CMS released three FAQs about ICD-10 billing, including how to bill encounters that cross the ICD-10 implementation date. That’s October 1, 2014 in case you forgot. And a claim cannot contain both...
In ICD-10-CM, the eyes get their own chapter of codes. No more sharing with the ears, hear that? One of the first things you’ll notice in the chapter on diseases of the eyes is the significant...
Betsy comes in to Stitch ‘Em Up Hospital suffering from a cerebral aneurysm. Dr. Jannettta performs a vessel embolization procedure to treat Betsy. [caption id="attachment_3480" align="alignright"...
Everyone is afraid of something. Some people are terrified of spiders. For others, the mere sight of a snake is enough to send them running in the other direction and screaming at the top of their...
Sometimes our patients are very sick, very injured, or undergo multiple procedures during their stay. So how do you pick your principal procedure code in ICD-10-PCS? The ICD-10-PCS guidelines offer...
Memorial Day kicked off the summer season and today we are seeing the first summer casualties here at the Fix ‘Em Up Clinic. Apparently not everyone’s holiday celebration went off without a hitch...
One of the advantages to coding in ICD-10-CM is how much information is packed into a single code. You’ll find combination codes throughout the ICD-10-CM Manual. In many cases, you are coding the...
Actress Angelina Jolie made headlines with her New York Times editorial explaining her decision to undergo a prophylactic double mastectomy to reduce her chances of breast cancer. She also plans to...
The ICD-10-PCS codes for 2014 are now available on the CMS website. CMS also posted the 2014 ICD-10-PCS guidelines and an ICD-10-PCS reference manual. You will find four new codes under new...
The American Medical Association (AMA) may not push for CMS to move directly to ICD-11 without implementing ICD-10 after all, according to a report of the AMA’s Board of Trustees . The report will be...
In a perfect world, inpatient facilities would receive the same payments for diseases and procedures after the switch to ICD-10-PCS. We know that won’t happen, that facilities will see some shift in...
Do you want to work harder or work smarter? We all know electronic medical records (EMR) are great in some ways, not so great in others. Drop down menus make life easier for physicians, but can also...
Planning a big bonfire for October 1, 2014, using your ICD-9-CM Manuals? You might want to think again. Not everyone is required to transition to ICD-10. Only HIPAA covered entities must begin using...
I love the ICD-10-CM external causes codes. I’m weird, I know, but I’m also a writer and I love telling good stories. When I first started coding, my boot camp instructor Peggy Blue, MPH, CPC, CCS-P...
Penny comes in to see Dr. Morang for pain in her wrist. After performing a comprehensive exam and history, Dr. Morang documents the following ICD-9-CM codes: 354.0, carpal tunnel 715.04,...
When coders begin using ICD-10-PCS the second and fourth character definitions seem simple enough: Second character-Body system Fourth character-Body part However, when coders start assigning codes,...
You know what keeps you up at night thinking about the ICD-10 transition. Have you ever wondered what causes CMS officials to lose sleep? For Denise Buenning, MsM, director of CMS’s administrative...
It was almost inevitable. The possibility of another ICD-10 delay was brought up during the AHIMA ICD-10-CM/PCS and CAC Summit in Baltimore April 24. And just as quickly as it was raised, the...
I wanted to share some interesting numbers from Torrey Barnhouse's presentation at the AHIMA ICD-10 Summit in Baltimore. Torrey is the founder and president of TrustHCS, which conducted an industry...
Trust is a basic human emotion. It allows us to explore out surroundings and grow. You can't expect grouth or change without trust. Cindy Seel, MSA, RHIA, director of education and training at HRS,...
Any healthcare organizations are considering computer-assisted coding (CAC) to help minimize the expected coder productivity decline in ICD-10. Lisa Knowles-Ward, RHIT, coding and reimbursement for...
ICD-10 implementation is only 18 months away. Sounds like a long time, doesn't it? It's really not, Kathleen Frawley, JD, MS, RHIA, FAHIMA, told attendees at the 2013 AHIMA ICD-10 and CAC Summit in...
By now you have probably heard that you need to train more than just your coders on ICD-10. Shelley Weems, RHIA, CCS, implementation lead for the Health Information Management Program Office for the...
How often do you default to an unlisted code or a non-specific code in ICD-9 because the physician just didn’t document enough information? For example, how many times do you see documentation...
Here’s a stat that will come as no surprise to most coders: approximately 50% of physicians, physician assistants, and nurse practitioners have no clue about ICD-10. Of the remaining 50%, only a very...
