My experience at an AHIMA trainer session Part 3

During this three-day training, we learned as much as possible about this new classification system. I received a letter in the mail right before leaving for the American Health Information Management Association (AHIMA) Academy for ICD-10 trainer session in Grapevine, TX, only to find out that the learning doesn’t end after the three days!

I still have to take the “final exam” between late October and late January 2010 to demonstrate that I understand and can apply this new system to become an “AHIMA certified ICD-10 trainer.”

I was surprised that there was not a specific credential or at least a designation, even if it was just an appendage onto one of my AHIMA certifications, to notate that I had endured this training. Even the American Academy for Professional Coders designates its professional medical coding curriculum (PMCC) instructors with an “I” at the end of their credential (i.e., CPC-I).

I’m not sure how to publicize that I did this training other than to add it as a tidbit of information onto my bio. It should be identified somehow right?

It was amazing to sit through such an intensive training session. I recently taught a class in Boston, and I had to admit to my students that I was reminded of how my Boot Camp attendees feel when we cover so much material in a five-day class. I had an increased sympathy for them, having endured it myself recently. It reinforced to me how important it is to have engaging, fun, and energetic instructors — especially in an intensive learning format.

This three-day session was definitely an information-overload experience, but I feel confident that I can share this information with the masses when the need arises.

Has your coding manager or coding staff members attended any kind of ICD-10 training sessions yet? Now that I’ve shared a bit of my experience, we would love to hear what yours was like. Please post your comment here.

My experience at an AHIMA trainer session Part 2

In a recent post, I talked about my experience attending an American Health Information Management Association (AHIMA) Academy for ICD-10 trainer session. While I am excited about certain aspects of ICD-10-CM, I’m not as quick to warm up to ICD-10-PCS, which is very different from what we currently use in ICD-9-CM Volume 3.

The use of the many tables and definitions of certain procedures make this system much more applicable in a clinical sense. However, I did find myself having to continually reference definitions of the various root operations in the front of the PCS manual.

I would read a question and have to really think about whether the question was about a “change,” “replacement,” “extraction,” “extirpation,” etc.

Extirpation was my word of the day. I looked this word up in the Merriam-Webster Dictionary only to find the definition includes the following:

• To pull up by the roots
• To destroy completely
• To remove by surgery

Well, that didn’t help me much considering some of my choices for root operations include destruction, resection, transplantation, and excision, which all seem similar, don’t they?

Luckily, the introduction to the ICD-10-PCS manual provides a specific definition for extirpation, which is “taking or cutting out solid matter from a body part” (e.g., removal of a calculus). I’m glad this definition was in the manual otherwise I would have had a hard time using the official definition.

One of the comments people made at the AHIMA session was, “Will all my physicians have to document ‘extirpation’?”  Rest assured, physicians do not need to use this exact verbiage for coders to assign the appropriate ICD-10-PCS codes.

However, because of the way the ICD-10-PCS system is set up, you do need to understand what the root operations are so you can reference the correct part of the procedure tables, identify the procedures the physicians document, and assign the correct codes.

My experience at an AHIMA trainer session

I recently completed the American Health Information Management Association (AHIMA) Academy for ICD-10 trainer session in Grapevine, TX. It was a whirlwind experience. The days were long, but it was fun to learn something new.

I am convinced now more than ever that ICD-10-CM is very much like ICD-9-CM. But ICD-10-PCS will take some getting used to.

For ICD-10-CM, we still follow the same steps to assign codes—they just don’t look like our beloved ICD-9-CM codes. I have memorized so many codes over the years (as I can imagine many of my fellow coders also have), so this will be one of the hardest adjustments to make. With ICD-10-CM, we will have to exercise our minds into learning and memorizing new codes. For example, all of us in the training session learned a new code the first day that I will never forget—I10 for hypertension!

There are definitely aspects about ICD-10-CM that I am excited about. We no longer need to concern ourselves with determining whether hypertension was benign or malignant or whether diabetes is uncontrolled or not stated as uncontrolled because ICD-10-CM codes are not differentiated in this manner.

For conditions such as septic shock, it is wonderful that we will have a combination code for sepsis with septic shock (R65.21). In ICD-9-CM, we generally have to report three codes (systemic infection, 995.92, and 785.52). With ICD-10-CM, we have to report only two codes: The underlying condition first and R65.21. Overall, we are still making progress in simplifying the system.

ICD-10-PCS is a whole different ball of wax! Stay tuned to hear more about this in a future blog. Have you attended one of AHIMA’s trainer sessions? What was your experience like? Share your comments here!

AAPC releases code translator tool

You’ll be happy to add this code translator to your collection of ICD-10 tools. The American Academy of Professional Coders (AAPC) released on October 20 a free ICD-10-CM online code conversion tool, which you can use to map ICD-9-CM codes to ICD-10-CM codes. The tool is based on the General Equivalency Mapping files CMS has posted on its Web site.

It’s incredibly easy to use the tool. First, you indicate whether you want to convert from ICD-9 to ICD-10, or from ICD-10 to ICD-9. Then you simply type in the code you want to look up.

