RSSAuthor Archive for Michelle A. Leppert

Michelle A. Leppert

Michelle A. Leppert, CPC, is a senior managing editor for JustCoding provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals.

In addition, she writes and edits the HCPro publication, Briefings on Coding Compliance Strategies. Email her at

It’s time to have the talk with your surgeons

TipsWe’re officially three months (okay, 91 days) away from ICD-10 implementation, so you need to give your surgeons a quick introduction to ICD-10-PCS.

Do NOT try to teach them to code. That’s not the idea. (And really we don’t want them coding. That’s our job.) Instead, talk to them about what information they need to document so coders can build an ICD-10-PCS code.

During your respectful, non-combative conversation, you will probably hear the surgeons say they don’t care about ICD-10-PCS.

I completely understand why some surgeons don’t care about ICD-10-PCS. It’s hospital coding and they will still be paid based on CPT® codes. That doesn’t mean they get to opt out of ICD-10-PCS.

Getting surgeons up to speed does not have to be a negative experience. Physicians are not evil and they are not the enemy. Most of them want to do the right thing and at the same time provide the best possible quality care for their patients.

So make it simple for them. Many surgeons use templated notes for their common procedures. Great. Find out what information is not included in the template and work with the surgeons and your IT department to update the template to capture all of the information you need for a PCS code.

Ask them to explain what they’re doing. Ask what they mean by certain terms. Many of them will be happy to share their expertise.


Here there be monstrous tumors

shutterstock_51169732Jurassic World is ruling the box office, so I thought I would use another blast from the past for the blog. Archeologists in Peru recently uncovered the skeleton of a teenage girl in a historic cemetery of the Chapel of the Divino Niño Serranito de Eten.

Big deal, right? A skeleton in a cemetery. Well, this particular skeleton included something extra—83 strange bits of bone and 37 oddly shaped teeth in her abdominal cavity.

That’s not something you see every day. Archeologists believe the extra bones and teeth represent the remains of an ovarian teratoma, a usually benign tumor in the ovary that contains various tissues including hair, teeth, and bone.

While this teratoma is really old, physicians still see these growths today. In fact, mature cystic teratomas account for 10-20% of all ovarian neoplasms. As a reminder, a neoplasm can be benign or malignant. By definition a neoplasm is new, abnormal growth of tissue.

If this girl came in to the Fix ‘Em Up Clinic, how would we code her condition?


Disemboweling documentation difficulties

shutterstock_46900594Richard came in to see Dr. Guts complaining of severe abdominal pain, nausea, vomiting, and blood in his stool. Dr. Guts sends Richard for a battery of tests and discovers Richard suffers from a Meckel’s diverticulum.

When we look up diverticulum, Meckel’s in the ICD-10-CM Alphabetic Index, we find two nonessential modifiers with the entry:

  • Displaced
  • Hypertrophic

Nonessential modifiers are supplementary words that may be present or absent in the statement of a disease or procedure without changing code assignment. It doesn’t matter if Dr. Guts includes the words “displaced” or “hypertrophic” in the diagnosis. We’re still reporting the same code (Q43.0).

The only time we would use a different code for Meckel’s diverticulum is if Dr. Guts states the diverticulum is malignant. In that case, the ICD-10-CM Alphabetic Index instructs us to “see Table of Neoplasms, small intestine, malignant.”

You probably noticed that our diagnosis code falls within the congenital malformations, deformations and chromosomal abnormalities chapter of ICD-10-CM. A Meckel’s diverticulum is a pouch on the wall of the lower part of the intestine that is present at birth, making it congenital. Patients may not have symptoms until years later.


CMS releases quick start guide for ICD-10

news blocksMultiple surveys have shown that physician practices are lagging behind in preparation for ICD-10.

CMS recently released a Quick Start Guide that outlines five steps healthcare professionals should take to prepare for ICD-10 implementation.

The steps include:

  • Make a plan
  • Train your staff
  • Update your processes
  • Talk to your vendors and health plans
  • Test your systems and processes

The guide does break the steps down further to include specific tasks involved in completing each step.

None of these steps are revolutionary or new. Hospitals have been working through them for years. However, some physician practices have put off implementation plans either because of resources or the changing implementation date.

What is a coding error?

guy with question marks (2)The American Medical Association (AMA) is pushing for a two-year safe harbor for physicians so the doctors won’t be penalized for “errors, mistakes, and malfunctions relating to the transition.”

That’s pretty vague language (something coders hate). What exactly constitutes an “error” or a “mistake”? Is it something as simple as reporting H65.01 (acute serous otitis media, right ear) when you should have reported H65.02 (acute serous otitis media, left ear)? I can see that happening. I can also see a lot of coders reporting H65.00 (acute serous otitis media, unspecified ear).

Incorrect or unspecified laterality is a simple mistake, probably caused by lack of familiarity with the codes or a lack of documentation. The payment isn’t going to change, so you may think of it as “no harm, no foul.” And you would be right, to a point. A problem could arise when the patient comes in for a follow-up visit and the physician is checking the wrong ear. The patient may remember and correct the physician or maybe not.

Not all errors or mistakes are so minor. Consider what happens when you report I13.2 instead of I31.2.


