All Entries Tagged With: "ICD-9"

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files that I use and just know that a few of the codes in the answers in the AHIMA text I reference above may be outdated.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.

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.

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?

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?

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.

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.

Monitor CMS’ ICD-10 Q&As

With all the complexities related to the implementation of ICD-10, it’s no wonder that so many in the healthcare industry have a number of questions related to the various aspects of this new coding system. While the list of questions and answers posted on this CMS Web page is not as extensive as you might hope, CMS has addressed a number of common queries and provided helpful links within the posts. Consider the following Q&A:

QUESTION: Are there any instances when there is no translation between an International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code and an International Classification of Diseases, 10th Edition (ICD-10) code? How do the General Equivalency Mappings handle this situation?

ANSWER: Yes, there are instances where there is not a translation between an ICD-9-CM code and an ICD-10 code. When there is no plausible translation from a code in one system to any code in the other system, the “No Map” flag indicates this. For example, the following codes are marked with the “No Map” flag:

• ICD-10-CM code Y71.3 – Surgical instruments, materials and cardiovascular devices (including sutures) associated with adverse incidents, which 
• ICD-9-CM procedure code 89.8 – Autopsy, which has no reasonable translation in ICD-10-Procedure Coding System.

For more information on this subject, see page 16 of the publication titled Procedure Code Set General Equivalence Mappings ICD-10-PCS to ICD-9-CM and ICD-9-CM to ICD-10-PCS 2009 Version Documentation and User’s Guide. The User’s Guide is posted in the Downloads Section within the file labeled “2009 Mapping – ICD-10-PCS to ICD-9-CM and ICD-9-CM to ICD-10-PCS; and User Guide, Reimbursement Guide, Diagnosis, and Procedures.”

On May 19, CMS hosted a conference call during which it addressed in further detail the use of General Equivalence Mappings (GEMs). The CMS representative said they had about 6,000 registrants for the call, so it looks like many of you are in planning mode, which is great news! A transcript of the call will be available on the CMS Web site soon.