Editor’s note: For purposes of today’s example, we are ignoring medical necessity. We’re going to say Sidney is an inpatient. In the real world, he would need to meet the criteria for an inpatient...
Never do today what you can put off till tomorrow. Maybe that worked for Aaron Burr, but it doesn’t really work for the ICD-10 transition. I’ve seen some disturbing numbers about ICD-10 preparation...
Anytown’s baseball team just completed its home opener and while the team came away with a win, not all of the players made it through the game. Eddie the outfielder suffered a painful run-in with...
Will you be ready for ICD-10? The ICD-10 implementation date draws closer by the day and CMS wants to help you make sure you’re ready. CMS is hosting a national provider call to discuss ICD-10...
CMS Transmittal 1199 updates the national coverage determination (NCD) hard-coded shared system edits to include ICD-10-CM codes. CMS included 30 spreadsheets with the transmittal. The spreadsheets...
When last we left our intrepid hero, Luke Skywalker, he was well on the road to recovery after being bashed by a wampa and spending the night in the belly of a Tauntaun. Now he’s off to the Dagobah...
We all know that procedure coding will change considerably on October 1, 2014 with the implementation of ICD-10-PCS. But what about change as an ICD-10-PCS root operation? In ICD-10-PCS, you will use...
The first series of codes in both the ICD-9-CM and ICD-10-CM manuals are infectious and parasitic diseases. What a fun (cough, cough) place to start. The very first disease listed in the ICD-9-CM...
Based on the prevalence of commercials for acid reflux remedies, you’d think the entire country suffered from some sort of digestive disease. Maybe some of it comes from coders who are sick to their...
There’s a bigger picture to the preparation for ICD-10 than just coding productivity. The bigger picture includes doing the process improvement now that is needed to break down all barriers to...
Many musculoskeletal conditions are a result of previous injury or trauma to a site, or are recurrent conditions. If a patient presents with a bone, joint or muscle conditions that are the result of...
Last week in my blog I referred to the Gustilo-Anderson open fracture classification. Since that time I have had several readers asking for more information. With the ICD-10-CM coding of fractures...
CMS recently announced it will rename the ICD-9-CM Coordination and Maintenance Committee the ICD-10 Coordination and Maintenance Committee effective with the March 2014 committee meeting. This...
Documentation opportunities abound in ICD-10-CM Chapter 13 (musculoskeletal system). The official ICD-10-CM Coding Guidelines provide us with plenty of instructions. The guidelines include...
ICD-10-PCS includes specific guidelines for coding spinal fusion procedures, including guidelines for selecting the body part value. The body part for a spinal vertebral joint(s) rendered immobile by...
Recently, I attended a large ICD-10 planning meeting. Attendees came from four different states and covered nine hospitals. There were coding, clinical documentation improvement (CDI), and revenue...
It’s Valentine’s Day and love is in the air. So are Cupid’s arrows. Does ICD-10-CM include a code for assault by Cupid’s arrow? Not quite. The arrow itself would leave a puncture wound (probably), so...
The Workgroup for Electronic Data Interchange (WEDI) is conducting an ICD-10 readiness survey through February 20. WEDI and CMS will use the survey results to measure the: Progress of ICD-10...
So how would you like to explain this accident to your physician? Doctor, I was crossing the street wearing ice skates and was hit by a bicycle. Believe it or not, there’s an ICD-10-CM code for just...
It’s Groundhog Day…over and over in the comedy Groundhog Day. Poor Phil Connors (played by Bill Murray) does his best to escape the never-ending cycle by killing himself in some creative ways. It’s...
We’re all thinking about documentation specificity needs in ICD-10-CM/PCS as we prepare of the October 1, 2014 compliance deadline. Increased communication between physicians and coders is paramount...
Underdosing is a new coding concept in ICD-10-CM and it has its own column in the table of drugs. Underdosing can be accidental (patient forgot to take the medication) or intentional (patient chose...
Now is the best time to consider the clinical documentation initiatives you need to implement in 2013. The preparation for ICD-10 has documentation needs first and foremost on everyone’s mind. Start...
ICD-10-PCS is vastly different from the ICD-9-CM procedure codes inpatient coders currently use. By now, you probably know that ICD-10-PCS codes must be seven characters in length. The letters I and...
