While working on various projects related to ICD-10-PCS, I have discovered many areas where I think coders are going to struggle because the rules either go against the way we code now in ICD-9-CM...
CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator procedures at the standardized inpatient rate as part of the calendar year 2012 Outpatient Prospective Payment System final rule. In addition, CMS finalized several changes regarding payments for 11 cancer centers, drug payment calculations, and physician supervision. Jugna Shah, MPH, and Kimberly Anderwood Hoy, JD, CPC, explain the changes facilities will see in 2012.
The ultimate goal of fetal surveillance is to prevent fetal death. Part of this process is a fetal non-stress test (FNST), the monitoring of the fetal heart rate in response to fetal movement. Lori-Lynne A. Webb, CHDA, CCS-P, CCP, CPC, COBGC, details what the FNST includes and how to code for it.
CMS added four new J codes for reporting drugs and biologicals that previously did not have specific codes available as part of the 2012 Outpatient Prospective Payment System updates ( Transmittal 2376 ).
The AMA added a total of 60 new codes throughout the surgery section of the 2012 CPT ® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section. Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, and Christi Sarasin, CCS, CCDS, CPC-H, FCS, highlight the significant changes for 2012.
QUESTION: The 2012 CPT ® Manual includes the typical time physicians spend at the bedside and on the patient’s hospital floor or unit for initial observation care codes 99218, 99219, and 99220. Do these codes only apply when the counseling and/or coordination of care support the respective 30/50/70 minutes of time? Do you know if CMS has published any new guidelines related to these times?
The 2012 ICD-10-CM updates include significant narrative changes for primary malignant neoplasms overlapping site boundaries and malignant neoplasm of ectopic tissue, as well as smaller narrative...
Coders should already be familiar with the 285 new, revised, and deleted ICD-9-CM codes that CMS finalized for fiscal year (FY) 2012. However, it’s critical that providers also examine how these changes directly affect MS-DRG assignment. Robert Gold, MD, examines a number of these changes, including MS-DRG assignment related to cardiac-specific comorbidities, autologous bone marrow transplants, excisional debridement, and thoracic aneurysm repair.
Medicare Advantage plans rely on the Hierarchical Condition Categories (HCC) system for reimbursement. HCC payments are linked to the individual health risk profiles for the members in the plan. MA Plans use ICD-9-CM codes as the primary indicators of each member’s health status. Therefore, it is essential for MA plans to make sure that providers capture the complete diagnostic profile of patients through accurate and complete physician coding. Holly J. Cassano, CPC, explains why coders need to have a complete understanding of the HCC process and risk adjustment, as well as the effects on the provider, the member, the MA plan, and overall reimbursement.
When Jim Brown, FHFMA, RHIA, CCS, started working at Jefferson Regional Medical Center in early November 2010, he quickly realized that there were a number of opportunities to improve their health information management operations and efficiencies. In this article, Brown shares strategies and tips for how he and his management team were able to identify areas that needed improvement and reduce department expenses and come in 9.5% ($149K) under budget for the end of fiscal year 2011.
Although the New Year marked the deadline for Version 5010 compliance, CMS recently reminded providers that it will not exercise enforcement until April 1, 2012. Despite the 90-day discretionary period, CMS urged providers that they should complete the transition to Version 5010 as soon as possible. This extension will not have any effect on the implementation date for ICD-10-CM/PCS, which remains set for October 1, 2013.
QUESTION: A patient had an aneurysm at arteriovenous (AV) fistula, and the physician excluded the aneurysm between two clamps, ends oversewn, and excised the aneurysm. The physician used a tunneler to tunnel an 8 mm Flixine graft from the arterial to the venous side, and two end-to-side anastomoses were then performed at the vein and arterial end. Should we report code 39.42 (revision of AV shunt for renal dialysis) with code 38.63 (other excision of vessel), or code 38.43 (resection of vessel with replacement), or another code(s)?
Learn about CMS' bundled payment initiative, computer-assisted coding, the need to scrutinize physician documentation, and new Medicaid rules, and save the Briefings on Coding Compliance Strategies 2011 Index for future reference.
Our coding experts answer your questions about determining ED visit level, coding open reduction and internal fixation of a radius fracture, and coding image-guided minimally invasive lumbar decompression.
Fortunately for providers, CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator (CRT-D) procedures at the standardized inpatient rate. The agency announced its decision as part of the CY 2012 OPPS final rule released November 1, 2011.
In this month's issue, you will find in-depth anaylsis of the OPPS Final Rule and a discussion on how to properly set charges to avoid payment reductions. In addition, we continue our occassional series of ICD-10 anatomy refreshers with the eye and our experts answer your coding questions.
