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.

CMS posts slide presentation explaining MS-DRG conversion project

I was poking around the CMS Web site today, in the ICD-10 section of course, and I noticed a brand new page devoted to the ICD-10 MS-DRG Conversion Project. While I’ve heard different CMS representatives discuss this conversion the agency has been working on for many months now, this page provides a great deal of specifics, including a slide presentation dated September 16, which details the project and a number of what it refers to as “resolved issues.”

In this section, you’ll also find a document that describes how CMS got to this point in the MS-DRG Conversion Project. The document states:

The project was an exercise to evaluate the effectiveness of the General Equivalence Mappings (GEMs) and to learn how best to use them in converting data. The GEMs are a tool that assist in converting ICD-9-CM codes to the relevant ICD-10-CM/PCS codes (forward mapping) and ICD-10-CM/PCS codes back to the relevant ICD-9-CM codes (backward mapping). The GEMs were developed to assist CMS as well as all other data users who would need to convert ICD-9-CM data or payment systems to ICD-10-CM/PCS codes.

CMS also provides the draft ICD-10-CM/PCS MS-DRG V26 Definitions Manual in the downloads section in both text and HTML versions with condensed and full title formats.

Final ICD-10 MS-DRG logic will be subject to rulemaking.

Two timelines plot out progress toward ICD-10 and 5010

The thought of sitting down and creating an ICD-10 transition timeline from scratch can be daunting. If you want some inspiration, check out these two timelines that are posted on the North Carolina Healthcare Information and Communication Alliance (NCHICA), Inc. Web site.

These timelines were discussed at the 17th National HIPAA Summit last week in Washington, DC, during a presentation given by Stanley Nachimson, principal at Nachimson Advisors, LLC,  in Resterstown, MD, and director of the WEDI-NCHICA Timeline Project, and a former senior advisor for HIT at CMS.

• ICD-10 timeline
• HIPAA 5010 timeline

Nachimson stressed that software vendors, payers, and providers all need to take an active role in planning for the transition to HIPAA 5010.

“The key is to take a look at how your business is going to have to change,” Nachimson said during the presentation. “It makes no sense to wait for the vendor to figure out how [the transition to HIPAA 5010] is going to impact your business. Look at the changes now, and make sure your vendors support these necessary changes.”

He said that providers should have already completed their impact assessment when it comes to ICD-10, adding that most will be amazed at the number of functions that the switch to ICD-10 will affect.

“You need to be able to report the codes, but you also have to have the right documentation to support the ICD-10 codes, so you have to think of other processes that must also change,” he said. “If you haven’t started planning, you’re already behind the curve.”

3M releases ICD-10 code translation tool

On September 16, 3M Health Information Systems announced that it had released the 3M™ ICD-10 Code Translation Tool, a new software application that helps convert ICD-9 based applications to ICD-10. The software assists providers and payers in translating ICD-9 codes from existing information systems into the language of ICD-10.

“Since patient care, revenue cycle, quality and coding functions must continue during the transition, it’s essential that organizations have a comprehensive strategy for converting existing ICD-9 applications to ICD-10 based applications,” said Tom Anastasio, senior vice president of provider markets for 3M Health Information Systems. “Translating systems, reports and records—any application where ICD-9 codes are used—will provide critical information that providers and payers can use immediately to educate staff, update processes, and prepare for a successful ICD-10 implementation.”

The 3M ICD-10 Code Translation Tool can be used to convert existing systems and software applications to ICD-10, or to create customized mappings for specific business needs. The 3M ICD-10 Code Translation Tool identifies all reasonable ICD-10 alternatives for the ICD-9 codes held in an information system, and performs automated mappings where a simple one-to-one map exists. The software then isolates the remaining complex codes and provides the user with reference data to assist in fine-tuning the final conversions to ICD-10.

Under contract with CMS, 3M developed the ICD-10 Procedure Coding System (PCS) and the General Equivalence Mappings (GEMs), and produced the initial conversion of MS-DRGs to ICD-10.

Learn more about the ICD-10 Code Translation tool by accessing the 3M Web site.

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!

Knowledge of anatomy vital for ICD-10-PCS

I have always thought that ICD-9 procedure codes were very non-specific and that it is no wonder that inpatient coders don’t like CPT coding. However after looking at what is going to happen with ICD-10-PCS, I have to say that as inpatient coders, we are in for quite a challenge. Coders who work in both inpatient and outpatient coding areas are probably going to be at an advantage to those who code only inpatient records.

Over the years, I had heard that the ICD-10-PCS system was going to be more specific. After all, we are going from approximately 3,000 ICD-9 procedure codes to 72,589 ICD-10-PCS codes. However, I have never actually gone out and looked to see what does this mean when we talk about code specificity?

I took time this week to sit down and actually look at the ICD-10-PCS coding system. The ICD-10-PCS system deals with tables to give us all of the characters necessary to code the procedure.  Consider the following examples of code characters and what they indicate:

• 0 (zero): Surgical/medical
• K: Muscles
• Q: Repair
• Fourth character represents the body part (e.g., left shoulder muscle is a “6”)
• Fifth character represents approach (e.g., arthroscopic is a “4”, percutaneous endoscopic approach)
• Sixth character represents an implant (“z” is no device)
• Seventh digit represents a qualifier (“z” for no qualifier)

The tables alone require you to understand each of the digit placements and what they represent. For example, what does the field “qualifier” mean? According to ICD-10-PCS, a qualifier is used with rehabilitation and speech assessment procedures.

There are several references that are available to assist us with each of the fields necessary to code the procedure correctly, including definitions for the various surgical approaches. I found it interesting that ICD-10 refers to arthroscopic as percutaneous endoscopic. ICD-10 also defines for you the body parts because it will be necessary to know the PCS definition in order to choose the appropriate character for the body part (e.g., biceps brachii tendon is considered an upper arm tendon). You will also need to select the appropriate code to indicate the left or right side of the body. As an orthopedic coder, the biceps tendon is often a part of a rotator cuff repair and so it is easy for one to think of the biceps as a part of the shoulder when it is actually part of the upper arm.

Because inpatient coders generally are not “speciality” coders, I find myself wondering whether we are going to need more knowledge of anatomy and physiology than ever before? If so, should I be proactive in obtaining the continuing education now?

Excludes notes get a makeover in ICD-10

Excludes notes in ICD-10 will have a slightly different look.

Currently in ICD-9, there are simply excludes notes listed below codes in italic font. In ICD-10, there are two types of exclude notes:

• Excludes1: A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be reported with the code above the Excludes1 note. An Excludes1 is used to indicate when two conditions cannot occur together, such as a congenital form and an acquired form of the same condition.
• Excludes2: A type 2 Excludes note is used to indicate ”not included here.” An Excludes2 note means that the condition excluded is not part of the condition under which it is listed, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to report both the code and the excluded code together.

Consider the following ICD-10 code:

F11.2 Opioid dependence

Excludes1: opioid abuse (F11.1x) opioid use, unspecified (F11.9x)

Excludes2: opioid poisoning (T40.0x-T40.2x)

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.