I am back to my ICD-10 blog following a long illness. It is great to be back! Why is it that a date ending in 2013 seems so much closer to October 2014? Others must feel this way because there seems...
Anytown got hit with some significant snowfall, which lead to some interesting injuries at the Fix ‘Em Up Clinic. Dave came in complaining of back pain after spending two hours shoveling his driveway...
Cold and flu season is in full swing, so I thought it might be a good time to look at coding for influencza in ICD-10-CM. If you look up influenza in the ICD-9-CM index, you might think we currently...
A sequela is the residual effect (condition produced) after the acute phase of an illness or injury ends. ICD-10-CM includes codes specifically designed to report sequela, such as I69.953 (hemiplegia...
Being a Jedi knight is hard work. And it’s dangerous, especially when your father is out to kill you and your friend gets encased in carbonite. Intrepid coders that we are, we will brave the frozen...
So far, we’ve covered three different ICD-10-PCS guidelines for multiple procedures. We’ve looked at how to report multiple procedures involving: Same root operation, different body parts as defined...
Happy 2013! We survived the Mayan apocalypse and received a one-year extension on ICD-10 implementation (which according to some people is more of an apocalyptic event than 12-21-12). Where do your...
The holiday presents have all been unwrapped, and while the children were (mostly) thrilled by their gifts, their parents aren’t as pleased with what happened once the kids started playing with them...
‘Tis the day before Christmas and all are not well at North Pole Industries. Ernie the head elf has lost his grip, literally. Ernie, it seems, can’t hold on to the toys he’s building. When he goes to...
It’s the end of the world as we know it and the people in the Fix ‘Em Up Clinic waiting room don’t feel fine. Apparently some people really believed that today would be the end of the world and their...
Moderation is not a term usually associated with the holiday season, as you can see from the waiting room at Fix ‘Em Up Clinic. Clark spent two days stringing holiday lights over everything: his tree...
ICD-10-PCS introduces plenty of new concepts. One that could cause coder confusion involves how to report a procedure when the physician changes the approach. The ICD-10-PCS guidelines state: If...
When you search the 2013 ICD-10-CM Official Guidelines for Coding and Reporting you will find chapter-specific guidelines for each chapter except for Chapters 3, 8, and 12. Chapter 1: Certain...
We’ve already discussed one of the multiple procedure guidelines in ICD-10-PCS, but we still have three more to go. And that’s not counting the guidelines that are not included in the multiple...
It’s the second week of deer camp and all the hunters are at Fix ‘Em Up Clinic. Moe came into the clinic with some serious frostbite. Apparently, he fell asleep in the latrine at the camp and spent...
The multiple procedure guidelines in ICD-10-PCS present possibilities for coder confusion. Several guidelines relate to the coding of multiple procedures, some under the heading of multiple...
Penny arrived at the Stitch ‘Em Up Hospital with a benign growth on her thyroid gland (ICD-10-CM code D35). The growth isn’t causing any functional problems, so we don’t need to report any additional...
Most of the odd ICD-10-CM codes, the ones that make us laugh or roll our eyes, live in Chapter 20 (External causes of mortality). Here you will find such gems as: X32, exposure to sunlight (which...
When coding for neoplasms in ICD-10-CM, coders will notice some differences in clinical documentation and sequencing. ICD-10-CM and ICD-9-CM coding for neoplams share some similarities, but ICD-10-CM...
When I first heard that the American Medical Association (AMA) is still fighting against ICD-10 implementation, I thought, “Seriously?” and rolled my eyes. In case you haven’t heard, the AMA’s House...
Black Friday marks the beginning of the holiday shopping season—and the holiday injury season at Fix ‘Em Up Clinic. Patients started showing up shortly after the stores opened this morning with...
Over the river and through the woods to the Fix ‘Em Up Clinic we go. Not exactly where our patients want to spend Thanksgiving (and neither do we), but we’re here to coding their holiday mishaps...
Do you find yourself wondering how you will ever learn everything to be ready for the ICD-10-CM/PCS compliance deadline? Does it feel overwhelming with how busy you are? The answer: Keep Calm and...
How many of you are worried about getting physicians on board with the ICD-10 transition? We all know physicians are busy people. So how do you get them engaged in learning about the increased...
You need enthusiasm and a desire to keeping learning to tackle the monumental task of learning ICD-10-PCS. In authoring an ICD-10 CM/PCS education program 10 hours per work I learn something new...
