H.I.M. On 10: ICD-10
It’s official. The CMS grace period for ICD-10 has ended. Healthcare IT News reports on the current situation and shares insights from industry experts. Below is an excerpt of the article. Click here to read the full story >>
Hospitals gird for ICD-10 claims specificity as CMS grace period ends
Executives involved with the code switch said the first year went smoothly. But they are now expecting a new level of difficulty in the next 18-24 months while coders must be more precise for CMS and private insurers to accept and pay claims.
The first year of ICD-10 came and went without many complaints. The anxiously anticipated coder productivity issues were not as troublesome as many people expected, while claims denials and revenue disruptions were relatively minimal.
But October 1, 2016 marked another new era in the classification system: The Centers for Medicare and Medicaid Services year-long grace period, in which it accepted claims as long as they were submitted in the right ICD-10 family, came to a close and now CMS is demanding greater specificity — as are commercial insurers.
“Even with our own people we had to go through multiple passes. It’s not like the old days of ICD-9, now with so many codes and conditions, you have to go through multiple passes.” –Manny Pena, a former senior director of the health information management department for New York Presbyterian Hospital’s Columbia-Presbyterian Medical Center.
I was recently interviewed by Healthcare Finance News about a topic that’s growing in popularity: ICD-10 specificity.
Here is an excerpt below. Click here to read the full article >>
A year after the much-hyped switch to the ICD-10 diagnostic coding library, healthcare providers now face pressures to assign codes with the right degree of specificity or risk claim denials.
While the Centers for Medicare and Medicaid Services ended its grace period for unspecified codes on Medicare fee-for-service claims on Oct. 1, commercial insurers are also insisting on greater specificity. All of this comes as more than 5,000 new codes are being added to the existing code set and others are set to be deleted or revised.
“The surprise was it went smoother than we anticipated,” said Carol Paret, who led the ICD-10 transition at Memorial Hermann in Texas. “At the six- to-eight-week mark, we wondered, when is the shoe going to drop?”
But experts worry that many of the ICD-10 fears that were calmed through these various grace periods could have pushed back negative effects.
Manny Pena, CEO and founder of H.I.M. ON CALL, said he also sees that if providers are getting paid, they don’t want to know information beyond that, at least right now. Read more >>
In a recent issue of ICD10 Monitor, my colleague Cassie Milligan and I analyzed the “Top 10 Coding Killers”. For the full article with more details for each topic, click here.
As it does every year, the Centers for Disease Control and Prevention (CDC) recently released its list of the leading causes of death in the United States. With the transition to ICD-10 and new codes facing provider organizations looming on Oct. 1, 2016, what should coders be aware of regarding this list?
A Look at the List
According to the CDC’s National Center for Health Statistics (NCHS) official report, these were the top 10 leading causes of death in the United States in 2015, along with the number of deaths for each:
- Heart disease: 614,348
- Cancer: 591,699
- Chronic lower respiratory diseases: 147,101
- Accidents (unintentional injuries): 136,053
- Stroke (cerebrovascular diseases): 133,103
- Alzheimer’s disease: 93,541
- Diabetes: 76,488
- Influenza and pneumonia: 55,227
- Nephritis, nephrotic syndrome, and nephrosis: 48,146
- Intentional self-harm (suicide): 42,773
For most organizations, this list is consistent with your top DRGs and high-volume cases. But knowing the specific ICD-10 changes for each is critical.
In a recent issue of ICD10 Monitor, I analyzed the proposed 2017 IPPS rule changes and identified key areas where coders need to pay close attention. This blog provides a quick overview of the coding areas most impacted by the proposed rule changes. For the full article with more details for each topic, click here.
Cardiovascular Monitoring Devices and Pacemakers
Practices and organizations specializing in cardiovascular treatments should be alerted to a number of changes in the coding directives. Noteworthy areas are changes to the coding of monitoring device insertion and revision. Specifically, some changes proposed relate to operating room versus non-operating room procedures. Not being aware of how to properly code these changes could impact revenue stream.
There are also a number of new ICD-10-PCS code combinations to describe pacemaker procedures. CMS hopes to simplify the coding of pacemaker devices and leads with the proposed changes.
In the proposed changes, rehabilitation cases lacking a principal diagnosis code from the MDC 23 list but including a procedure code from the list of rehabilitation procedures for MS-DRGs 945 and 946, will not be assigned to MS-DRGs 945 or 946. The case will instead be assigned to a MS-DRG within the MDC where the principal diagnosis code is found. Closer scrutiny of rehabilitation coding is expected as more organizations participate in bundled payments and must closely monitor rehabilitation patients post-discharge.
Move from Surgical to Non-Surgical Procedures
Many procedures are moving from surgical to non-surgical procedures. Some categories impacted by this change include insertion of an infusion device, dilation of stomach, removal of drainage device, inspection of certain body sites, and endoscopic removal of infusion or monitoring device.
Confusing Information Regarding Pressure Injury
Coders should also be aware of a confusing shift in terminology. Pressure ulcers will be coded as pressure injuries under the proposed changes. Currently, when the coder sees a diagnosis of a pressure ulcer, he or she goes to the index to find “ulcer,” and it takes them to the correct coding section.
Once coders start seeing the terminology for a pressure “injury,” they will logically look up “injury,” leading them to a traumatic injury code. This code is incorrect for these ulcers, and it is further complicated by the possibility that coders could start adding external cause codes (also incorrectly). Look for more guidance in the months ahead for these terms.
While there are other important changes in the proposed rule, these changes carry the highest potential impact for clinical coders. Stay tuned to our “On TEN” blog for the latest news and information on ICD-10 coding.
In the June 2016 issue of the Journal of AHIMA, myself and four other industry experts defined new benchmarks and best practices for conducting ICD-10 coding audits.
