Author Archive for Shannon McCall

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!

ICD-10 solves some old problems, but also creates new ones

As each day passes, we get closer to the implementation date of ICD-10-CM and ICD-10-PCS. I have been scouring the ICD-10 manual to identify things that will change (some things for the better, some not so much). For example, substance abuse/dependence codes (ICD-9-CM categories 303-305) in ICD-10 present solutions to ongoing challenges for coders but also create new issues.

In ICD-9-CM, we are given specific descriptors for the fifth digit (e.g., continuous, episodic) for substance abuse or dependence depending on the frequency of substance abuse. Do physicians usually document these specific terms? Not really. We seem to default to the fifth digit ‘0’ for ‘Unspecified’ more often than not. So what’s new and great when it comes to assigning codes for substance abuse and dependence in ICD-10-CM?

In ICD-10-CM, the only ICD-9-CM fifth digit descriptor that has a counterpart in ICD-10 is ‘in remission’. This solves one problem but leaves us with the age old issue of “once an alcoholic, always an alcoholic.” So when is it considered ‘in remission’ and when is it a history of alcoholism?

You will still need to assign codes based on physician documentation because there is a separate code for a personal history of alcohol dependence (F10.21). ICD-10-CM will get very specific in relation to alcohol abuse (F10.1xx) and alcohol dependence (F10.2xx). The 6th digits further identify the following:

• Uncomplicated
• Intoxicated
• Associated with an alcohol induced disorder
• Other specific information

Many times physicians do not document specifics such as “abuse” or “dependence.” So one note of interest is that in ICD-10-CM, coders have a new code category that indicates just alcohol use (F10.9). It excludes those conditions described as abuse or dependence.

At first, I started to think that this may cause patients to refrain (even more than they probably do now) when they provide information related to drinking habits, especially when a code can be assigned for it. But the good news is that this code is only meant to be reported for patients with current intoxication and/or alcohol induced disorders, not just simply alcohol use. The categories for drug abuse, dependence and use are set up exactly like the codes for alcohol disorders with categories for abuse, dependence and use.

ICD-10-CM will also provide additional specificity with supplementary codes for blood alcohol levels (Y90).

Y90: Evidence of alcohol involvement determined by blood alcohol level

Code first any associated alcohol related disorders (F10)

• Y90.0 Blood alcohol level of less than 20 mg/100 ml
• Y90.1 Blood alcohol level of 20-39 mg/100 ml
• Y90.2 Blood alcohol level of 40-59 mg/100 ml
• Y90.3 Blood alcohol level of 60-79 mg/100 ml
• Y90.4 Blood alcohol level of 80-99 mg/100 ml
• Y90.5 Blood alcohol level of 100-119 mg/100 ml
• Y90.6 Blood alcohol level of 120-199 mg/100 ml
• Y90.7 Blood alcohol level of 200-239 mg/100 ml
• Y90.8 Blood alcohol level of 240 mg/100 ml or more
• Y90.9 Presence of alcohol in blood, level not specified

I think this could be helpful with criminal investigations for drunk driving accidents, work accidents, and other alcohol-related disorders that can be further identified by the amount of alcohol content in the patient’s blood.

ICD-10-CM adds specificity, but it still does not solve all of the problems we encounter with ICD-9-CM, such as knowing when to assign a history of alcoholism and when to code as alcoholism “in remission.” Makes our jobs all the more interesting, right? I’ll post some other topics like this in future blog posts. Happy coding!

A coding instructor’s point of view

As I heaved my ICD-9 Manual, projector, and laptop into the overhead bin on my flight home from Atlanta this past Friday after teaching an inpatient coding boot camp, a thought occurred to me: What am I going to do when ICD-10 is released?

With about 150,000 codes (diagnoses and procedures), I wonder how small the print will be in the coding manuals? I don’t know about you, but the print is pretty small right now. A document CMS recently posted titled ICD-10-CM/PCS Myths & Facts stated that one publisher’s ICD-10 coding manual was only about two inches thick.

Consider the following numbers: In the July 2009 version of the ICD-10-CM manual, the Alphabetic Index alone contains about 1,350 pages, and the Tabular Index is about 2,350 pages! So that adds up to 4,700 pages of diagnosis codes (Volumes 1-2). If you measure the width of your current book, it is probably about two inches now with about 14,000 codes. So how do all the codes fit on the same number of pages when they are increasing by 54,000 codes? I’ll be interested to see.

Coders who work in an inpatient or hospital setting may not use a hard copy coding book these days anyway with the advent of the encoder many moons ago. But for consultants, auditors, or coders who work in an office setting, the hard copy coding book is a staple in our arsenal of resources. There are many coding professional who still routinely carry their coding manuals. Coders for physician offices will be able to choose from almost 70,000 diagnosis codes in ICD-10-CM, so some may decide to purchase coding software as an alternative to the hard copy manuals.

As a coding instructor, I think the whole methodology of teaching and learning coding will require adaptation to the times. Live coding classes may have to accommodate automated coding software as well as hard copy manuals. This is a bit worrisome because it could disrupt the flow of everyone learning using the same medium. As a strong advocate of live learning, I think remote learning options may unfortunately become more prevalent.