Removal sounds like it should be an easy root operation in ICD-10-PCS. Removal means taking something out, right? Physicians remove things all the time—your appendix, a cyst, the toy your son stuck...
When a physician frees a body part from an abnormal physical constraint by cutting or by use of force, coders will use the root operation release (N) in ICD-10-PCS. Keep in mind, though, that you...
The Medicare Code Editor (MCE) is software that detects and reports errors in the coding on claims that are submitted for payment. All Part A inpatient discharges and transfers pass through the MCE...
In ICD-10-PCS, coders assign the root operation bypass (third character 1) when the surgeon’s objective in the procedure is to reroute the contents of a tubular body part. Bypass procedures includes...
In the medical and surgical section of ICD-10-PCS, character 5 refers to the approach or method used to reach or expose a body part during a procedure. As a result, coders will need to look for...
CMS recently posted a file that identified duplicate codes within the ICD-9-CM and ICD-10-CM systems. The list isn’t terribly extensive, but in this atmosphere of transitioning from one system to the...
Looking for the 2012 ICD-10-CM code updates? Want to see what's included in the final regular update before implementation? Check the CMS’ ICD-10-CM and GEMS website. CMS posted the 2012 ICD-10-CM:...
Get ready to say goodbye to Coding Clinic for ICD-9 , and hello to Coding Clinic for ICD-10 . The AHA will cease publication of its ICD-9 guidance, but is already planning for an ICD-10-CM/PCS...
For those who work in environments where codes from category V57 (care involving use of rehabilitation procedures) are a staple, you be surprised to learn that when it comes to ICD-10-CM, all V57...
Late effects are considered to be the residual effects after the acute phase of an illness, disease, or injury. Typically, late effects are considered chronic conditions and can result from the...
CMS’ Office of E-Health Standards and Services (OESS) won’t enforce compliance with the HIPAA 5010 transaction set until March 31, 2012, the agency announced November 17 . The 90-day delay will not...
The American Medical Association (AMA) House of Delegates voted to “work vigorously to stop implementation of ICD-10” during the closing session of its semi-annual policy-making meeting November 15...
Coders are sharpening their knowledge of anatomy and physiology and honing their ICD-10-CM/PCS skills. The HIM department is getting ready for the transition, but did you remember to explain it to...
I had the opportunity to attend the American Health Information Management Association convention this year in Salt Lake City, and I helped work in HCPro's exhibitor booth. As a former HIM director...
Will the new ICD-10-CM concept of using seventh character code extensions to identify initial encounters vs. subsequent encounters cause additional confusion in relation to professional services, for...
Representatives from the American Hospital Association (AHA), the American Health Information Management Association, and the Centers for Disease Control and Prevention will discuss ICD-10...
As I continue to learn more and work with ICD-10-PCS codes, I find myself questioning the ancillary service codes in ICD-10-PCS. In my experience as an inpatient facility coder, I know that there are...
Coders will use the root operation division when the physician plans to cut into, transect, or otherwise separate all or a portion of a body part. Do not use division if the physician plans to cut or...
2013 is right around the corner. Learn how to kick start your hospital-wide ICD-10 educational plans. During this live 90–minute audio conference, our expert speakers will walk you through two...
As an AHIMA ICD-10 certified trainer, I have been doing a lot of work on various ICD-10 projects. When it comes to working with the new coding system, I find myself wondering whether the first ICD-10...
Coders should focus on chest pain, among other areas, as part of a larger review of ICD-9-CM codes and in preparing for ICD-10-CM. Coding chest pain in ICD-9-CM requires the physician to document the...
5010. That’s the cool way of saying Version 5010 of the Accredited Standards Committee (ASC) X12. It is the next version of the HIPAA electronic transaction standards that providers and all HIPAA...
Coders will find they need more information to select the appropriate code in chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue [M00–M99]) of the ICD-10-CM Manual. Most of the...
Over the summer, I was in the process of going through the American Health Information Management Association Academy for ICD-10-CM for trainers. I had completed the online, self-paced part of the...
Another new term coders will need to know for ICD-10-PCS root operations is fragmentation. Fragmentation is breaking solid matter in the body into pieces. Note that in a fragmentation procedure, the...
When should a coder report multiple procedures performed during a single operative session in ICD-10-PCS? Look to the official guidelines for information. According to the guidelines, coders should...
These days it seems like a new ICD-10 tool is waiting for you around every corner. Be sure to periodically check different organization's websites, as many of them are constantly updating information...