For some codes, you’ll get fairly simple translations. Consider the following examples:

• When you look up ICD-9-CM code 277.81 (Primary carnitine deficiency), you get ICD-10 code E71.41 (Primary carnitine deficiency).
• When you look up ICD-9-CM code 577.2 (Cyst and pseudocyst of pancreas), you get ICD-10 codes K86.2 (Cyst of pancreas) and K86.3 (Pseudocyst of pancreas).

For other codes, the translations are more complex. When you look up ICD-9-CM code 424.0 (Mitral valve disorders), you get the following ICD-10 codes:

• I34.0 (Nonrheumatic mitral [valve] insufficiency)
• I34.1 (Nonrheumatic mitral [valve] prolapse)
• I34.2 (Nonrheumatic mitral [valve] stenosis)
• I34.8 (Other nonrheumatic mitral valve disorders)
• I34.9 (Nonrheumatic mitral valve disorder, unspecified)

As a disclaimer, the AAPC advises those using the tool to keep in mind that while many ICD-9 codes map directly to ICD-10 codes, some may require a clinical analysis to determine which code(s) should be selected for the appropriate mapping.

So give it a try, and post a comment to let us know what you think about the AAPC’s tool. Happy mapping!

AHIMA posts ICD-10 practice briefs

On October 2, the American Health Information Management Association (AHIMA) posted three new practice briefs related to ICD-10 on its Web site. Click on “All current practice briefs in chronological order by publication date, and then access the three briefs:

• ICD-10-CM/PCS Project Management Resources
• Transitioning ICD-10-CM/PCS Data Management Processes
• Planning Organizational Transition to ICD-10-CM/PCS

It can be a challenge sifting through all the ICD-10 information out on the Web these days,  deciding what’s fluff and what’s not. Trust me–you don’t want to miss out on these valuable nuggets from the AHIMA. For example, consider this excerpt from the “Planning Organizational Transition to ICD-10-CM/PCS” practice brief:

The transition and post-implementation period will likely require parallel coding support. Assessing coder workload and preparing for the compliance date will assist in reducing the variability and backlog as the transition occurs. To begin planning, management can assess the potential impacts and areas of weakness by determining:

• What to communicate to the medical staff about documentation
• What companies can be subcontracted for coding and when this process should begin
• What phasing out of just-in-time ICD-9-CM coding will mean to the organization
• The best coders to assist in phasing out cases up to September 30, 2013
• Any temporary changes to time-off policies and their implications leading up to the compliance date
• If one set of coders will conduct the phase out or if each coder participates once October 1, 2013, arrives

A coding tip that will make your ears perk up

This is just one of hundreds examples of changes coming with ICD-10. Every family practice regardless of size should identify a person(s) to be the designated ICD-10 expert. To develop appropriate education, every practice should take the time to recognize areas upon which ICD-10 will have a significant impact. As we get closer to the October 1, 2013, ICD-10 implementation date, take your current encounter form and convert it to ICD-10. The ICD-10 codes published today may not be exactly the same in 2013, but this conversion could be a good tool to show senior leaders in your practice how specific this new coding system can be.

For example, ear wax removal currently has one code. But this will expand to four codes in ICD-10:

Diagnosis: Impacted Cerumen

ICD-9

• 380.4 Impacted cerumen

ICD-10

• H61.20 Impacted cerumen, unspecified ear
• H61.21 Impacted cerumen, right ear
• H61.22 Impacted cerumen, left ear
• H61.23 Impacted cerumen, bilateral

Check out AHIMA’s implementation preparation checklist

There are a number of ICD-10 checklists floating around out there in cyberspace, but this one created by the American Health Information Management Association (AHIMA) and included in a recent CMS presentation is one of the best ones I’ve seen. The AHIMA suggests the following checklist when performing an ICD-10  impact assessment:

• Establish interdisciplinary steering committee to oversee implementation
• Educate affected departments and individuals about the change in code sets and what it meansfor their area of responsibility (both in terms of
• preparation planning and benefits)
• Assess organizational readiness for the change to the ICD-10 code set
• Assess impact of change on organizational operations
• Assess staff education needs
• Identify reports and forms requiring modification (e.g., physician practice superbill)
• Assess extent of changes to systems, processes, policies/procedures
• Use code set change as opportunity to improve data flow, work flows, and processes
• Perform comprehensive systems audit for ICD-10 compatibility
• Determine vendor readiness and timeline for upgrading software to new code sets
• Assess quality of medical record documentation and implement documentation improvement program if necessary
• Develop implementation budget

But it’s good to look at this checklist as a skeleton upon which to build your own impact assessment because it’s easy to see how each one of these bullets could have its own subset of smaller checklists. Do you have a checklist you would like to share? Post a comment, your checklist, or the Web link to the checklist so we can all take a look!

AAPC opposes ICD-9 freeze prior to ICD-10 implementation

On its Web site, the American Academy of Professional Coders (AAPC) states that it does not support a freeze to ICD-9-CM coding updates prior to the October 1, 2013 implementation of ICD-10.

