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No more ICD-10 delay: Contact your local legislators today

ICD-10 implementation is not game. Tell your elected officials to stop playing around with the implementation date.

ICD-10 implementation is not game. Tell your elected officials to stop playing around with the implementation date.

Word has begun circulating throughout the healthcare industry that ICD-10 may face additional delay.

A letter drafted by Republican Michigan Representative Fred Upton and Republican Texas Representative Pete Sessions on behalf of the Medical Society of the State of New York seeks an additional two-year delay in the implementation of ICD-10 until October 1, 2017. You can read the letter here:

We at ACDIS strongly oppose further delay to ICD-10. Hospitals and CMS have already conceded with prior delays, at great cost: CMS estimated that the last delay cost the healthcare industry up to $6.8 billion in training, software, and other investments.

Further delay would result in additional costs, and also hurt patient care. The nation’s current coding and disease classification system, ICD-9, is out of date and desperately in need of the additional specificity that is the hallmark of ICD-10. Contrary to statements made in the above letter, improved coding specificity is not just tied to reimbursement, but also quality of care and patient safety.

It goes without saying that a further delay would also greatly damage the work already being done by CDI departments across the country, many of which have been diligently collaborating with their physician staffs with formal education and queries for the additional specificity needed under ICD-10.

ACDIS has received permission from our friends at the American Health Information Management Association (AHIMA) to share the following information with our members. It includes AHIMA’s recommended approach to contacting your local legislator and making your voice heard.

If you click this link, it will take you to Capwiz, a tool that makes it very easy to send letters directly to Congress: The form is pre-populated with reasons why the industry opposes efforts to delay ICD-10. This can be sent verbatim, or modified with your own thoughts and experiences with using ICD-10. The ACDIS advisory board stresses that you should urge Congress to act now, rather than wait to voice your opinion on the fate of ICD-10.

Congress is due to recess for the year on Friday, December 12. Time is of the essence, so please take action now.

If a delay is to occur, we all need to know in order to prepare and plan for 2015.

In addition, if you’d like to do more, consider the following course of action as recommended by AHIMA:

Call the leaders listed below TODAY and tell them that ICD-10 is needed in 2015.
Follow these 4 steps:

  1. Call Chairman Upton at 202-225-3761.
  2. Ask for the Health Legislative Aide
  3. Use the talking points below:
  • Do not delay ICD-10. We need the code sets in 2015!
  • According to a recent survey, small physician practices are expected to spend between $1,900—$6,000 to transition to the new code set. This is much lower than previous reports. The study can be found on
  • Physician practices do not use all 13,000 diagnosis codes available in ICD-9. Nor will it be required to use the 68,000 codes that are in ICD-10. The majority of the code increases are due to laterality-which is not currently available in ICD-9.
  • CMS offers a robust plan for physician practices to transition to ICD-10. The Road to 10 can be found here:

When you are done, call the other congressional leaders and Tweet also.

Name Phone                              Twitter Handle
Fred Upton 202-225-3761 @RepFredUpton
Pete Sessions 202-225-2231 @PeteSessions
House Speaker John Boehner 202-225-6205 @SpeakerBoehner
Minority Leader Nancy Pelosi 202-225-4965 @NancyPelosi
Kevin McCarthy 202-225-2915 @GOP Leader

Tweet your Representatives and be sure to use the following #s! #ICD10Matters #ICD10NoDelay

On behalf of ACDIS, thank you for making your voice heard on this important issue.


Brian Murphy

Director, ACDIS

Guest Post: Night before Christmas (um, ICD-10)

shawn.macphee (426x640)

Shawn Macphee

As part of its fall 2014 meeting the Michigan ACDIS Chapter held an essay contest. Although in the following hardly constitutes an essay (I do hold a master’s degree in poetry believe it or not and this falls into poetic realm), it nevertheless easily earned honors and was thankfully turned over to us here at ACDIS to share with you this holiday season. Kudos to the Michigan ACDIS Chapter leaders and to the poet, Shawn MacPhee, MSN, RN, CCDS!

