HIMSS Urges CMS to Maintain ICD-10 Adoption Date

<br /> <section class="body"> <div style="text-align: justify;"> The Healthcare Information and Management Systems Society (HIMSS) has <a href="http://www.himss.org/content/files/HIMSS_LetterHHS_CMS_ICD10Recommendations.pdf">submitted a lette</a><a href="http://www.himss.org/content/files/HIMSS_LetterHHS_CMS_ICD10Recommendations.pdf">r</a> to Secretary Kathleen Sebelius and Acting Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner to reiterate strong support for maintaining the October 1, 2014 revised date for nationwide adoption of ICD-10.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> In its Feb. 7 letter, HIMSS urged CMS to “send a strong message that ICD-10 has already been thoroughly vetted, will be implemented on the regulatory date, and that we must move forward with the nationwide implementation of ICD-10 by the current adoption date of October 1, 2014 in order to realize the significant advantages of healthcare transformation." Advantages cited in the letter include: </div> <ul> <li style="text-align: justify;">Enhanced patient experience</li> <li style="text-align: justify;">Emphasis on health IT as the groundwork for overall healthcare transformation</li> <li style="text-align: justify;">Quality of population health and healthcare delivery improvement</li> <li style="text-align: justify;">Eliminating waste by improving clinical and business intelligence</li> <li style="text-align: justify;">Cost savings in avoiding loss of billions of dollars in already-invested efforts in preparing for ICD-10.</li> </ul> <div style="text-align: justify;"> HIMSS outlines its considerable education efforts to support providers and provider organizations with ICD-10 transition, including its ICD-10 Playbook and the HIMSS/Workgroup for Electronic Data Interchange (WEDI) ICD-10 National Pilot Program currently in development. HIMSS also notes that the “improvement and standardization of electronic transactions has already proven to be a beneficial cost savings to the industry and must continue progress in this area or we stand to lose these savings.”</div> <div style="text-align: justify;"> HIMSS strongly encourages CMS to avoid any further delays in the ICD-10 adoption date, and noted that any further delays in ICD-10 will only signal that CMS is not serious about administrative simplification and HIPAA requirements.</div> </section>

ICD 10 Updates ICD-10 coding skills HIMSS Urges CMS to Maintain ICD-10 Adoption Date

The Healthcare Information and Management Systems Society (HIMSS) has submitted a lette r to Secretary Kathleen Sebelius and Acting Ce...

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ICD-10 Spotlight: Know the codes (Coding Convention/Guideline: Excludes1 and Excludes2, and Borderline Diagnosis Codes)