Quite a few campers took advantage of the nice weather this weekend to make one last trip into the woods before winter. Unfortunately, some of them ended up in Fix ‘Em Up Clinic as a result of their...
Do you know what you don’t know about ICD-10? Do you know where your knowledge gaps are? Unfortunately, the answer is probably no. More than half of the people who responded to our completely...
Wile E. Coyote may bill himself as a Super Genius, but based on his last visit to the ACME ED, I think that’s overstating things a bit. What landed Wile E. back in the ED, you ask? Another...
It’s All Saints Day (you know, the day after Halloween) and the waiting room at the Fix ‘Em Up Clinic is full of ghosties and ghoulies and long-legged beasties. I’m not sure if we have any things...
Hurricane Sandy blasted the Mid-Atlantic region this week, causing plenty of destruction in its wake. We could undoubtedly spend a lot of time coding for the injuries people suffered as a result of...
Inpatient coders will face a big learning curve when it comes to ICD-10-PCS. It’s a completely different system with a lot more detail than ICD-9-CM Volume 3. The biggest potential problem could be...
Anytown hosted a national ICD-10 conference this week and some of the Fix ‘Em Up Clinic’s coders attended the sessions to learn all about the new coding system. The rest of us got to meet some of the...
Getting physicians on board with the transition to ICD-10 won’t be easy, but CMS is trying to help. CMS will host a National Provider Call: Preparing Physicians for ICD-10 Implementation at 1:30 p.m...
Outpatient coders currently report procedures using CPT codes. That won’t change after the switch to ICD-10. However, some facilities currently require outpatient coders to also report procedures...
Legendary Green Bay Packers coach Vince Lombardi once described the ideal linebacker as agile, hostile, and mobile. Sadly, some of our local linebackers are significantly less agile and somewhat...
The rugby players who come into the Fix ‘Em Up Clinic are a pretty tough group. They can shrug off broken ribs, downplay dislocations, and boast about bruises. They are no match for gnats, though...
We all know coder productivity will go down after the transition to ICD-10 and it may never rebound to current levels. The question is, how much will productivity decline? It could drop more than you...
News flash: The sky is NOT falling. You don’t need to press the panic button when you think about the transition to ICD-10. It’s time to prepare, practice, and plan. The transition will be a huge...
How tired are you of hearing the phrase “documentation, documentation, documentation” as you prepare for ICD-10? I have a new phrase that you’ll soon dread as well: “Practice, practice, practice.”...
Got an ICD-10 question? Answers are coming soon. ICD-10 implementation is still almost two years away, but the American Hospital Association’s Coding Clinic will add an ICD-10 section starting in the...
Hospitals and physician practices are used to being in competition with each other and maintaing a veil of secrecy over internal operations. Well, that’s not really limited to just healthcare, it...
The transition to ICD-10 code set is expected to be one of the most substantial changes in medical coding history and providers and payers need to start preparing now. Undoubtedly, you still have...
Wouldn’t it be nice if the physician documented a definitive diagnosis for every patient at the time the patient left the office, clinic, or hospital? We know that will never happen. Sometimes, the...
Football season is underway in Anytown and we have some crazy players coming in to Fix ‘Em Up Clinic with some crazy-looking knee injuries. Quarterback Tom is in after suffering an unhappy triad of...
What do you know, bubonic plague is still hanging around. It seems like we should have eradicated it by now. Turns out, if you go to the desert southwest and play with dead animals you too can...
Dr. Cap I. Larry is back at work on some blood vessels at Stitch ‘Em Up Hospital. Let’s see what she’s up to today. For all of Dr. Larry’s procedures, we’re going to be coding from the Medical and...
Athenian philosopher Socrates famously drank poisonoud hemlock after being found guilty of corrupting the minds of the youth of Athens and of impiety for not believing in the gods of the state...
Ever have one of those nights when you just can’t sleep? Maybe you’re awake fretting about the transition to ICD-10. Or maybe you had one too many cups of coffee. Never fear, we have plenty of ICD-10...
Today we are taking a peek into OR 3 at the Stitch ‘Em Up Hospital to watch Dr. Cap I. Larry work on some blood vessels. Then we’re going to code her procedure. Dr. Larry is harvesting part of the...
By now, you probably know that ICD-10-PCS codes contain seven alpha-numeric characters. Each character represents a specific piece of information and those meanings can vary by section. In the...
If you have looked at the ICD-10-PCS Manual, you know that the codes are arranged in tables based on the first three characters of the code. The table contains all of the possible choices for...