In a statement directed to members of the ICD-9-CM Coordination and Maintenance Committee, which met in Baltimore September 16 and 17, the AAPC stated that because medical science is continually evolving, the committee should limit any suspension of updates to diagnostic coding so it does not affect reporting accuracy.

However, the association does support a freeze to changes to ICD-10-CM and ICD-10-PCS beginning October 1, 2012. According to the AAPC statement:

Because all users will be setting up entirely new systems to accommodate ICD-10-CM and ICD-10-PCS in the year(s) prior to implementation, AAPC supports a freeze on changes to the ICD-10-CM and ICD-10-PCS code sets beginning Oct. 1, 2012 (one year prior to implementation) and continuing until Oct. 1, 2014 (one year following implementation). This will provide a 24-month hiatus from any changes to the new system, which will ease the burden of adoption for all participants.

What do you think about a potential code freeze? Would it help or hurt? Post a comment on ICD-10 Watch!

Do you have an ICD-10 tale to tell?

Although the U.S. healthcare community is bracing themselves for this massive switch to ICD-10 in 2013, many other countries have already been through it. For example, providers in Canada transitioned to ICD-10 in 2001. Are you a vendor, payer, provider, or other expert who experienced the transition to ICD-10 in Canada? We want to hear your story! What are your lessons learned, and what steps did you take to ensure a successful transition to this new coding system? Interested in sharing your experience with our ICD-10 Watch community? Please e-mail me at dbentley@hcpro.com.

Part 3: One coder shares list of cost-effective ICD-10 resources

Looking back a year later, I now feel relatively confident in my background knowledge of ICD-10. And I did not spend any money. Read more in Part 1 and Part 2 of this blog post about my cost-effective strategy to learn about ICD-10.

As soon as I know whether there will be a freeze date, I will make plans to create/update my own personal coding references and training materials accordingly.

One possible expenditure I would recommend would be the purchase of the American Health Information Management Association’s (AHIMA) practice exercise text on ICD-10, which is based on the 2009 code set and guidelines, and you can also take the proficiency assessments for validation of your self-education efforts.

I’m not too concerned about the possibility of the ICD-10 code set changing again a couple more times because I would just update the current desktop files that I use and just know that a few of the codes in the answers in the AHIMA text I reference above may be outdated. These potential changes will not significantly hamper your studies to the point that it would be worth purchasing an updated text. My personal plan is to not make any significant expenditures until I know about whether CMS will impose a code freeze.

So bottom line, you already know ICD-9 and the general coding conventions and guidelines, so it’s just a matter of understanding the differences in those guidelines and conventions in ICD-10 (Find out by reading the ICD-10-CM official guidelines and the ICD-10-PCS official guidelines found in Appendix B of the Reference manual.) and then download the files (one for the PCS and the index and tabular for ICD-10-CM) and start coding in ICd-10 what you code daily for practice.

If you need extra support and don’t have access to real patient records, then use AHIMA’s textbooks and/or create your own training materials. The textbooks on ICD-10 are the same books that the AHIMA will use in the Train the Trainer sessions. Yes, the AHIMA’s sessions will also have training slide presentations, but you can train your staff by just sitting down and coding your hospital records in ICD-10.

Because the AHIMA has copyrighted their training materials and slide presentations, you can’t take them back to your facility or school and incorporate them into your programs. When the question was raised in the Assembly on Education community of practice (member’s only discussion board) regarding whether the AHIMA’s training materials that attendees receive at the Train the Trainer programs could be used freely for any other setting or for any other entity even within your own organization, the AHIMA clarified that the training materials (e.g., Coding Training Manual with Exercises) are copyrighted and cannot be used internally or for any other purpose. Any entity that you teach using these materials must purchase multiple sets of these training materials at a bulk rate discount.

Familiarize yourself with ICD-10 by reviewing the following free information that I compiled. You will find overlap for some of the information, but one thing you will not want to miss is the AHIMAs’ field test project done in 2003 for ICD-10. Consider my list of must-have resources:

• AHIMA’s ICD-10 page: Includes a list of all the CodeWrite issues with the ICD-10 checkpoints in them as well as other articles on ICD-10)
• AHA ICD-10 resources
• AAPC’s Web site on ICD-10
• CMS’ conference calls on ICD-10: I listened to calls from 2008 and 2009, reviewed the presentations and transcripts, and even wrote up a summary on one of the latest 2009 calls
• Excellent article on ICD-10-CM: I used this article to get my first introduction to ICD-10-CM
• Excellent article on ICD-10-PCS: I used this article for a school paper on ICD-10-PCS
• ICD-10 Coding Corner: This has multiple coding scenarios that you can practice with for free, with answers from ICD-10-CM and ICD-10-PCS.
• International Federation of Health Records Organizations’ (IFHRO) international training on ICD-10 sponsored by AHIMA Foundation Of Research and Education
• Also, be on the lookout for local AHIMA chapter training programs or local AMA/AHA training programs or local Medicare contractor training programs.