All Entries Tagged With: "CMS"
Find answers to your ICD-10 questions
Over the last six months, I have noticed that the FAQ sections for different associations and organizations have increased in size and detail. Are you interested in learning the answers to the following questions:
- How soon after a code has been added or deleted will the General Equivalence Mappings (GEM) be updated to reflect these changes?
- Will there be a phase-in time period for ICD-10-CM and ICD-10-PCS where providers can use either ICD-9-CM or the ICD-10 based coding systems?
- Am I going to have to sit for my CPC (-H, -P) again to keep my AAPC credential once ICD-10-CM is implemented?
Check out the FAQ pages for the following organizations:
Check out AHIMA’s implementation preparation checklist
There are a number of ICD-10 checklists floating around out there in cyberspace, but this one created by the American Health Information Management Association (AHIMA) and included in a recent CMS presentation is one of the best ones I’ve seen. The AHIMA suggests the following checklist when performing an ICD-10 impact assessment:
- Establish interdisciplinary steering committee to oversee implementation
- Educate affected departments and individuals about the change in code sets and what it meansfor their area of responsibility (both in terms of
- preparation planning and benefits)
- Assess organizational readiness for the change to the ICD-10 code set
- Assess impact of change on organizational operations
- Assess staff education needs
- Identify reports and forms requiring modification (e.g., physician practice superbill)
- Assess extent of changes to systems, processes, policies/procedures
- Use code set change as opportunity to improve data flow, work flows, and processes
- Perform comprehensive systems audit for ICD-10 compatibility
- Determine vendor readiness and timeline for upgrading software to new code sets
- Assess quality of medical record documentation and implement documentation improvement program if necessary
- Develop implementation budget
But it’s good to look at this checklist as a skeleton upon which to build your own impact assessment because it’s easy to see how each one of these bullets could have its own subset of smaller checklists. Do you have a checklist you would like to share? Post a comment, your checklist, or the Web link to the checklist so we can all take a look!
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!
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.
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.
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?
CMS posts ICD-10 presentation for physicians
CMS recently posted on its Web site a presentation titled “Introduction to ICD-10-CM/PCS: For Physician Specialty Group Representatives.”
In addition to CMS representative Pat Brooks, a number of speakers from other organizations also led the presentation: Donna Pickett from the Centers for Disease Control and Prevention, Dr. Lee Hilborne of the UCLA Health System and RAND Corporation, Deborah Grider of the American Academy of Professional Coders (an ICD-10 Watch blog contributor), Sue Bowman of the American Health Information Management Association, and Nelly Leon-Chisen of the American Hospital Association.
In the presentation, CMS discussed information to:
- Assist in crafting messages for your members regarding ICD-10 implementation and how to begin preparing for this transition
- Describe what implementation of ICD-10 will mean for physicians’ offices
- Provide guidance on how ICD-10 implementation can be approached so as not to overwhelm the physician community
- Provide information that will reassure the physician community that implementing ICD-10 will not require changes in medical practice
- Describe common myths about ICD-10 implementation and provide accurate information
- Describe coding resources that are available
What kind of feedback have your physicians conveyed to you regarding the coming transition to ICD-10? How are you engaging physicians and getting them involved in the plan for implementation?
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.
CMS explains General Equivalency Mappings (GEMs)
CMS has created a tool that can help ease the process for mapping out equivalent codes between ICD-9 and ICD-10.
On May 19, CMS hosted an ICD-10-CM/PCS implementation and General Equivalence Mappings (GEM) national provider conference call to further explain the GEMs and how to use them. JustCoding.com recently posted a story, “CMS explains general equivalency maps to help the industry transition from ICD-9 to ICD-10,” which highlights information a CMS representative presented to explain how the agency used the GEMs to convert one major diagnostic category (MDC) in the MS-DRG system from ICD-9 to ICD-10. Click on the link above to read this story in its entirety. (You must be a JustCoding.com member to access this article)
CMS used the GEMs to convert three MS-DRGs related to inflammatory bowel disease in MDC 6 (digestive system). Using the GEMs, it found that although there are four principal diagnosis codes for enteritis in ICD-9-CM (i.e., 555.0, 555.1, 555.2, and 555.9), there were 28 equivalent codes in ICD-10-CM. From this experience, CMS determined that the GEMs were indeed effective in facilitating this conversion, said Pat Brooks, RHIA, the senior technical advisor for CMS’ Hospital and Ambulatory Policy Group.
In its General Equivalence Mapping: Top 10 Question and Answer Fact Sheet, CMS says the intended audiences for the GEMs are coding professionals, payers, providers, medical researchers, informatics professionals, and any other individuals who use coded data. These individuals can use the GEMs to convert payment systems, payment and coverage edits, risk adjustment logic, quality measures, and a variety of research applications that involve trend data.
Have you taken a closer look at the GEMs? You can access the presentation that was covered in this CMS call, the GEMs Fact Sheet, and a transcript of the call on the CMS Web site.
Let us know what you think of the GEMs and how you plan to use these tools.
