Last week the Centers for Medicare & Medicaid Services (CMS) announced, in cooperation with the American Medical Association, an agreement not to audit and penalize practices for incorrect ICD-10 coding as long as a valid code in the correct category is reported for one year after ICD-10 goes live on Oct. 1, 2015. CMS also developed a document to... Read more...
A joint announcement issued on July 6, 2015, by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) tackled a number of ICD-10 issues in an effort in ease the burden for physician practices transitioning to ICD-10. While this effort addressed several important issues, at the same time it raised other important questions...Read more...
“Lately it occurs to me what a long, strange trip it's been.” No sooner had custodians cleaned up the remaining debris from the three-night “Fare Thee Well” concert by the Grateful Dead at Chicago’s Soldier Field last week than the Centers for Medicare...Read more...
Project managers (PMs) understand that the key elements of the ICD-10 project—making a plan, training your clinical staff, updating internal processes, communicating with vendors and payers, testing internal systems, and testing externally are all table stakes: Doing well in these areas is no guarantee of success, regardless of the facility size...Read more...
October, 15 2013 / Kim Carr
Roseanne Barr once said that she likes facts and data because they help her think clearly. With dual coding, it is easy to rationalize the reasons and justify the means. But what really matters is the output. Dual-coding efforts must produce useful information to prepare your organizations for ICD-10. Measuring, monitoring, and tracking dual-coding data ensures that investments in time, money, and staff produce a solid return. Business intelligence gleaned from dual-coding data helps accurately measure ICD-10’s productivity, quality, and financial impacts. With dual coding already underway, now is the time to build your arsenal of ICD-10 data... Read more...
April 27, 2015 / Laurie M. Johnson, MS, RHIA, CPC-H, FAHIMA
With the repeal of the sustainable growth rate (SGR) in the recently passed H.R. 2 bill, it appears that ICD-10 implementation is on again. Taking into consideration the weekends and holidays between now and Oct. 1, 2015, we barely have 90 working days to prepare for the adventure. Hopefully we will be able to maintain our sanity! Mental and behavioral health codes have undergone major revisions and may present some challenges under ICD-10-CM/PCS. What are the required documentation updates? Let’s take a look at some examples... Read more...
July 19, 2015 / Tom Darr, MD
With less than three months until ICD-10 go-live, you may still be having trouble engaging providers around the new code set. If so, that’s not surprising. While we know that patient care will ultimately benefit from ICD-10’s increased specificity and data detail... Read more...
November 21, 2014 / Mark Spivey
The countdown is on. With less than a year to go before the scheduled implementation of ICD-10, healthcare industry chatter about the new code set is reaching a fever pitch. Because ICD-10 is about overall system readiness, the discussion focuses mostly on how to get ready, what barriers to overall readiness exist, and what the industry can do to remove those barriers. Problems will inevitably arise if only part of the industry... Read more...
November 25, 2014 / Wilbur Lo, MD, CDIP, CCA
According to the National Institute of Mental Health, Autism Spectrum Disorder (ASD) is characterized by a wide range of symptoms and levels of impairment or disability that are typically recognized during the first two years of life. ASD is a complex clinical diagnosis and includes deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior, interests, or activities. The symptoms will cause... Read more...
January 19, 2015 / Evan M. Gwilliam, DC, MBA, BS, CPC, NCICS, CCPC, CCCPC, CPC-I, MCS-P, CPMA
Unfortunately, chiropractic physicians have a reputation as the providers with the worst documentation. According to the 2013 CERT Annual Improper Payment Report, chiropractic services were paid improperly 51.7 percent of the time. Of those improper payments, reviewers determined that 92.5 percent of them were due to insufficient documentation. As a certified professional medical auditor and a chiropractor, I have performed chart audits and provided expert witness testimony on documentation issues... Read more...
January 5, 2015 / Robert M. Tennant, MA
As the healthcare industry transitions to the ICD-10 coding system in 2015, physician practices will need to have an aggressive action plan in place for meeting the many challenges associated with implementing the new code set. Many practices began their ICD-10 implementation processes in 2014 only to put those efforts on hold following passage of the Protecting Access to Medicare Act of 2014... Read more...
August 21, 2014 / Mark Morsch, MS, AHIMA-approved ICD-10 trainer
Technology continues to play an important role in supporting facilities and physicians engaged in the transition to ICD-10. Many organizations have purchased technology such as computer-assisted coding (CAC), clinical documentation improvement systems, natural language processing (NLP) and/or coding workflow solutions. These technologies hold the promise of significant benefits to key functions such as clinical ... Read more...
January 5, 2015 / Lou Ann Wiedemann, MS, RHIA, CHDA, CDIP, FAHIMA
In a December 2014 statement on the implementation of ICD-10, U.S. House of Representatives Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and House Rules Committee Chairman Pete Sessions (R-Texas) called the new coding set "an important milestone in the future of healthcare technologies." The statement clearly indicated that the congressmen will continue to work closely with the Centers for Medicare & Medicaid Services (CMS) to, as the statement put it, "ensure that the deadline can successfully be met by stakeholders... Read more...