‘Twas the night before ICD-10, when all through the house

Over the hills of ICD-10 preparation

Over the hills of ICD-10 preparation

not a CDS was sleeping, their anxiety wouldn’t douse

The code books were ready, studied with care

In hopes that the documentation would be there

The coders were nestled, all snug in their beds

While visions of procedure codes danced in their heads

The CFO was restless, the CEO too

Trying to trust the CDS knew just what to do

The next morning dawn came with a shatter

The CDS staff worked without much chatter

Census sheets printed off in a flash

They made assignments in a dash

To the floors they ran, with DRG books in tow

The freshly waxed floors all a glow

The physicians all a rounding did appear

With their handy new CDI tip cards near

Progress notes were written, H&P’s too

The CDS’s reviewed the charts, looking for a clue

Diagnoses like asthma, a-fib and gout

The CDS staff was on the look out

Specificity was on their mind

Acute or chronic their goal to find

Then what to their wondering eyes did appear?

The etiology and manifestations weren’t quite clear

A query must be done – it was true

So up to the physician the CDS flew

The physician agreed, and thanked the nurse

He appreciated her for being terse

The documentation was added

The chart was complete

The CDS decided it was time to repeat.

Reading health records throughout the day

Feeling proud to be leading the way

You see, ICD-10 it’s not scary

Once implemented we shall all be merry

The day is almost over – relaxation in sight

So query now, query often, and to all a good night!

News: CMS sets ICD-10 testing process in place

ICD-10 testing process in play

ICD-10 testing process in play

The new ICD-10 implementation date is less than a year away, and CMS is gearing up its end-to-end testing process in preparation.

CMS will select submissions from approximately 2,550 volunteers for three separate testing opportunities in January, April, and July 2015, and will make an effort to choose participants that represent a variety of provider, claim, and submitter types. MLN Matters SE1409 Revised states that the goal of the testing is to demonstrate the following:

  • Providers or submitters are able to successfully submit claims containing ICD-10 codes to the Medicare fee-for-service claims systems
  • CMS software changes made to support ICD-10 result in appropriately adjudicated claims (based on the pricing data used for testing purposes)
  • Accurate remittance advice is produced

Take action as early as possible regardless of whether your organization opts to test with CMS or another payer, says Barbara Hinkle-Azzara, RHIA, vice president of HIM operations at HRS Coding in Baltimore. Throughout the transition to ICD-10, organizations have made the mistake of assuming they will be able to test with payers only to find themselves left out because payers are only testing with a limited number of providers, she says.

Continue reading “ICD-10 countdown: Testing may offer a glimpse into the future” on the HCPro website.

TBT: Watch out for uninvited turkeys

Don't use Thanksgiving as a time to talk turkey. Count your blessings. Be thankful. Use compassion for those less fortunate who surround you.

Don’t use Thanksgiving as a time to talk turkey. Count your blessings. Be thankful.

Editor’s Note: In social media memes Throw-back Thursday generally means sharing an old high school photo, something you most likely wish had been left unpublished. We’ve picked up the theme going back into our archives to highlight some salient tid-bit. Today, in honor of Thanksgiving we’ve pillaged the archives over at the ICD-10 Trainer for this pearl pulled from the New York City headlines.

A feral flock of wild turkeys has invaded New York City. Seriously. And with them, they bring all sorts of code-ready diseases and mishaps. But what happens when a turkey tries to cross Broadway? Well, if the bird is unlucky, it will get run over. New Yorkers stop for no fowl.

However, if the birds are smart enough to cross en masse, they could cause some serious traffic disruptions and possibly some traffic accidents. We’ll leave the specific injuries (contusions, lacerations, broken bones, etc.) out of the equation for the moment and look at the External Causes codes associated with traffic accidents.

ICD-10-CM includes multiple code possibilities for transport accidents in sections V00-V99. The introductory note for the section states:

This section is structured in 12 groups. Those relating to land transport accidents (V01-V89) reflect the victim’s mode of transport and are subdivided to identify the victim’s ‘counterpart’ or the type of event. The vehicle of which the injured person is an occupant is identified in the first two characters since it is seen as the most important factor to identify for prevention purposes. A transport accident is one in which the vehicle involved must be moving or running or in use for transport purposes at the time of the accident.