For those taking national coding certification exams (e.g., CPC, CCS, CCS-P), administering organizations such as the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC) will likely have to allow automated coding software for examinations. Currently, the AHIMA administers their exams on computers, but you still utilize the hard copy coding manuals to assign codes. The AAPC exams are currently on paper using the hard copy manuals. I am sure that both organizations are already working on how they can accommodate this major increase in the volume of codes in 2013 (e.g., what code books people will use, how they will access the code sets).

ICD-10 brings with it many challenges that I think will not be realized until much closer to the implementation date. Right now, it seems so far away. But as someone who will be thinking ahead about how to prepare people for ICD-10, the challenge extends beyond just knowing the code sets but also being able to use any technology that may replace the current hard copy manuals. Hospitals use costly encoders, but what about small physician offices? What will they do if the coding manual is too cumbersome?

Check out AHIMA ICD-10 resources

To prepare for the transition to ICD-10-CM and ICD-10-PCS, it may be helpful to have a list of resources that are currently available either online or in print through the American Health Information Management Association (AHIMA):

• The association’s official ICD-10-CM and PCS Web site
• Educational sessions on anatomy and physiology
• Checklist for preparation
• Articles such as the ICD-10-CM/PCS gap analysis of workflow tool (Journal of AHIMA)
• Body of Knowledge on the AHIMA website contains many relevant articles, position statements and position statements
• Codewrite contains the “ICD-10 Checkpoint,” which shows comparative case scenarios using ICD-9-CM to ICD-10-CM codes
• AHIMA Academy for ICD-10-CM/PCS Trainers workshops

As one of the four cooperating parties for ICD-10-CM/PCS, the AHIMA is a valid resource for education and information regarding ICD-10-CM. Although many of us consider it quite early to get formal training, I think reading about any related issues pertaining to the ongoing preparation will only enable us to transition easily and seamlessly to this exciting new system on October 1, 2013.

ICD-10 guideline for urosepsis illustrates need for specific documentation

One of the most poorly documented and miscoded diagnosis is when a physician documents the term “urosepsis.” Does the physician mean that the patient has a systemic infection originating from a urinary origin, or does the patient simply have a urinary tract infection (UTI)? Currently, the default ICD-9-CM code for a UTI  is 599.0.

I had mixed feelings when I saw the following guideline in the ICD-10 Official Guidelines for Coding and Reporting (2009 version) for urosepsis:

(ii) Urosepsis
The term urosepsis is a nonspecific term. It is not to be considered synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term, he/she must be queried for clarification.

The ICD-10-CM alphabetic index states:

Urosepsis – code to condition

On one hand, it will prevent (or hopefully prevent) coders from assigning a diagnosis for sepsis when the patient has only a UTI. But on the other hand, I think this will only lead to more physician queries because it is fairly common for physicians to use this term.

The implementation of ICD-10 will inherently bring with it the need for more specific documentation. With that increased need for specificity, physicians must revise their documentation for conditions such as urosepsis.

Some AHIMA training sessions already sold out

The American Health Information Management Association (AHIMA) is hosting three sessions of the “Academy for ICD-10-CM/PCS Trainers”:

• July 24 – 26, 2009 | Las Vegas, NV | Planet Hollywood Resort SOLD OUT
• September 9-11 | Chicago, IL | AHIMA National Office SOLD OUT (1st session); but AHIMA added a 2nd session
• October 8-10 | Grapevine, TX | In conjunction with the AHIMA Convention and Exhibit

I was already planning to attend the national AHIMA convention October 3-8th and thought it would be a great time to attend the “train the trainer” sessions following the convention. Why make two separate trips right? Well, I had no idea that getting a seat in one of these sessions would be such an ordeal. I was concerned about registering for the October session after seeing how the first two locations were already sold out and they were more than two months away!

So, I called the AHIMA to inquire about the number of seats they had in these sessions because they seemed to go like hotcakes. The very nice representative e-mailed me and explained that they were only allowing 50 people per session (at the time) and that registration would not be available until May 1.

I marked my calendar to make sure I registered on May 1, when the registration opened. I felt like I was a teenager waiting for the hottest concert tickets to go on sale at 8 a.m. (minus the sleeping outside in the cold – not that I have ever done that anyway!)

I logged on at 8:30 a.m. EST, and registration still wasn’t available. Of course, I now remembered that the AHIMA is in Chicago, which means they are on CT. I logged back in at 9:30 a.m. EST and was able to register. Whew! I got a seat! I was so excited.

I did notice that they have now increased the maximum number to 100 attendees.

I sure hope this training is as valuable as I expect. The price is $1,900! The AHIMA doesn’t mess around being that this education will bring in approximately $190,000 per session. I am glad it is a nonprofit organization.

I am not sure whether the reason it is such a hot commodity right now is based on the fact that attendees are being proactive to get their organization ready or whether it is because there is going to be a band wagon of people “putting out shingles” that they are AHIMA certified ICD-10-CM/PCS trainers. I know that I intend on using the knowledge to share with the thousands of students who have come to rely on HCPro for their training.