before classification into a DRG 46 AHIMA 2009 Audio Seminar Series 23

29 18 MCEs 1. Invalid diagnosis or procedure code 2. E-code as PDX 3. Duplicate PDX (as a secondary) 4. Age conflict (newborn (0), pediatric (0-17), maternity (12-55), adult age (15-124)) 5. Sex conflict 6. Manifestation code as PDX 7. Nonspecific PDX 8. Questionable admission 9. Unacceptable PDX MCEs 10. Nonspecific OR procedure 11. Noncovered procedure 12. Open biopsy check 13. Bilateral procedure 14. Invalid age 15. Invalid sex 16. Invalid discharge status 17. Limited coverage procedure 18. Wrong procedure performed 48 AHIMA 2009 Audio Seminar Series 24

30 MCE Corrections for FY 2010 Unacceptable PDX edit removed Code first note at category 209 should not be interpreted that these codes cannot be PDX Manifestation codes as PDX Code first note was removed for codes (10/1/2008) Invalid Diagnosis or Procedure Code Code Therapeutic ultrasound of vessels of head and neck is a valid code 49 MCE Corrections for FY 2010 DX allowed for males only Inadvertently left off the list, codes 603.0, 603.1, and were added Procedure allowed for females only Inadvertently left off the list, codes and were added 50 AHIMA 2009 Audio Seminar Series 25

31 New MCE! Wrong Procedure Performed Edit triggered when one of these E codes are either primary or secondary E876.5 Performance of wrong operation (procedure) on correct patient E876.6 Performance of operation (procedure) on patient not scheduled for surgery E876.7 Performance of correct operation (procedure) on wrong side/body part 51 Reportable Never Events CMS renders zero payment to a hospital for an encounter involving one of 3 never events as specified by the coverage determination Required condition codes: MX Wrong surgery on patient MY Surgery on wrong body part MZ Surgery on wrong patient 52 AHIMA 2009 Audio Seminar Series 26

32 OIG 3 Serious Reportable Events Verify claims Checking for omitted E-code Checking for the E-code listed in the first 9 diagnoses (not in the E-code field) Subject to RAC review Claim denied Pattern of abuse referral to the OIG Aug. 27, 2009 Federal Register page HACs versus Wrong Procedure Performed Different rationale HAC has the potential of reducing payment MS-DRG that has the potential of changing based on MCC or CC The condition is the only MCC or CC Wrong procedure is a denial of payment 54 AHIMA 2009 Audio Seminar Series 27

33 Documentation & Coding Adjustment The expected 1.9% documentation and coding adjustment will not be implemented for FY 2010! Beginning in FY 2008, CMS adjusted reimbursement based on: MS-DRG s improved accounting for severity Complete documentation Complete case coding Maximum IPPS payment 55 Documentation & Coding Adjustment CMS did not have a full year of 2009 data to analyze showing the extent of the documentation and coding effects on the case mix index (CMI) CMS may phase in future adjustments for FY 2011 based on 2008 and 2009 data Continue documentation improvement efforts! 56 AHIMA 2009 Audio Seminar Series 28

34 American Reinvestment & Recovery Act Provisions 50% reduction in FY 2010 capital IME adjustment for teaching hospitals which was not finalized. Three requirements: 1. Meaningful use of certified EHR technology 2. Electronic exchange of health information 3. Reporting on quality measures using certified EHR technology 57 Value Based Purchasing Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program 97% of hospitals received the full update last year Similar to FY09, in which a 2% payment reduction was applied if hospitals fail to report quality measures, FY 10, hospitals not in full compliance with the FY 2010 quality reporting requirements will receive a 2% payment reduction (equivalent to the inflation update of 2.1%- 2% which is 0.1%---essentially cancelling out the entire update). 58 AHIMA 2009 Audio Seminar Series 29

35 Add 15 New Quality Measures 30 quality measures as of FY09 15 new added this year 13 added in this Final IPPS Rule FY10 2 added from the Final OPPS Rule FY09 READM-30-AMI Acute Myocardial Infarction (AMI) 30-Day Readmission Rate READM-30-PN Pneumonia (PN) 30-Day Readmission Rate 59 Minus 1 Quality Measure Now Totals to 44 One measure retired AMI 6 Beta blocker at arrival 60 AHIMA 2009 Audio Seminar Series 30