If the turkeys on the Great White Way caused an accident, we would likely head to V40 (car occupant injured in collision with pedestrian or animal). Our choices include:

  • V40.0, car driver injured in collision with pedestrian or animal in nontraffic accident
  • V40.1, car passenger injured in collision with pedestrian or animal in nontraffic accident
  • V40.2, person on outside of car injured in collision with pedestrian or animal in nontraffic accident
  • V40.3, unspecified car occupant injured in collision with pedestrian or animal in nontraffic accident
  • V40.4, person boarding or alighting a car injured in collision with pedestrian or animal
  • V40.5, car driver injured in collision with pedestrian or animal in traffic accident
  • V40.6, car passenger injured in collision with pedestrian or animal in traffic accident
  • V40.7, person on outside of car injured in collision with pedestrian or animal in traffic accident
  • V40.9, unspecified car occupant injured in collision with pedestrian or animal in traffic accident

All of these codes require a seventh character to indicate the encounter type, so you’ll also need two placeholder Xs so the seventh character ends up in the seventh spot.

So if you’re flocking to New York for the holidays, watch out for those wild birds.

Boot Camp News: California, here we come!

dont miss itThe ICD-10 for CDI Boot Camp heads to sunny San Diego, California, December 8-10. The documentation issues that exist with ICD-9 will continue in ICD-10. The ICD-10 for CDI Boot Camp provides strategies that can be implemented immediately to improve documentation and facilitate a smooth transition to ICD-10-CM. ACDIS’ ICD-10 for CDI Boot Camp is the only training developed with CDI specialists in mind. Our instructors have in-the-field CDI experience and know exactly what CDI specialists need to know about the new coding system. You will get a CDI perspective on how to:

  • Evaluate, revise, and focus physician educational efforts and queries to meet documentation requirements for ICD-10-CM
  • Determine the impact ICD-10-PCS will have on the organization and whether CDI specialists should query for surgical procedures
  • Highlight changes from the ICD-9-CM to ICD-10-CM Official Coding Guidelines so that CDI specialists can get coders the specificity needed
  • Recognize how ICD-10-CM documentation requirements will affect principal diagnosis selection, additional diagnosis reporting, and diagnosis sequencing
  • Identify solutions that will maximize efficiency and limit productivity losses during and after the transition

We’ll be in San Diego in December, Las Vegas in February, and Orlando in March. Won’t you join us? Click here to learn more about the ICD-10 for CDI Boot Camp or call us at 800-650-6787.

Haunted Coding: The tell-tale chart

The month marked the 165th anniversary of Edgar Allan Poe’s death. We’re still not sure of the cause of Poe’s demise but there are have plenty of theories.


No more poor Poe.

First is the popular “he drank himself to death” theory that many people have heard. Poe was found “in great distress” outside of a polling place in Baltimore and died four days later. If Poe, who couldn’t really hold his liquor, did succumb to alcohol poisoning, how would we code it? First, we head to the Table of Drugs and Chemicals, then find alcohol and its 28 related entries. Apparently you can be poisoned by a lot of different types of alcohol.

In Poe’s case, it was probably ethanol (T51.0X-). In fact, 13 of the terms under alcohol in the Table of Drugs direct you to T51.0X-.

Now we need the intent behind the poisoning. We have specific codes for:

  • Accidental (unintentional)
  • Intentional self-harm
  • Assault
  • Undetermined

We also need a seventh character to denote the encounter. We have three choices:

  • A, initial encounter
  • D, subsequent encounter
  • S, sequela

Most likely, the alcohol poisoning (if that’s what put an end to the poet) was accidental, so we would report T51.0X1A.

However, we are faced with a more sinister possibility. Some have speculated that Poe was actually the victim of cooping, a method of voter fraud practiced by gangs in the 19th century. The gangs would kidnap people and take them around to various polling places so they could vote multiple times. After each successful casting of the ballot, the gang would reward their victim with alcohol.

You might be able to make a case for this being an assault, although that is probably a tough sell. You could also make a case for undetermined.

You’ll also find the following note under T51.01X-:


  • Acute alcohol intoxication or ‘hangover’ effects (F10.129, F10.229, F10.929)
  • Drunkenness (F10.129, F10.229, F10.929)
  • Pathological alcohol intoxication (F10.129, F10.229, F10.929)

An Excludes2 note tells us that the conditions listed are not part of T50.1X-, but a patient could be suffering from one of these conditions as well. So if Poe’s doctor documented pathological alcohol intoxication, we would code it in addition to the alcohol poisoning.

Sadly Poe’s medical records have gone missing and shall be seen nevermore.

Editor’s Note: This article originally published on the ICD-10 Trainer Blog.