Do you remember the Y2K scare? Vendors and information technology staff were entranced with making upgrades to computers and information systems months in advance to make sure that the internal...
Some of the removal root operations can easily be confused with other root operations that involve taking out solids, fluids, or gases from a body part (e.g., drainage, extirpation, and fragmentation...
The CDC updated the terminology used to describe asthma in ICD-10-CM to reflect the current clinical classification of asthma. In ICD-9-CM, asthma is described as extrinsic or intrinsic. In ICD-10-CM...
Given the many differences between the ICD-9-CM and ICD-10-CM/PCS system and the thousands of new codes that will be used, all skilled-nursing facility (SNF) and homecare agency staff members...
A step-by-step approach to code assignment is helpful when trying to understand the complexity of ICD-10-PCS. Step one: Determine the first character, which denotes the general category of the...
When I hear "YouTube," I think of video clips of babbling babies, stupid pet tricks, and “don’t try this at home” stunts. But did you know that CMS is now on YouTube? Who’d a thunk it! They even have...
I’m not really crazy about the title of this blog post, but that’s how the adage goes. Once you get used to something, like ICD-9-CM for example, change is met with resistance. I don’t want to think...
When we think of all of the steps we have to take to get ready for ICD-10 implementation, missing one step in the planning process could cause chaos in your facility. Don’t forget about 5010! Your...
If an excision involves cutting out a portion of a body part, and a resection involves cutting out all of a body part, what then is an extraction? According to the ICD-10-PCS guidelines, an...
Will physician documentation be specific enough so coders can select the most appropriate code in ICD-10-CM/PCS or will coders be defaulting to unspecified codes? For starters, don't dwell on details...
With ICD-10-PCS, coders will have 31 root operations to choose from and not all of them are clear cut. Start learning the root operations now to prepare you for the switch to ICD-10-PCS. The ICD-10-...
One of the things that has concerned me about ICD-10-CM is the lack of guidance regarding sequencing. Since the American Hospital Association announced that it would not be converting Coding Clinic...
If you haven’t already done so, now is a good time to look at your system capabilities and see what you need to update or upgrade before the transitions to HIPAA Version 5010 and ICD-10-CM/PCS. Start...
As a kid, do you remember playing the game where you sat round in a circle and one person whispered a phrase in the ear of the person sitting next to them, and that person passed it along until...
CMS created the following four podcasts based on the January 12 national provider call, “Preparing for ICD-10 Implementation in 2011:” Welcome and ICD-10 Overview Implementation Strategies for 2011...
So the transition to ICD-10-CM/PCS is still more than two years away, and it’s too early to start learning actual codes. But you can start reviewing some of the major concepts of ICD-10-CM/PCS with...
ICD-10-PCS codes include one digit for the root operation that the provider performs. The root operation is always the third character is the seven-character code. The definitions of these root...
Well, CMS apparently wants to make sure everyone tests the HIPAA Version 5010 transaction sets. CMS previously announced two national testing days, and is adding 5010 testing week. CMS scheduled 5010...
CMS recently posted the 2012 ICD-10-PCS codes and coding guidelines . A summary of the major changes for 2012 states that there are 1,182 new codes, 381 revised titles, and 1,345 deleted codes. In...
You’ve probably heard that it’s too early to start learning ICD-10-CM/PCS codes. After all, the codes are still in draft format. However, it’s not too early to start learning the root operations for...
With 2013 seemingly so far away, many post-acute care organizations, including long-term care facilities, homecare agencies, and hospices, have not started their ICD-10 coding training. Many want to...
The complexity and costs of the switch to IDC-10-CM/PCS will vary by the size of the organization. A large, multi-facility health system needs to review more areas and plan more changes than a five-...
I attended the live portion of the American Health Information Management Association ICD-10-CM training in Baltimore last week. It is definitely not for the faint-hearted! It was a good overview...
As I look at the ICD-10-CM codes and take into consideration some of the possible documentation issues we might face, one of the questions that comes to mind is are we actually taking a step backward...
General Equivalency Mappings (GEMs) are crosswalks between ICD-9-CM and ICD-10-CM codes. They are a helpful way to start looking for a code when you move from ICD-9-CM to ICD-10-CM. But GEMs are not...
Right now only one in five hospital claims is fully paid without a payer request for more information, according to a RAND Corporation report. With the upcoming transition to ICD-10-CM/PCS, providers...
One of the things that I like about the ICD-10-CM manual is use of the vertical gray bars in the Volume II “Alphabetical Listing for Diseases.” This greatly enhances the ability to see how far the...