July 13, 2015 / Betty Lengyel-Gomez
Cooperative Exchange (CE), the National Clearinghouse Association recently surveyed its members regarding its recent ICD-10 testing experiences. The CE received informative and helpful feedback on members testing with different types of payers: Medicare; Medicaid; commercial health plans; Tricare; Property and Casualty (P&C); and group health payers. As you can imagine, each clearinghouse’s experience varied depending on the payers they engaged. First... Read more
July 19, 2015 / Ken Bradley
When something needs fine-tuning, it’s either near the end of preparation (“Hey, let’s fine-tune the presentation before tomorrow’s meeting”) or in pretty good shape overall (“Fortunately, that squeak is no big deal; your car just needs fine-tuning”). For most providers, both scenarios are likely an accurate reflection of their ICD-10 status. After months of hard work, the finish line is in view—a fact that elicits relief alongside a healthy dose of stress as everyone asks, “Will we be ready on October 1? What are our weak points?” And lastly, the... Read more
June 22, 2014 / Cathie Wilde, RHIA, CCS
It’s one of the most important questions coders must ask while using ICD-10: Is there a single combination code that fully identifies the patient’s relevant conditions, or is it necessary to report two separate codes? This question is also important in ICD-9; however, the volume of combination codes in ICD-10 has increased, making it imperative for coders to be alert and aware of instances in which combination codes are applicable... Read more
December 9, 2014 / Betty Gomez
ICD-10 will impact nearly all of the processes in your practice or organization, and using that fact as the starting point for your ICD-10 testing will make the process smoother and more worthwhile for everyone involved. Although it may not be possible to coordinate or synchronize all aspects of the testing, the more comprehensive your testing plan is, the better prepared your organization will be on Oct. 1, 2015. In addition to helping you gauge your readiness for ICD-10... Read more...
July 13, 2015 / Denise M. Nash, MD, CCS, CIM
Does it seem that the government comes out with major decisions that we in healthcare may not perceive as wise either on a Friday after 5 p.m. or, as in the recent compromise, over a holiday? I can’t help but think of another Great Compromise, which took place on July 16, 1887, which provided a dual system of congressional representation. The Centers for Medicare & Medicaid Services (CMS) did indicate that, “a valid ICD-10 code will be required on all claims starting October 1, 2015.” At least the dual coding (as suggested by some members of Congress) has been averted thus far... Read more
January 5, 2015 / Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC
A new year can bring about many changes, and you never really know how all those changes can pan out. One thing is for sure in looking back, however: many of us were surprised by the ICD-10 delay. What side of the fence you stood on surely determined your thoughts of whether it was welcomed or not. Whether you were for or against a delay, however, we learned a lot in a short period of time. Here are four top things we have learned from the delay – and if you haven’t started... Read more
November 26, 2013 / Lolita M. Jones, RHIA, CCS
ICD-10-PCS represents a major departure from ICD-9-CM procedure coding, and as such, many coding specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM). In order to ease the transition from one code.... Read more
August 21, 2013 / Sherry Wilson and Tina Greene
Just like “Where’s Waldo?” the property & casualty (P&C) industry that includes workers’ compensation and auto billing also requires the tracking of state healthcare requirements to highlight whether ICD-9 or ICD-10 is required when submitting bills to payers. Payers, vendors, and providers that bill P&C across states are required to comply with each state’s requirements. There are numerous... Read more
March 19, 2013 / Rebecca DeGrosky, RHIT
In the Medical and Surgical section (first character 0), there are 31 root operations with standardized terminology and no procedure names, no diagnostic information, and no eponyms. So far, we have covered 24 of them, and today will bring us to the remaining ones. We have gone over the notion that a fracture reduction is the root operation reposition, and that there is no appendectomy listing in ICD-10-PCS. Coders... Read more
July 1, 2014 / Tim McMullen, JD, CAE
Whether you were annoyed or relieved by the announcement of another delayed implementation of ICD-10, the benefit of having additional time to ensure a smooth transition can work to your favor. The expertise that is held by your practice management system (PMS) vendor is a key component that can contribute to a smooth transition. Many PMS vendors have integrated ICD-10 within their systems, so these vendors are ready and have the ability to test now. You likely have been getting updates from your vendor... Read more
December 8, 2014 / Lolita M. Jones, RHIA, CCS
The process of constructing codes in ICD-10-PCS is designed to be logical and consistent: individual letters and numbers, called "values," are selected in sequence to occupy the seven spaces of the code, called "characters." ..... Read more
April 6, 2015 / Michael Stearns, CPC, CFPC, MD
CD-11 has been in development since 2007 but will not be ready for use in the United States, by some estimates, until the year 2023 or later. ICD-11 is an important undertaking, as its precursor, ICD-10, is the most widely used code set in the world. The World Health Organization (WHO) has elected to modernize ICD so that it will be suitable for use “with electronic health applications and information systems... Read more...
The Last Chance to Get It Right: ICD-10 Coding Management Essential 3-Part Workshop Series
The upcoming weeks, days, and minutes are becoming increasingly critical. The closer the ICD-10 implementation deadline approaches, the faster the time will fly by — and you don't want to be caught unprepared when that deadline arrives on October 1, 2015.
ICD-10-PCS Solutions for Non-Operating Room Procedures: 11-Part Series
Hospitals don't need to code inpatient procedures that do not impact the MS-DRG assignment. The reporting of "significant" procedures is embedded in the rules...
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