All Entries Tagged With: "ICD-10"

AAPC to host free Webinars

The American Academy of Professional Coders (AAPC) will host later this week and next week a three-part Webinar series for providers and a two-part series for payers. These Webinars are designed to assist physicians, managers, coders, health plans, and other health care professionals toward a successful implementation of ICD-10.

These Webinars will provide implementation guidance steps to help with the transition. The Webinars are presented at no cost as a service to the health care community and will be available for download after each Webinar session for later reference. It is vitally important to begin preparing for ICD-10 now.

ICD-10 implementation amounts to much more than just asking your vendors for a software update. With the expanded specificity of ICD-10, our new coding system will change how providers document in the medical record, change medical payment policies, and may change contracting with health plans as well. It is not time to begin learning the code set, but it is time to begin planning.

Provider Webinar (Three-part series):
Part I-Thursday, July 16 (1 p.m. EST)
Part II-Thursday, July 23 (1 p.m. EST)
Part III-Thursday, July 30 (1 p.m. EST)

The provider Webinar series has already reached its limit of 1,000 registrants, however you can still register to be alerted in case space opens up. And of course, the presentation will be available soon after the series. But it’s not too late to register for the payer Webinar series.

Payer Webinar (Two-part series):
Part I-Tuesday, July 21 (1 p.m., EST)
Part II-Tuesday, July 28 (1 p.m. EST)

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.

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.

Understand excludes notes in ICD-10

ICD-10 will bring a lot of welcome changes and correct many of the issues and shortcomings with ICD-9. One particular source of confusion with ICD-9 relates to the excludes notes. In ICD-9, the excludes notes can mean two things:

1. Do not code both of these codes together under any circumstances (e.g., a non-obstetrics code such as 629.81 [habitual aborter without current pregnancy] with an obstetrics code such as 646.33 [habitual aborter, antepartum condition], or a component of combination code 785.4 [gangrene] with combination code 440.24 [atherosclerosis of the extremities with gangrene]).

2. A particular condition is not classified to a specific code, but the coder is directed to another code or code category for the proper code for that particular condition; however, if both conditions occur, coders should assign the code that specifies both conditions. For example, code 787.9X (other digestive system symptoms) excludes gastrointestinal (GI) hemorrhage (code 578.x); however when both GI hemorrhage and diarrhea are present, then the coder can report both codes. An additional example would be when certain neurological symptoms classifiable to the 781 code category are present but they are not due to depression (code 311), the coder can code the neurological symptoms along with 311 despite the excludes note because both conditions are present.

This is very confusing concept in ICD-9 that will not be present in ICD-10.

In ICD-10, you will find the following:

• An excludes 1 note: meaning that the two codes are never assigned together
• An excludes 2 note: meaning simply that a different code should be assigned for that specific condition

I currently use ICD-10 to resolve personal coding questions of this nature when there is no other official guidance available. For example, I was trying to determine whether or not I can code pulmonary hypertension along with essential hypertension, which has been a controversial coding question for a long time. To make up my mind as to how I was going to treat the excludes note, I checked the ICD-10 codes for pulmonary hypertension, and the type of excludes note there is an excludes 1 note. So I used that to help me decide that I will only report code 416.0 or code 401.9, but I will not report both codes together.

Look for ICD-10 sessions that go beyond the basics

You might be far enough along in your ICD-10 implementation timeline to attend some informational sessions that go beyond the basics. “You’re going to see more companies advertising functional learning as opposed to theoretical sessions,” says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, director of coding and HIM at HCPro, Inc., in Marblehead, MA.

Just to provide some examples, I’ll highlight two that I recently came across:

• The Workgroup for Electronic Data Interchange (WEDI) will host a conference July 28-30 in Fairfax, VA, titled, “Advancing Along the Implementation Highway: The Road Map to Success” covering implementation of the HIPAA 5010 transaction sets and the ICD-10 code sets.

“This will not be a 101-level session on the 5010 transactions or the differences between ICD-9 and ICD-10,” according to WEDI. “Instead, come prepared to discuss and develop ‘working solutions’ to business impacts in sessions that invite your input.”

HIPAA 5010 sessions will cover a range of topics, including:

1. Transactions/implementation issues
2. How to influence senior executives to make 5010 a priority now
3. What Level I compliance means
4. Medicare EDI front-end changes
5. Development of test scenarios

ICD-10 sessions will cover a range of topics, including:

1. Crosswalks
2. Testing
3. The impact assessment process
4. Project team formation and structure
5. Clinical considerations

• The Massachusetts Health Data Consortium is hosting an information session in Waltham, MA, on June 23 titled, “Preparing for ICD-10 Implementation, ” during which two CMS regional representatives will offer their thoughts on how ICD-10 will affect Massachusetts healthcare organizations. What are the implications of ICD-10 for your organization? How will it affect patient care, office efficiency, and healthcare organization revenue?

Look for similar sessions in your area. Check with local, regional, and national associations.