<div dir="ltr" style="text-align: left;" trbidi="on"> <br /> Each month, AmeriHealth will feature an example of how ICD-9 codes will translate to ICD-10 codes. We will present coding examples from different specialties and popular disease categories to demonstrate the granularity that the new ICD-10 code set will provide.<br /> <br /> <br /> <div class="subhead"> <b><i>CODING CONVENTION/GUIDELINE</i></b>: <b>Excludes1 and Excludes2, and Borderline Diagnosis Codes</b></div> <div class="subhead"> <b><br /></b></div> <div class="subhead"> Similar to ICD-9, there are coding conventions, general guidelines, and chapter-specific guidelines in ICD-10. These conventions and guidelines are rules and instructions that must be followed to classify and assign the most appropriate code. As with ICD-9, adherence to these guidelines is required under the Health Insurance Portability and Accountability Act (HIPAA). Many of the conventions and guidelines in ICD-9 are the same in ICD-10. This article will focus on a new Coding Convention: Excludes1 and Excludes2, and a new General Coding Guideline: Borderline Diagnosis Codes.</div> <br /> <div class="subhead2"> Excludes1 and Excludes2</div> <div class="subhead2"> <br /></div> As in ICD-9, a variety of notes appear in both the Alphabetic Index and Tabular List of ICD-10. These types of notes consist of inclusion notes, excludes notes, code first notes, use additional code notes, and cross reference notes. ICD-10 incorporates two types of excludes notes: Excludes1 and Excludes2. Each type of note has a different definition for use but are similar in that they indicate codes excluded from each other are independent of each other.<br /> <br /> <div class="subhead2"> EXCLUDES1</div> <br /> <ul>A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" It corresponds with what the current ICD-9 Excludes note indicates. An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 note is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.</ul> <ul><b>K51.4 - Inflammatory polyps of colon</b><br /><b><br /></b> <b><i>EXCLUDES1:</i></b><br /> <ul type="disc"> <li>adenomatous polyp of colon (D12.6)</li> <li>polyposis of colon (D12.6)</li> <li>polyps of colon NOS (K63.5)</li> </ul> </ul> <div class="subhead2"> <b>EXCLUDES2</b></div> <br /> <ul>A type 2 Excludes note represents "Not included here." An Excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.<br /><b>J37.1 - Chronic laryngotracheitis</b><br /> <b><i>EXCLUDES2:</i></b><br /> <ul type="disc"> <li>acute laryngotracheitis (J04.2)</li> <li>acute tracheitis (J04.1)</li> </ul> </ul> <div class="subhead2"> <i><b>Borderline Diagnosis*</b></i></div> <div class="subhead2"> <i><b><br /></b></i></div> If the provider documents a "borderline" diagnosis at the time of discharge, the diagnosis is coded as confirmed, unless the classification provides a specific entry. If a borderline condition has a specific index entry in ICD-10, it should be coded as such. Since borderline conditions are not uncertain diagnoses, no distinction is made between the care setting (inpatient versus outpatient).<br /> <br /> <b><i>Examples of Specific Borderline Entries:</i></b><br /> <ul type="disc"> <li><b>F60.3</b> Borderline personality disorder</li> <li><b>R41.83</b> Borderline intellectual functioning</li> <li><b>H40.021</b> Open angle with borderline findings, high-risk, right eye</li> </ul> <div> <table border="0" cellpadding="0" cellspacing="0"><tbody> <tr valign="top"><td rowspan="5" width="749"><div id="content"> For additional information related to the AmeriHealth transition to ICD-10, please visit the <a href="http://www.amerihealth.com/icd10" rel="nofollow">ICD-10</a>section of our website. On this site you will also find other examples of how ICD-9 codes will translate to ICD-10 codes in the <a href="http://www.amerihealth.com/pdfs/providers/claims_and_billing/icd_10/icd_10_spotlight_ah.pdf" rel="nofollow">ICD-10 Spotlight: Know the Codes </a>booklet<span style="font-family: Arial;">.</span></div> </td><td rowspan="5" width="24"></td></tr> </tbody></table> </div> </div>

icd 10 codes ICD 10 latest Articles ICD 10 Training ICD 10 Updates ICD-10 codes ICD-10 coding skills ICD-10 Spotlight: Know the codes (Coding Convention/Guideline: Excludes1 and Excludes2, and Borderline Diagnosis Codes)

Each month, AmeriHealth will feature an example of how ICD-9 codes will translate to ICD-10 codes. We will present coding examples from di...

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Putting ICD-10 into Practice: Coding exercises and scenarios

