All Entries Tagged With: "ICD-9-CM"

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!

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!

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?

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.