The 411 on HIPAA version 5010

One of the many things that will be affected in order to accommodate the ICD-10 codes is the format of electronic claims. CMS recently announced that it receives more than 99% of the Medicare Part A claims and more than 95% of the Part B claims electronically. Today, physicians submit electronic claims to Medicare using Accredited Standards Committee (ASC) X12N Version 4010/4010A1. Because the existing format lacks functionality for certain transactions (e.g., the ICD-10 reporting system), Version 5010/D.0 will eventually replace the current electronic claims version. 

Electronic communication between physicians and payers and hospitals requires that we have standardized codes to enable the electronic exchange of certain health information.

Standards exist today for eight electronic transactions and six code sets. The transactions are:
• Health Care Claims or Equivalent Encounter Information
• Eligibility for a Health Plan
• Referral Certification and Authorization
• Health Care Claim Status
• Enrollment and Disenrollment in a Health Plan
• Health Care Payment and Remittance Advice
• Health Plan Premium Payments
• Coordination of Benefits

The code sets are:
• International Classification of Diseases, 9th Edition, Clinical Modification, Volumes 1 and 2
• International Classification of Diseases, 9th Edition, Clinical Modification, Volume 3 Procedures
• National Drug Codes
• Codes on Dental Procedures and Nomenclature
• Health Care Common Procedure Coding System
• Current Procedural Terminology, 4th Edition

The ICD-9 code sets, developed nearly 30 years ago, contain approximately 17,000 codes and can no longer be adequately expanded. The ICD-10 code sets have more than 155,000 codes to accommodate advances in diagnoses and procedures. The ICD-10 and transaction rules have long been expected and must move together, as Version 5010 was designed to be used with the ICD-10 code sets. While Medicare contractors will be ready to handle the new standards and the HIPAA 5010 claim format by January 1, 2011, the compliance date for submitting claims in the new format is not required until January 1, 2012. CMS recently released a Special Edition MedLearn Matters article SE0904 that provides a high-level overview of some of the differences between the two claim formats, with additional resources.

CMS seeks feedback from the industry on a potential code freeze

On May 19, CMS hosted a conference call during which it addressed the use of General Equivalence Mappings (GEMs). A transcript of the call is now available on the CMS Web site.

CMS representative Pat Brooks, RHIA, senior technical advisor for the hospital and ambulatory policy group highlighted an important agenda item that will be discussed at the September 16-17 ICD-9-CM Coordination and Maintenance meeting.

Many in the industry have expressed to CMS that they feel it is important for CMS and Centers for Disease Control and Prevention to consider freezing updates to the ICD-9-CM and ICD-10 coding systems prior to the October 1, 2013 implementation. Many have said that freezing the codes would make it easier to develop educational materials for the implementation without worrying about updating them each year. Many people also said that they felt this kind of freeze would 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 and seek input from various providers and vendors and others on what they thought about this suggestion. CMS will pose the following questions at that September 16-17 meeting:

• 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? 

“These are the kinds of things we need to know from the industry,” Brooks said during the call. “We’ll be actively soliciting input from you to speak about whether there should be a freeze, and if so, when should the freeze be? Come to the meeting and discuss this.”

You can register for this meeting beginning August 14. Or write to CMS after the meeting, and provide your own input. Be sure to answer the following questions:

• How important would this freeze be to your organization? 
• Should ICD-9-CM and/or ICD-10 be frozen prior to ICD-10 implementation?
• When should the freeze begin?

AAPC shares perspective on coder training

Since the Department of Health and Human Services’ January announcement on the final rule for the implementation of ICD-10, many questions have popped up. Some in the industry feel that if they do not contract a trainer or a consultant to provide training right now, they will fall behind and not meet the October 2013 compliance date.

However, the American Academy of Professional Coders’ (AAPC) emphasizes that now is not the time to begin training. Will you really remember everything you’re learning in 2009 four years later in 2013? Chances are that you will not, and to make the implementation as seamless and efficient as possible, the AAPC recommends holding off on training for the time being.

Our plan is unique in that our trainers will undergo an intensive “Train the Trainer” program, which we are not opening to the general healthcare population to ensure consistency with correct information conveyed to the healthcare community.

I must reiterate that now is not the time to begin learning the ICD-10 code set. The best time to begin is late in 2012 or early 2013. The AAPC has streamlined its training curriculum into different phases, starting this summer, when the association will give a three-part, free introduction to ICD-10 implementation Webinar. For more information, visit the AAPC’s ICD-10 Web page.

Compare commonly used codes in ICD-9 vs. ICD-10

Since we have talked and read globally about ICD-10, I thought we should turn the pages a little deeper and look at some commonly used codes and see what they will look like October 1, 2013, when the new ICD-10 coding system takes effect. I selected codes for essential hypertension and elevated blood pressure reading.

There are some significant changes. The terms “benign, malignant, and unspecified” will no longer be used in defining the code selection. Also, another big change is that it appears the hypertension table is not used in ICD-10.

I took the codes in the current 2009 ICD-9 Manual and compared them to the most recent ICD-10-CM codes available. I created a table to illustrate the breakdown of this comparison.

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.