36 4 New Measures w/financial Implications FY new measures for FY 2011 payment determination only These will not affect 2010 payment determination 2 new Surgical Care Improvement Project (SCIP) measure sets: SCIP Infection (INF) 9 Urinary catheter removed on postoperative day one (POD1) or postoperative day two (POD2) SCIP INF 10 Surgery patients with peri-operative temperature management The two structural measures include the following: Participation in a systematic clinical database registry: Nursing sensitive care Participation in a systematic clinical database registry: Stroke care 61 Charge Compression CMS definition: the practice of applying a lower charge markup to higher-cost services and a higher charge markup to lowercost services Reimbursement ramifications: true costs of providing services is not reflected in payments 62 AHIMA 2009 Audio Seminar Series 31

37 Cost Centers for Devices FY08 added 2 new cost centers: Emergency Room Blood and Blood Products FY09 changed into one line: Medical Supplies Implantable Devices CMS is not proposing any changes to the existing cost-based relative weight methodology for FY 2010 citing the need for further research 63 Other Regulatory Issues JC hospital deeming authority status had been revoked, per a special MIPPA provision, but as of April 9, 2009, the status is renewed Quarterly reporting of attestation forms was not required for FY09 For the FY 2011 payment determination, CMS will require hospitals to electronically acknowledge their data accuracy and completeness for the RHQDAPU program once between January 1, 2010, and August 15, 2010 and annually thereafter 64 AHIMA 2009 Audio Seminar Series 32

38 Other Regulatory Issues CMS s standing orders clarification: The use of standing orders must be documented as an order in the patient s medical record and signed by the practitioner responsible for the care of the patient, but the timing of such documentation should not be a barrier to effective emergency response, timely and necessary care, or other patient safety advances Signatures are required on pre-printed order sets Medicare does not accept the use of rubber stamps for payment purposes 65 Resource/Reference List FY 2010 IPPS Final Rule (Federal Register 8/27/09) CMS IPPS Regulations, Notices & Downloads NCHS ICD-9-CM Diagnosis Addenda & Guidelines CMS ICD-9-CM Procedure Addenda marytables.asp 66 AHIMA 2009 Audio Seminar Series 33

39 Audio Seminar Discussion Following today s live seminar Available to AHIMA members at Click on Communities of Practice (CoP) icon on top right AHIMA Member ID number and password required for members only Join the Coding Community from your Personal Page under Community Discussions, choose the Audio Seminar Forum You will be able to: Discuss seminar topics Network with other AHIMA members Enhance your learning experience AHIMA 2009 Audio Seminar Series 34

40 Become an AHIMA Member Today! To learn more about becoming a member of AHIMA, please visit our website at ahima.org/membership to Join Now! AHIMA Audio Seminars Visit our Web site for information on the 2009 seminar schedule. While online, you can also register for seminars or order CDs, pre-recorded Webcasts, and *MP3s of past seminars. *Select audio seminars only AHIMA 2009 Audio Seminar Series 35

41 Upcoming Seminars/Webinars FY10 ICD-9-CM Procedure Code Updates September 17, 2009 FY10 Rehabilitation Coding and IRF PPS Update September 24, 2009 Procedure Coding for Radiation Oncology October 1, 2009 Thank you for joining us today! Remember sign on to the AHIMA Audio Seminars Web site to complete your evaluation form and receive your CE Certificate online at: Each person seeking CE credit must complete the sign-in form and evaluation in order to view and print their CE certificate Certificates will be awarded for AHIMA Continuing Education Credit AHIMA 2009 Audio Seminar Series 36

42 Appendix Resource/Reference List CE Certificate Instructions AHIMA 2009 Audio Seminar Series 37

43 Appendix Resource/Reference List AHIMA 2009 Audio Seminar Series 38

44 To receive your CE Certificate Please go to the AHIMA Web site click on the link to Sign In and Complete Online Evaluation listed for this seminar. You will be automatically linked to the CE certificate for this seminar after completing the evaluation. Each participant expecting to receive continuing education credit must complete the online evaluation and sign-in information after the seminar, in order to view and print the CE certificate.