Author Archive for Christina Benjamin

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files that I use and just know that a few of the codes in the answers in the AHIMA text I reference above may be outdated.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.

Part 2: One coder’s cost-effective strategy for education

In my last blog post, I explained how I tackled the challenge of educating myself about ICD-10, realizing the significant cost that would be associated with registering for every ICD-10 Webinar, seminar, and educational session under the sun.

In addition to creating quizzes and memory aids to help myself learn ICD-10 codes, I also worked to refine my own coding reference Excel spreadsheet, which became a valuable tool and part of my daily routine.

I read through most of the 2003 Draft ICD-10-CM Official Guidelines for Coding and Reporting for Acute Short-term and Long-term Hospital Inpatient and Physician Office and other Outpatient Encounters and then I began to crosswalk a homegrown coding reference Excel spreadsheet that I currently use on a daily basis to ICD-10. My plan was to complete crosswalking my spreadsheet and then after purchasing an ICD-10 Manual, proceed to practice assigning ICD-10 codes for charts that I code on a regular basis.

I also started to incorporate ICD-10 into my daily discussions with other coders. When I answered an ICD-9 coding question, I would also provide the ICD-10 codes, especially when the discussion was about controversial, problematic issues related to ICD-9 (e.g., there is not a specific enough code). I felt that this daily application and routine of looking up of ICD-10 codes for various questions that I answer on listservs and through other informal coding discussions would get me into an ICD-10 coding frame of mind.

After that, I started to read through the ICD-10-PCS reference manual, and I started memorizing the characters for each section and body system for the procedural coding system. I also planned to create a quiz on the structural differences between ICD-9-CM Volume 3 and ICD-10-PCS. I had recently written a comprehensive training module on ICD-9-CM Volume 3 procedures, and my plan was to update that training module as well as any other ICD-9 Volume 3 reference sheets that I had.

At the beginning of 2009, I noted the updated 2009 official coding guidelines, namely  ICD-10-CM Official Guidelines for Coding and Reporting, and prepared notes detailing the differences between the 2003 and the 2009 guidelines. I also updated my coding files that I had downloaded to my desktop for daily use to reflect the new 2009 coding system.

At that point, I had heard about the possible freeze of ICD-10, so I decided to hold off on completing the conversion of my diagnosis and procedure reference sheets and training materials until at least 2010 in hopes of being able to plan around any possible freezes. Access a recent ICD-10 Watch post to learn more about this possible freeze.

I continue to code with ICD-10-CM and ICD-10-PCS when answering coding questions, and I continue to study the ICD-10-PCS reference manual. If you’re looking for a low-cost strategy for acquiring ICD-10 education, keep in mind that all of this practice using ICD-10 costs only my time.

Tune in for my next blog post, when I share some ideas for building on this foundation of knowledge.

Has your coding team come up with some cost-effective strategies for learning about ICD-10? Post a comment, and share your tips with other ICD-10 Watch subscribers.

Looking to learn ICD-10 without breaking the bank? One coder shares her strategy

Are you an educator who needs to learn ICD-10 as soon as possible so that you can be prepared to teach your students, coding staff members, or other clients and entities that you serve?

Are you working for a vendor or a third-party payer and need to know the underlying fundamentals of ICD-10 so that you can start upgrading coding software and payment systems as soon as possible?

Are you concerned that your employer may not be willing to expense the few available training programs that are currently being offered, some costing as much as $1500-$1,900?

Guess what – there is a low cost (practically free) option for comprehensive training. I am an educator and have students and clients who will be looking to me for ICD-10 education. In addition, I have set my own professional goal of being a leader on the cutting edge.

I knew that I could not waste time trying to determine whether any of my employers or clients would reimburse the costs, and being an independent consultant I certainly did not have the funds to expend $1,000 or more on training. So I decided that the best option was to educate myself.

I had already been reading and had even contributed to the American Health Information Management Association’s ICD-10 CheckPoint section in their monthly CodeWrite publication, which outlined a table comparing and contrasting ICD-9 and ICD-10 for common conditions. I had also written a paper on the structure of ICD-10-PCS for a school project. So with that background, I was determined to educate myself on both ICD-10-CM and ICD-10-PCS.

Back in July/August of 2008 when I first constructed my self-directed education plan, there weren’t nearly as many resources as there are now. I put together a list of Internet links that contained ICD-10 information.

Then I came up with a mnemonic (i.e., memory aid) to memorize all the letters that precede each section of ICD-10-CM so that I could better recognize the codes by their first letter. For example, all codes beginning with O are obstetric codes, and all codes beginning with P are perinatal codes.

As a refresher for the basic structural differences between ICD-9 and ICD-10, I prepared a quiz for myself with questions and answers pertaining to this facet. Then I started reading through the official guidelines for ICD-10, which at the time were from 2003.

