In my experience as an inpatient facility coder, I know that there are a handful of procedures that will be considered ancillary services in ICD-10-PCS when the new coding system takes effect in 2013. Things like ventilation management, insertion of nasogastric tubes, peripherally inserted central catheter and central lines, and some radiology services that relate mostly to cardiology procedures (e.g., angiography and angiocardiography in relationship to cardiac catheterizations). I know that some providers actually assign ICD-9-CM volume 3 procedure codes now for things like transfusions of blood products and vaccines.
With the development of the ICD-10 coding system, some of these procedures will actually be covered in the medical/surgical section of ICD-10-PCS, while others are found in the following sections:
- Placement (immobilization)
- Administration (transfusions)
- Measurement and monitoring
- Extracorporeal assistance and performance (ventilation management)
- Extracorporeal therapies (decompression)
- Imaging (computed tomgraphy/magnetic resonance imaging)
- Substance Abuse Treatment (detox)
All of which make me wonder, do we focus on the medical/surgical and obstetrics sections, from which come the majority of procedures that impact payment? And how much time and effort do we need to focus on the other sections such as those listed above?
In my experience working with various hospitals, not all providers code the same when it comes to those procedures that do not impact the MS-DRG system (e.g., transfusions). Some hospitals that I worked for wanted us to capture the ICD-9-CM volume 3 code 99.04 (transfusion of packed cells), whereas other hospitals that I worked for didn’t want us to pick it up, stating that it is a chargemaster issue. Therefore, it would be picked up with the CPT code on the floor/unit where the procedure occurred. As a coder, I never got into the “why’s.” I just simply followed the process set in place at the various hospitals. I often had a list that said “pick these up” or “don’t pick these up” for each hospital, and I would code accordingly.
As I work with the ICD-10-PCS system now, I wish I had a copy of those lists so that I would be able to look back on them as an educator and determine where I should focus my attention.
The inpatient coder in me says to look at what impacts reimbursement and worry about those others down the road as we get advice on whether facilities will actually be capturing data with the ICD-10-PCS code. The educator in me says that I need to know what facilities plan to do. If they are currently capturing those procedures with an ICD-9-CM volume 3 code, are they planning on continuing the process with the ICD-10-PCS code? Or will they adopt the attitude that other facilities have that if it doesn’t impact reimbursement and it is being captured with the chargemaster system, then they will not be picking it up with an ICD-10-PCS code.