ICD-10 is going to the birds

9588217310_a412dbedd0_zMary decided to take advantage of a break in the rainy weather to head out and do some bird watching. The birds, however, were in no mood to be watched.

Mary first came upon a warbler nest with four (almost) cute baby birds. While she was oohing and ahhing over the babies, momma warbler returned (or maybe it was daddy warbler) and attacked. Warblers aren’t very big birds, but they can pack a wallop when they start pecking you.

Mary suffered multiple puncture wounds from the bird’s beak. To code Mary’s puncture wounds, we need to know where they are. ICD-10-CM breaks injuries down by the body area, not the type of injury like ICD-9-CM.

For Mary’s bird attack, we could use the following codes (depending on our physician’s documentation):

  • S01.342A, puncture wound with foreign body of left ear, initial encounter
  • S51.031A, puncture wound without foreign body of right elbow, initial encounter
  • S61.032A, puncture wound without foreign body of left thumb without damage to nail, initial encounter


Flaws in the AMA’s latest plan

CadusiusSometimes the logic of the American Medical Association (AMA) escapes me. Okay, most of the time, I have no idea what the people at the AMA are thinking. Take the organization’s continuing crusade to kill ICD-10.

During its House of Delegates meeting Tuesday, the AMA approved a resolution asking for a two-year grace period for ICD-10 coding, so that physicians would not be penalized for “errors, mistakes, and/or malfunctions of the system.”

The resolution further instructed the AMA to educate members about ways to cancel payer contracts and move to a cash-only practice. The problems associated with that plan are staggering. Yet the AMA resolved to aggressively promote this cash-only option to “protect patients’ access to care and physicians’ practices.”

I’m not sure how going to a cash-only practice protects patients’ access to care.

My parents live in rural Western Pennsylvania. We don’t even have a stop light in my hometown, that’s how rural we are. The nearest healthcare providers are 10-15 miles away. Like most retired folks, my parents are on a fixed income. They have Medicare as well as another insurance plan. Some of Dad’s medical care is provided free by the Veterans Administration, but he does have a primary care provider in private practice that he sees as well.


Alabama Senate joins anti-ICD-10 bandwagon

The Alabama state Senate passed a Joint Resolution urging Congress to delay the October 1, 2015 ICD-10 implementation. In and of itself, the resolution means very little. States cannot override the federal government, so Alabama can’t opt out of ICD-10. If a majority of states pass similar resolutions, though, that could catch Congress’ attention.question marks

The resolution follows a disturbing trend. The American Medical Association (AMA) has been very vocal this week renewing its opposition to ICD-10. The House of Delegates voted to request a two-year grace period on ICD-10 codes that would allow physician practices to be paid even if they make coding errors. The AMA also resolved to explain how to break payer contracts and move to a cash-only practice.

Alabama’s state medical association posted a blog entry encouraging a delay in ICD-10 implementation. In the post, the medical association again raises the specter of more codes and what a burden those additional codes will be.

Guess what? No physician or coder is ever going to use all 68,000-plus ICD-10-CM codes. Not gonna happen. So who cares that ICD-10-CM has four times as many codes as ICD-9-CM?

Williams Jefferson Terry, M.D., a Mobile, Alabama urologist who spoke during the House Energy and Commerce Health Subcommittee in February, for one. [more]

AMA wants to join Cooperating Parties

CadusiusThe American Medical Association (AMA) is trying to get a seat at the ICD-10 table by resolving to request inclusion as one of the Cooperating Parties.

Mind you, today’s resolution at the AMA annual meeting does not mean the AMA is backing down from its fight against ICD-10. It also passed a resolution calling for a two-year grace period for physician coding (more on that in another post).

Currently four Cooperating Parties develop the ICD-9-CM and ICD-10-CM/PCS Official Guidelines for Coding and Reporting as well as the American Hospital Association (AHA) Coding Clinic for ICD-9-CM and AHA Coding Clinic for ICD-10-CM/PCS. The current Cooperating Parties are:

  • AHA
  • CMS
  • National Center for Health Statistics (NCHS)

The four current Cooperating Parties “only allow certain physician groups and individuals to serve as ‘advisors’ on ICD-9-CM or ICD-10-CM,” according to the AMA’s resolution.

The resolution also states that the Cooperating Parties deliberate and make final decisions as to how ICD-9-CM and ICD-10-CM is constructed and interpreted “in secret without direct physician input and control influencing the final decisions and without the publication of minutes outlining their reasoning, perpetuating the gaps between the provider and the coder.”


Meet the new blogger

We’re very excited to add a new voice to the ICD-10 Trainer blog family. I’ve (cough, cough) volunteered Steve Andrews to write for the blog. The joys of being the boss.

Steve joined HCPro and JustCoding two years ago and currently oversees the outpatient side of JustCoding. In addition, he writes and edits Briefings on APCs, HCPro’s outpatient newsletter. Steve also moderates webcasts, edits books, and manages an additional weekly enewsletter, APCs Insider.

Steve is still getting to know the staff at the Fix ‘Em Up Clinic and the Stitch ‘Em Up Hospital, so they may not send him records to code just yet. However, Steve has plenty to say about the upcoming transition to ICD-10.

Look for Steve’s first post coming soon!