Register for CMS education call on HIPAA Version 5010

CMS will host its third national Medicare fee-for-service (FFS) education call on HIPAA Version 5010 on September 9, from 2 p.m. to 3:30 p.m.  Providers will need to transition to this new transaction standard to be ready for ICD-10 implementation in 2013. Learn more about this vital switch to HIPAA Version 5010 by accessing a recent JustCoding.com story.

The presentation will cover:

• Medicare FFS error handling transactions (TA1, 999, and 277CA)
• Planned use of each transaction
• Applicable rules and exceptions for the Medicare FFS program

It’s important to note that this presentation is geared toward billing software programmers or developers that reside within provider organizations. So if you’re a medical coder or HIM staff member, it’s important that you pass this information along to your IT department.

You must register for the call. If you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

To register for the call participants need to:

• Go to http://www2.eventsvc.com/palmettogba/090909
• Fill in all required data
• Verify your time zone is displayed correctly the drop down box
• Click “Register”

You will be redirected to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation e-mails.

A few days prior to the call, check the Educational Resources page on CMS’ 5010 Web page to obtain a copy of the presentation that will be used during the call. Participants will have an opportunity to ask CMS experts questions during a Q&A session following the presentation.

Registration will close at 2 p.m. ET on September 8 or when available space has been filled.  

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?

Note changes for OB codes in ICD-10

Even though it’s still early to start studying and learning ICD-10 codes, at this point you should at least take a look at codes you commonly assign to get a sense of the changes and to see whether there are any significant differences regarding coding conventions.

For example, note Chapter 11 in the ICD-9 Manual, “Complications of Pregnancy, Childbirth, and the Puerperium.” This chapter will be Chapter 15 in ICD-10. Rather than reporting codes according to the episode of care, coders will report pregnancy codes by trimester in ICD-10.

Currently under ICD-9, pregnancy coding is defined by the following episodes of care:

• Unspecified
• Delivered
• Antepartum

However, coders will report pregnancy codes in ICD-10 based on the stage of pregnancy:

• First trimester
• Second trimester
• Third trimester

According to ICD-10 guidelines, trimesters are counted from the first day of the last menstrual period, and they are defined as follows:

• First trimester: Fewer than 14 weeks, zero days
• Second trimester: Fourteen weeks, zero days to fewer than 28 weeks, zero days
• Third trimester: Twenty-eight weeks, zero days until delivery

Have you taken a look at the codes you will most frequently report for your specialty in ICD-10? Share your quick tip for your specialty codes.  Did any of the new codes or the code descriptions surprise you? What interested you most about the changes?

Share your ICD-10 questions, tips, and strategies

What is your organization doing to plan for the transition to ICD-10? Have you formed an ICD-10 implementation committee? Have coding staff members attended any recent educational sessions, such as the free Webinars the American Academy of Professional Coders (AAPC) receently sponsored? If so, what feedback did they have to share? What did they learn?

Aren’t you curious to hear what others are doing to tackle this transition?

We want to hear your story! We want to share your questions about ICD-10 as well as your strategies for making the transition as seamless as possible. Submit your comment and learn from others in the industry.

ICD-10 is more specific than ICD-9 most of the time, but not always

It is widely known that ICD-10 is going to be much more specific than ICD-9. While that is true, there are some ICD-9 codes that will not be as specific in ICD-10. Here are two examples:

ICD-9 codes:

• 010.90 Primary tuberculous infection, unspecified
• 010.91 Primary tuberculous infection, bacteriological/histological exam not done
• 010.92 Primary tuberculous infection, bacteriological/histological exam unknown (at present)
• 010.93 Primary tuberculous infection, tubercle bacilli found by microscopy
• 010.94 Primary tuberculous infection, tubercle bacilli found by bacterial culture
• 010.95 Primary tuberculous infection, tubercle bacilli confirmed histologically
• 010.96 Primary tuberculous infection, tubercle bacilli confirmed by other methods

ICD-10 code:

• A15.7 Primary respiratory tuberculosis

ICD-9 codes:

• 635.50 Legally induced abortion, complicated by shock, unspecified
• 635.51 Legally induced abortion, complicated by shock, incomplete
• 635.52 Legally induced abortion, complicated by shock, complete
• 636.50 Illegal abortion, complicated by shock, unspecified
• 636.51 Illegal abortion, complicated by shock, incomplete
• 636.52 Illegal abortion, complicated by shock, complete

ICD-10 code:

• O04.81 Shock following (induced) termination of pregnancy

Have you accessed the General Equivalence Mapping (GEM) tool on the CMS Web site to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS? Did you think the GEM was useful?