<div dir="ltr" style="text-align: left;" trbidi="on"> <br /> <div style="text-align: justify;"> The ICD-10 Spotlight: Know the codes feature that appeared throughout Partners in Health Update last year was designed to communicate various coding conventions, general guidelines, and chapter-specific guidelines in ICD-10. These conventions and guidelines are rules and instructions that must be followed to classify and assign the most appropriate code. As with ICD-9, adherence to these guidelines is required under the Health Insurance Portability and Accountability Act (HIPAA).</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> As announced in the January 2013 edition of Partners in Health Update, we have introduced a new feature called Putting ICD-10 into Practice: Coding exercises and scenarios. Each month this feature will help you put the new guidelines and conventions you learned about last year into practice. If needed, use the ICD-10 Spotlight: Know the codes booklet for assistance with these exercises. An answer key is provided below so you can verify if your answers are correct. In addition, a list of code narratives is included to describe each ICD-10 code.</div> <div style="text-align: justify;"> <br /></div> <b><i>Coding exercises</i></b><br /> <b><i><br /></i></b> <b><i>Code the following conditions according to ICD-10 coding conventions and guidelines:</i></b><br /> <br />     Borderline glaucoma<br />     Congestive heart failure due to hypertension<br />     HIV positive status without symptom<br />     Urinary frequency<br />     Morbid obesity with a BMI of 42 in an adult<br />     Congenital red cell aplastic anemia<br />     Cleft palate involving both the soft and hard palate with bilateral cleft lip<br />     Severe persistent asthma with acute exacerbation<br />     Fatigue fracture of vertebra, lumbar region, and subsequent encounter for fracture with delayed healing<br />     Interstitial cystitis due to E. coli with hematuria<br />     Sleep-related teeth grinding<br />     Non-conclusive HIV-test finding in infants<br /> <br /> <b><i>Coding scenario</i></b><br /> <b><i><br /></i></b> <b><i>Code the following scenario according to ICD-10 coding conventions and guidelines:</i></b><br /> <br />  Jane and John Doe were shopping at the mall the day after Thanksgiving to take advantage of the sales. While rushing for the newest iPhone, John fell down the stairs. Thankfully, John sustained only minor abrasions to his right elbow.<br /> <br /> <b>Narratives</b><br /> <br /> The following are the corresponding code narratives for each of the ICD-10 codes in the answer key for the coding<br /> exercises and coding scenarios:<br /> <div style="text-align: left;"> <br />    H40.001: Preglaucoma, unspecified, right eye<br />    I11.0: Hypertensive heart disease with heart failure<br />    Z21: Asymptomatic human immunodeficiency virus [HIV] infection status<br />    R35.0: Frequency of micturition<br />    E66.01: Morbid (severe) obesity due to excess calories<br />    Z68.41: Body mass index (BMI) 40.0 – 44.9, adult<br />    D61.01: Constitutional (pure) red blood cell aplasia<br />    Q37.4: Cleft hard and soft palate with bilateral cleft lip<br />    J45.51: Severe persistent asthma with (acute) exacerbation<br />    M48.46xG: Fatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with delayed healing<br />    N30.11: Interstitial cystitis (chronic) with hematuria<br />    B96.20: Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere<br />    G47.63: Sleep-related bruxism<br />    R75: Inconclusive laboratory evidence of human immunodeficiency virus [HIV]<br />    S50.311A: Abrasion of right elbow, initial encounter<br />    W10.9xxA: Fall (on) (from) unspecified stairs and steps, initial encounter<br />    Y92.59: Other trade areas as the place of occurrence of the external cause</div> <br /> For additional information related to the AmeriHealth transition to ICD-10, please visit the ICD-10 section of our website. On this site you will find examples of how ICD-9 codes will translate to ICD-10 codes in the ICD-10 Spotlight: Know the codes booklet. In addition, you will find examples of ICD-10 coding exercises and scenarios in the Putting ICD-10 into Practice: Coding exercises and scenarios booklet.<br /> <br /> <br /> <span style="font-size: x-small;">Answers to coding exercises:</span><br /> <span style="font-size: x-small;">1) H40.001 2) I11.0 3) Z21 4) R35.0 5) E66.01, Z68.41 6) D61.01 7) Q37.4 8) J45.51 9) M48.46xG 10) N30.11, B96.20 11) G47.63 12) R75</span><br /> <span style="font-size: x-small;"><br /></span> <span style="font-size: x-small;">Answer to coding scenario:</span><br /> <span style="font-size: x-small;">S50.311A, W10.9xxA, Y92.59</span><br /> <span style="font-size: x-small;"><br /></span> <span style="font-size: xx-small;">Source: http://provcomm.amerihealth.com/ProvComm/ProvComm.nsf/a1bebce7a0e985578525791f006068b2/9f5ff82dcbd251bf85257b05005125a8!OpenDocument</span><br /> </div>

icd 10 codes ICD 10 latest Articles ICD 10 Updates ICD-10 codes ICD-10 coding skills Putting ICD-10 into Practice: Coding exercises and scenarios

The ICD-10 Spotlight: Know the codes feature that appeared throughout Partners in Health Update last year was designed to communicate var...

