All Entries Tagged With: "ICD-10"

Questions to ask your IT team

During a November 17 virtual meeting hosted by the American Health Information Management Association (AHIMA), co-presenter Laurine Johnson, MS, RHIA, CPC-H, director of HIM services at Ingenix, gave the following list of questions you should ask your information technology (IT) team to prepare for ICD-10 implementation:

• How does 5010 impact my ICD-10 implementation?
• Which databases contain ICD-9-CM codes?
• Which software packages include ICD-9-CM codes?
• Which interfaces include ICD-9-CM?
• What reports contain ICD-9-CM codes?
• How does ICD-10 impact my electronic health record?
• How many vendors are involved with the software, databases, connectivity, and interfaces?
• What are the vendor plans for implementing ICD-10 and how does it impact this organization?
• Should we convert data from ICD-9-CM to ICD-10? Should we convert ICD-10 data to ICD-9-CM codes?
• Does software need to be upgraded or replaced?
• What will be the capital and operating budget impact?
• What is the testing plan?

Have you already consulted with your IT team regarding ICD-10 implementation? Are there other questions you would add to this list? Were you surprised to hear any of the answers your IT team provided? Share your feedback, and post a comment!

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.

AAPC releases code translator tool

You’ll be happy to add this code translator to your collection of ICD-10 tools. The American Academy of Professional Coders (AAPC) released on October 20 a free ICD-10-CM online code conversion tool, which you can use to map ICD-9-CM codes to ICD-10-CM codes. The tool is based on the General Equivalency Mapping files CMS has posted on its Web site.

It’s incredibly easy to use the tool. First, you indicate whether you want to convert from ICD-9 to ICD-10, or from ICD-10 to ICD-9. Then you simply type in the code you want to look up.

For some codes, you’ll get fairly simple translations. Consider the following examples:

• When you look up ICD-9-CM code 277.81 (Primary carnitine deficiency), you get ICD-10 code E71.41 (Primary carnitine deficiency).
• When you look up ICD-9-CM code 577.2 (Cyst and pseudocyst of pancreas), you get ICD-10 codes K86.2 (Cyst of pancreas) and K86.3 (Pseudocyst of pancreas).

For other codes, the translations are more complex. When you look up ICD-9-CM code 424.0 (Mitral valve disorders), you get the following ICD-10 codes:

• I34.0 (Nonrheumatic mitral [valve] insufficiency)
• I34.1 (Nonrheumatic mitral [valve] prolapse)
• I34.2 (Nonrheumatic mitral [valve] stenosis)
• I34.8 (Other nonrheumatic mitral valve disorders)
• I34.9 (Nonrheumatic mitral valve disorder, unspecified)

As a disclaimer, the AAPC advises those using the tool to keep in mind that while many ICD-9 codes map directly to ICD-10 codes, some may require a clinical analysis to determine which code(s) should be selected for the appropriate mapping.

So give it a try, and post a comment to let us know what you think about the AAPC’s tool. Happy mapping!

AHIMA posts ICD-10 practice briefs

On October 2, the American Health Information Management Association (AHIMA) posted three new practice briefs related to ICD-10 on its Web site. Click on “All current practice briefs in chronological order by publication date, and then access the three briefs:

• ICD-10-CM/PCS Project Management Resources
• Transitioning ICD-10-CM/PCS Data Management Processes
• Planning Organizational Transition to ICD-10-CM/PCS

It can be a challenge sifting through all the ICD-10 information out on the Web these days,  deciding what’s fluff and what’s not. Trust me–you don’t want to miss out on these valuable nuggets from the AHIMA. For example, consider this excerpt from the “Planning Organizational Transition to ICD-10-CM/PCS” practice brief:

The transition and post-implementation period will likely require parallel coding support. Assessing coder workload and preparing for the compliance date will assist in reducing the variability and backlog as the transition occurs. To begin planning, management can assess the potential impacts and areas of weakness by determining:

• What to communicate to the medical staff about documentation
• What companies can be subcontracted for coding and when this process should begin
• What phasing out of just-in-time ICD-9-CM coding will mean to the organization
• The best coders to assist in phasing out cases up to September 30, 2013
• Any temporary changes to time-off policies and their implications leading up to the compliance date
• If one set of coders will conduct the phase out or if each coder participates once October 1, 2013, arrives

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.

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.