The move to ICD-10-CM/PCS adds a layer of audit complexity and requirements as hospitals and health systems step up their coding quality review processes, procedures and partners. This article discusses coding audit processes and procedures using the same we had in place for ICD-9:
- Daily pre-bill second level review of all Medicare cases, hospital-acquired conditions (HACs), and mortalities
- Third-level risk adjusted clinical review for mortality cases (performed by clinical documentation improvement (CDI) specialists)
- Review of all PSIs (patient safety indicators) for validation, coding, and clinical opportunities daily by coding and CDI teams.
Read the full article to gain expert insight and advice as new ICD-10 coding patterns and trends emerge.
In a recent issue in the Journal of AHIMA, our company experts discussed the interconnected world of a global coding workforce and domestic HIM departments.
Our company began training an international coding workforce in 2012 and continued through the October 1, 2015 go-live of ICD-10. Lessons learned overseas are parlayed into best practices for coder training both here at home and abroad. The following is a summary of seven lessons learned based our global coder education experience:
LESSON #1: Coders learn at their own pace.
The majority of the company’s ICD-10 training pre- and post-ICD-10 implementation focused on ICD-10-PCS coding for complex procedures. As with domestic coders, however, offshore coders require remedial education tailored to individual strengths and weaknesses. Managers need a mechanism to monitor performance continually. It should also be noted that many offshore coders have previously worked in other areas of healthcare, including direct patient care. Take this into consideration when developing training material that capitalizes on this knowledge.
LESSON #2: Build a dedicated training department/team.
Coding managers are often too busy and distracted to be able to focus on the unique needs of coding professionals’ training. It’s important to identify one or more ICD-10 instructors who interact directly with trainees. For an international team, the instructor should reside and work within the same location as the coding professionals. It was found that an onsite coding trainer was most effective because the instructor could:
- Monitor coding professionals’ performance
- Answer questions as they arise
- Identify and refine training needs accordingly
LESSON #3: Coding credentials help maintain compliance.
Credentials demonstrate coding proficiency and a commitment to the profession. Budget for the cost of enabling all coding staff to become credentialed once they are trained–overseas or domestic. Also budget for ongoing continuing education necessary to maintain credentials and ensure compliance.
To read the full Journal of AHIMA article, click here.
The Zika virus has been all over the news lately. During a February 1 news conference, Dr. Margaret Chan, Director General of the World Health Organization (WHO), acknowledged just how serious the virus has become, describing it as “meeting the conditions for a public health emergency of international concern.” Unfortunately, neither ICD-9 nor ICD-10 include specific codes for the Zika virus. In ICD-9, coders reported code 066.3 (mosquito-borne fever NEC). In ICD-10, coders report code A92.8 (other specified mosquito-borne viral fevers). Once the partial code freeze is lifted on October 1, 2016 (if not before), we’ll hopefully get a more specific code for this condition that continues to spread.
The good news is that ICD-10 does provide more specific descriptors for other contagious and infectious diseases. Consider the following:
- Ebola. In ICD-9, coders reported code 078.89 (other specified diseases due to a virus). This vague code also included other conditions such as epidemic cervical myalgia and Marburg virus. Now, in ICD-10, we thankfully have a specific code for the Ebola virus disease—A98.4.
- Typhoid fever. In ICD-9, coders reported code 002.0 (typhoid fever). They were not prompted to report any related complications separately. In ICD-10, however, there are seven codes in the A01.0- category that denote typhoid fever. These codes include:
- A01.00 (typhoid fever, unspecified)
- A01.01 (typhoid meningitis)
- A01.02 (typhoid fever with heart involvement)
- A01.03 (typhoid pneumonia)
- A01.04 (typhoid arthritis)
- A01.05 (typhoid osteomyelitis)
- A01.09 (typhoid fever with other complications)
- Chikungunya. In ICD-9, coders reported one of two fairly vague codes—065.4 (mosquito-borne hemorrhagic fever) or 066.3 (other mosquito-borne fever). ICD-10 includes a specific code for Chikungunya virus disease (A92.0).
ICD-10 is here. Your organization’s coder productivity and DFNB have remained stable. You’ve had a few technical glitches and maybe a few denials. The transition to ICD-10 must have gone smoothly, right? Not necessarily.
How do you know whether your coding accuracy took a hit?
Consider establishing a process for auditing and monitoring using these tips:
Go back to audit basics.
Focus on coding specificity.
Be flexible as new ICD-10 guidance is published.
Conduct through assessment of your coding management and staff
Strengthen external auditing relationships.
To learn more about the importance of auditing in ICD-10, click here.
The uncertainty associated with ICD-10 has negated many fears and anxieties associated with offshore coding. Provider organizations are realizing that quality coding is quality coding, regardless of where a coder resides and works. This is a reassuring development, given the skill sets and knowledge that many offshore coders possess. Click here to learn more about how to strengthen the relationship with your outsource coding provider–particularly when bringing in offshore support.
In the How Well Do Your Coders Really Know ICD-10, ICD10 Monitor article from August 2015, I identified five best-practice steps to take during ICD-10 coding reviews and audits. As ICD-10 trouble spots emerge in November and December of 2015, coding managers should consider the following strategies to closely monitor coder knowledge, proficiency and performance.
Consider these general auditing tips to closely monitor coder knowledge, proficiency and performance:
- Ask coders to code the same cases so you have an apples-to-apples comparison using real cases and live documentation.
- Establish and use consistent answer keys with your entire coding team.
- Focus primarily on the accuracy of the principal diagnosis, as this drives MS-DRG assignment.
- Once coders have mastered the principal diagnosis, begin to audit CCs and MCCs.
- Finally, move beyond CC and MCC capture to audit any additional/secondary diagnoses.