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How to Prepare For Documentation Changes and Improvements with ICD-10

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="Categorydesc" style="line-height: 17px; padding: 5px 20px;"> <div style="text-align: justify;"> Although the final rule on the proposed ICD-10 deadline change has not been published yet, it is important to continue planning for the transition. ICD-10 will require an increased granularity and specificity in documentation of patient encounters. This change will mean that providers and payers need to adjust how they document patient visits but will create more detailed data that can be used to improve patient care. More specific code sets can also assist providers avoid delays in reimbursement payments by identifying why certain claims are being rejected or denied by payers.<br /> <br /> <b>You will need to prepare for these changes in clinical documentation by taking certain steps:</b></div> <ol> <li style="text-align: justify;"> <b>Inventory Systems and Identify Discrepancies:</b> You should review your systems that currently use ICD-9 in order to identify areas in your revenue cycle, reimbursement rates, health information management, electronic medical records, and clinical systems that will eventually use ICD-10.  These systems will be affected by the increased specificity of documentation as well as the increase in number of codes used in ICD-10. Your systems inventory will need to evaluate any potential gaps in clinical conditions or work flow processes that could be affected by increased documentation. Once you have identified any discrepancies, you can update and modify your systems and processes prior to transitioning to the new code sets. This will save your organization time by finding incomplete or non-specific data and ensuring that they do not cause a delay with coding and billing when you finalize implementing ICD-10. <br />  </li> <li style="text-align: justify;"> <b>Evaluate Current Software Systems:</b> As you conduct your systems inventory, you may realize that some of your systems have become out-of-date or are redundant. You will need to determine if it is more cost-effective and efficient to upgrade these systems or centralize and replace them before ICD-10 implementation.<br />  </li> <li style="text-align: justify;"> <b>Train and Educate Staff:</b> Your organization should identify staff members, from providers to coders, who currently use ICD-9 codes. Staff who will now be using ICD-10 will need training to become familiar with the increased documentation standards necessary with the new code sets. Training will help staff members become comfortable with both the heightened specificity and increased number of code sets that they will be using frequently.  <br />  </li> <li style="text-align: justify;"> <b>Test the Documentation Process: </b>Finally, your organization will need to test each stage of the new documentation process in a trial setting. Staff members should simulate a typical patient encounter in its entirety to ensure that data is being documented thoroughly and consistently. This will also help identify any areas that still require improvement in the coding process.</li> </ol> </div> </div>

ICD 10 latest Articles icd 10 pcs reference manual ICD 10 Training ICD 10 Updates ICD-10 codes ICD-10 coding skills icd-10 implementation training How to Prepare For Documentation Changes and Improvements with ICD-10

Although the final rule on the proposed ICD-10 deadline change has not been published yet, it is important to continue planning for the ...

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Practice Makes Perfect When It Comes to ICD-10