I was so happy to see easier guidelines for sepsis, rheumatic heart disease, angina, myocardial infarction, and ulcers (just to name a few), and I marked up my copy of the guidelines to highlight all guidance that was different from that in the ICD-9 .

I downloaded the 2007 version of ICD-10-CM (both the index and the tabular) to my desktop so that I could readily open and reference the files at any time. I did not purchase books because I felt that it was a little too soon to do that because CMS was still updating the codes. However, I did see the need for detailed anatomy references (for bones, vessels, nerves, etc.), and I considered that I would probably invest in a detailed anatomy reference for these if I did not have access to Elsevier’s Anatomy Plates by 3M. I also considered using Gray’s Anatomy.

This is where I start to really get my hands dirty. Tune in for my next blog post, when I  describe how I dove headfirst into refining my own homegrown coding reference Excel spreadsheet — a valuable tool that had become part of my daily routine.

Have you created your own action plan for learning ICD-10? What resources did you turn to?

One ICD-10 myth debunked: Will coding books become a thing of the past?

CMS recently posted a very good document titled ICD-10-CM/PCS Myths & Facts , which clarified many myths regarding ICD-10 and specified facts upon which you should base your plan for implementation. For example, take the following myth and the corresponding fact:

Myth: There will be no hard copy ICD-10-CM and ICD-10-PCS code books. When ICD-10-CM/PCS is implemented, all coding will need to be performed electronically.

Fact: ICD-10-CM and ICD-10-PCS code books are already available and are a manageable size (one publisher’s book is two inches thick). The use of ICD-10-CM/PCS is not predicated on the use of electronic hardware and software.

I personally was told by a representative of a prominent encoder vendor that coders would have to go “all electronic” and that having code books would not be practical due to the sheer size of the volumes (I am picturing something like a volume of Oxford dictionaries). I was devastated because I never liked coding using an encoder, and I wondered how I would adapt to actually coding from an encoder alone, something I had been told all my career cannot be done (You must have the code books to verify your code choice and not rely on an encoder alone, and you must initially learn a code set using the books before going to the encoder).

I found out that this rumor of having to code using only electronic means versus code books was not true when earlier this year I was searching the American Health Information Management Association library, and I noted that a vendor was offering manuals for ICD-10-CM and ICD-10-PCS. I was shocked. I still wondered about the size of the coding books though, and I was quite amused when one coder asked whether we would have to start lifting weights to get in shape just to be able to haul these huge ICD-10 coding books.

Judging by the size of the 2009 files, which I had downloaded to my desktop for handy reference for daily coding, I figured that the books would probably be a little bigger, but not that much bigger. However, I was not completely certain of this until I read this document today. So read the CMS document, and put your mind at ease.

What other ICD-10 myths have you heard? Share your experiences so we can help put these myths and misconceptions to rest.

Understand excludes notes in ICD-10

ICD-10 will bring a lot of welcome changes and correct many of the issues and shortcomings with ICD-9. One particular source of confusion with ICD-9 relates to the excludes notes. In ICD-9, the excludes notes can mean two things:

1. Do not code both of these codes together under any circumstances (e.g., a non-obstetrics code such as 629.81 [habitual aborter without current pregnancy] with an obstetrics code such as 646.33 [habitual aborter, antepartum condition], or a component of combination code 785.4 [gangrene] with combination code 440.24 [atherosclerosis of the extremities with gangrene]).

2. A particular condition is not classified to a specific code, but the coder is directed to another code or code category for the proper code for that particular condition; however, if both conditions occur, coders should assign the code that specifies both conditions. For example, code 787.9X (other digestive system symptoms) excludes gastrointestinal (GI) hemorrhage (code 578.x); however when both GI hemorrhage and diarrhea are present, then the coder can report both codes. An additional example would be when certain neurological symptoms classifiable to the 781 code category are present but they are not due to depression (code 311), the coder can code the neurological symptoms along with 311 despite the excludes note because both conditions are present.

This is very confusing concept in ICD-9 that will not be present in ICD-10.

In ICD-10, you will find the following:

• An excludes 1 note: meaning that the two codes are never assigned together
• An excludes 2 note: meaning simply that a different code should be assigned for that specific condition

I currently use ICD-10 to resolve personal coding questions of this nature when there is no other official guidance available. For example, I was trying to determine whether or not I can code pulmonary hypertension along with essential hypertension, which has been a controversial coding question for a long time. To make up my mind as to how I was going to treat the excludes note, I checked the ICD-10 codes for pulmonary hypertension, and the type of excludes note there is an excludes 1 note. So I used that to help me decide that I will only report code 416.0 or code 401.9, but I will not report both codes together.