Certification in this day and age has become a vital part of obtaining and proving proficiency in coding and other related fields. Many years ago, coders did not have to be certified to secure...
Just when I thought that ICD-10 would resolve those annoying coding guideline and definition inconsistencies, I have discovered that some will still exist in ICD-10, too. Oh no—say it ain’t so! The...
Small rural facilities that haven’t yet started planning for ICD-10-CM/PCS shouldn’t panic yet, but they also shouldn’t delay much longer, says Jeff Wieters, RHIA, senior technical advisory...
I have been doing this workout program called P90X. It’s a challenge, and I’m not nearly as faithful to it as I should be. There is one segment called “Ab Ripper X,” during which our fearless leader...
CMS will host a national provider teleconference, "CMS ICD-10 Conversion Activities," on May 18, 1 - 2:30 p.m. EST. Presenters will discuss the ICD-10 conversion process currently taking place within...
When teaching ICD-9-CM coding, I often use a little ditty, “sprains and strains are the same,” to remind myself that when a physician documents “strain,” I need to start with the main term of “sprain...
Many of the speakers at the AHIMA’s ICD-10 Summit April 11-12 in Baltimore stressed the importance of working together. Physicians, coders, and information technology folks all need to work together...
Getting clinicians onboard and trained for the transition to ICD-10-CM/PCS will be one of the biggest challenges for most facilities, according to Patricia A.C. Hildebrand, MSN, RN, AHIMA-approved...
Coding productivity will decrease at least initially with the switch to ICD-10-CM/PCS. But do you know how productive your coders are now? If the answer is no, consider following the example of Mary...
As most people in the healthcare industry know, the conversion to ICD-10-CM/PCS isn’t the only initiative organizations are trying to implement. So where does the ICD-10 conversion fit within your...
When it comes to training staff members for the upcoming transition to ICD-10-CM/PCS, not everyone has the same needs or characteristics. They don’t even belong to the same group of shareholders...
The current versions of the X12 Version 4010/4010A1 transaction standards lack certain functionality that are pertinent to the healthcare industry. By now, health plans, healthcare clearinghouses,...
Coders are discussing whether they need to be trained in ICD-10-CM only or should they also receive training in ICD-10-PCS. Well, the answer may depend on what setting you are currently employed in,...
One of the things I have always liked about ICD-9-CM is that no matter how poor the documentation, if a code requires a fourth and/or fifth digit the manual always gives what I call the “out” by...
The 2011 ICD-10-CM Official Guidelines include several changes relating to the correct coding for neoplasms. Chapter 2 of the ICD-10-CM contains the codes for most benign and all malignant neoplasms...
I saw a question posted recently regarding the inclusion or exclusion of Workers Comp, property, casualty, and auto under the CMS mandate to implement ICD-10. My first reaction was why wouldn’t they...
HCPro is conducting research into how organizations are assessing their ICD-10 readiness. Click the link below to participate. http://www.zoomerang.com/Survey/WEB22C5AE44S33/
The American Health Information Management Association (AHIMA) recently posted on its ICD-10 webpage a Top 10 List: Phase One . In early 2011, Phase I (first quarter 2009–second quarter 2011) of the...
ICD-10-CM/PCS now has guidelines for reporting conditions that are present on admission (POA). As part of the 2011 guidelines updates, CMS and the National Center for Health Statistics added Appendix...
As we work toward the implementation of ICD-10 in 2013, strategic opportunities for change abound. Remember all those items that have remained static on your operational wish list? Perhaps you can...
As a regulatory specialist, I find myself asking my students, fellow coders, and other colleagues (e.g., clinical documentation improvement specialists) where they are in terms of preparation for ICD...
The Centers for Disease Control (CDC) posted the new 2011 guidelines for ICD-10-CM on its website. You won’t find many significant changes to conventions, general coding guidelines, and chapter...
CMS has posted two new frequently asked questions (FAQs) about ICD-10 national provider teleconferences and the partial code freeze. To access these FAQs, please visit the CMS ICD-10 webpage , click...
Before you can think about implementing ICD-10, you need to be sure your numerous Hospital Information Systems (HIS) and Practice Management Systems (PMS) are upgraded for the change. It can be a...
As many of you know, before we switch to ICD-10-CM/PCS, we first will be transitioning to HIPAA Version 5010. In fact, that date is less than one year away. By January 1, 2012, providers need to be...
This series of entries will not follow a random bi-weekly topic but will focus on the chronological transition to ICD-10 readiness. My intent is to dispel myths and compare real-world experience in...