<div dir="ltr" style="text-align: left;" trbidi="on"> Though the implementation deadline delay for ICD-10 came as a disappointment to health information professionals, it may actually be a blessing in disguise. This extra year provides HIM and other industry professionals with a window of opportunity to perfect one’s ICD-10 skills.<br /> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> According to AHIMA’s 2011 ICD-10-CM/PCS Transition: Planning and Preparation Checklist, “Hospital inpatient coding staff will require an estimated 50 hours of ICD-10 education because they will need to learn both ICD-10-CM and ICD-10-PCS.” CMS cited these same numbers in the proposed “HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS” published January 16, 2009 in the Federal Register.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <b><span style="font-size: large;">Training is Not Enough</span></b></div> <div style="text-align: justify;"> Many vendors are using this 50-hour inpatient training benchmark as the foundation for their ICD-10 training programs. However, training is not enough. Training teaches key concepts in ICD-10-CM and ICD-10-PCS. It does not teach a coder the application of these concepts to the ongoing coding of actual or simulated cases. That comes with practice.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> In order to become expert coders, HIM professionals will need to practice coding records as a part of weekly coding activities until ICD-10 is implemented. This practice should be planned and scheduled to ensure all coders have the opportunity to perfect their skills over the next 24 months.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <b>Coding managers have three options to provide this ongoing practice:</b></div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;">     Option 1: Create a library of the facility’s records</div> <div style="text-align: justify;">     Option 2: Require the coders to perform parallel coding</div> <div style="text-align: justify;">     Option 3: Use a vendor’s practice tools</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <b><span style="font-size: large;">Vetting the Practice Options</span></b></div> <div style="text-align: justify;"> Option 3 is the most cost-effective choice because it capitalizes on practice materials created and vetted by a vendor already proficient in ICD-10. When contracting with a vendor, the coding manager needs to ensure there is a significant number of inpatient and outpatient practice records encompassing the entire classification.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> The simulated records should be available through a web-based library or online practice module available to staff when they need them. The coding manager should verify the vendor’s solution provides access to each coder’s cases so the manager can identify areas of continuing weakness for each coder.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> One of the benefits of selecting option 3 is easy access to a library of simulated records or online practice modules and immediate feedback to coders as they are practicing. Another benefit is the coder will be more productive because the simulated records are structured to provide only documentation pertinent to coding the cases. The negative aspect is the vendor library cases are not formatted the same as the facility’s records.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <b>Option 1</b> can be achieved by a coding manager skilled in ICD-10 selecting ICD-9 coded cases, and then re-coding them in ICD-10 and creating a library of records with an answer key. For inpatient cases this may require 30 to 45 minutes per record.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Outpatient records may require 20 to 30 minutes per record. It is recommended that codes from all chapters of ICD-10-CM and the 31 root operations of ICD-10-PCS are included in the library. Case selections should include inpatient and outpatient cases. The coding staff can then code these cases in ICD-10 and compare their code assignments to the answer key.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <b>With option 2</b>, the coders can assign codes in ICD-10 at the same time as they are coding the record in ICD-9 for billing purposes. It is beneficial to have available a list of diagnoses and procedures including all chapters of ICD-10-CM and all root operations in ICD-10-PCS. A coding manager will need to check the ICD-10 code assignments and provide feedback regarding incorrect ICD-10 code assignments.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> The main benefit of selecting either option 1 or 2 is that the coder will be working with their own facility’s documentation. A negative aspect of option 1 is the considerable investment of time by the coding manager to select the records, code them in ICD-10, and create an answer key.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> A negative aspect of option 2 is, again, the time commitment by the coding manager to check all records coded in ICD-10 and provide feedback to the coders. These two options require the coding manager have expertise in ICD-10; otherwise, the coders could receive incorrect feedback on the coding of certain diagnoses or procedures.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> The coding manager should do a cost/benefit analysis of each of the three options in order to determine the most cost-effective option—the one producing the greatest results.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <b><span style="font-size: large;">Practice Now, Save Productivity Later</span></b></div> <div style="text-align: justify;"> Another aspect to consider when deciding to provide the coding staff the opportunity for ongoing practice is productivity. Estimates of 20 to 50 percent reduction in coder productivity are documented in numerous articles regarding ICD-10 implementation. If the coding manager provides time for ongoing practice prior to the ICD-10 implementation, the impact on unbilled days in A/R due to loss of productivity will be greatly reduced.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Any one of these three options will provide the coding manager with the tools to support the coding staff in their ongoing development of <span class="Apple-style-span" style="font-weight: bold;">ICD-10 coding skills</span>. Once the choice is made, the manager needs to commit time on a weekly basis to practice, practice, practice.</div> <br /></div>

icd 10 codes ICD 10 Training ICD 10 Updates ICD-10 coding skills Practice Makes Perfect When It Comes to ICD-10

Though the implementation deadline delay for ICD-10 came as a disappointment to health information professionals, it may actually be a bles...

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