Have you established your implementation timeline?

In a recent JustCoding.com mini-poll, we asked subscribers the following question:

Has your organization established a timeline for the transition to ICD-10? This is the breakdown of the 151 responses:

• Yes: 8%
• We’re planning the timeline now: 23%
• No, but we feel like we have plenty of time: 52%
• No, and we feel like we’re falling behind: 17%

However, a July 31 article on HealthLeaders Media stated the following:

Industry experts have repeatedly said that ICD-10 implementation must begin immediately in order for hospitals, health plans, and vendors to meet the October 1, 2013 compliance deadline. But now there is detailed evidence to prove it.

On July 20, the North Carolina Healthcare Information and Communications Alliance, Inc., (NCHICA) and The Workgroup for Electronic Data Interchange (WEDI) released a timeline that quantifies each ICD-10 preparation task in terms of the number of days it will take to complete.

NCHICA and WEDI estimate it will take providers nearly 1,286 work days to implement ICD-10. For vendors, it will take nearly 1,521 work days to complete. And the clock is ticking.

Has your organization established a timeline for implementing ICD-10? Do you feel like you have plenty of time, or are you starting to feel like you’re falling behind?

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?

Surely trainers need exposure to ICD-10 now, but who should train the trainers?

How much ICD-10 training are you ready for today?  The American Health Information Management Association states:

It would be impractical and a waste of resources and time to start training coders now on the specific updates to the code sets. Coders should be trained much closer to the 2013 implementation date so the updates are fresh when they need to start using them.

I understand that philosophy. If you don’t use it, you lose it. However, we can’t all wait until 2013 for training. Certainly key people, such as trainers, ought to be exposed to the new coding system now. My question is, how far in advance of the October 2013 implementation date should you wait to receive training? Will your organization send a few staff members for training ahead of sending the bulk of your department for training? Will your organization have a few people attend education sessions and then come back and train the rest of your coders? When you seek training, what kind of experience do you want the instructors to have? Would you be comfortable learning about ICD-10 from someone who just learned the new coding system six months prior?

Coders weigh in on potential freeze of coding systems

In a previous blog, I discussed how CMS was considering freezing updates to the ICD-9-CM and ICD-10 coding systems prior to the October 1, 2013 implementation. Many in the industry have said that freezing the codes would:

• Make it easier to develop educational materials for the implementation without worrying about updating them each year
• Help vendors develop products

In the ICD-10 final rule, CMS said that it would take this issue to the ICD-9 Coordination and Maintenance Committee meeting in September and seek input from various providers and vendors and others regarding the following points:

• Should there be a freeze?
• If so, should it be of both ICD-9 and ICD-10 or one or the other? 
• When should the freeze begin? For example, should October 1, 2012 be the last time ICD-9-CM codes and ICD-10-CM and PCS codes are updated? Or should a freeze be established as early as 2011? 

We polled JustCoding News subscribers in June, and we wanted share the results.

Should CMS freeze updates to ICD-9 codes, ICD-10 codes, or both prior to ICD-10 implementation? This is the breakdown of the 179 responses:

• ICD-9 codes: 22%
• ICD-10 codes: 5%
• Both ICD-9 and ICD-10 codes: 33%
• I don’t think CMS needs to freeze updates prior to ICD-10 implementation: 40%

If CMS decides to freeze updates to ICD-9 and ICD-10 codes, when should it implement this freeze? This is the breakdown of the 143 responses:

• October 1, 2011: 44%
• October 1, 2012: 56%

What do you think about a potential freeze of ICD-9 and ICD-10 code updates?

Transaction standard 5010’s vital role in switch to ICD-10: Check out new CMS Web site

Although the health care community is primarily focusing on the implementation to ICD-10 in 2013, a critical step before the new coding system takes effect is the switch to transaction standard version 5010. On July 17, CMS launched a Web site that includes information about HIPAA transaction standard version 5010, which providers must implement by January 1, 2012.

The new CMS Web site also includes information related to:

• Version D.0: The new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions
• Version 3.0: A new NCPDP standard for Medicaid pharmacy subrogation

It also includes a link to an FAQ that addresses many common questions related to the new 5010 transaction standard.

On June 9, CMS hosted a national education conference call for Medicare fee-for-service providers titled, “HIPAA Version 5010 – What you need to know!” that addressed Medicare’s implementation of the new standard. The transition to HIPAA 5010 is a necessary prelude to the implementation of ICD-10 in 2013.

Access a recent JustCoding news brief to learn more about Transmittal 495 in the One-Time Notification Manual, which addresses requirements and deadlines for 5010 implementation.

What steps have you taken to address the move to transaction standard 5010?