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Stay the Course - Or Survive the Storm!

Written by Ellen VanBuskirk

I feel like the fog is beginning to lift with the resignation of Kathleen Sebelius as head of Health and Human Services. It has become more obvious to me why the ICD-10 delay did not get killed in the Senate and why the President did not execute his veto power. With the voice of the American Medical Association (AMA) and other organizations against I-10 and the potential for high risk challenges, one might suspect that there is political strategy to ward off a storm of risk and potential chaos, which industry surveys have supported in the last few months...

The ICD-10 Implementation Olympics Rewind!

Written by Laurie M. Johnson, MS, RHIA, CPC-H, FAHIMA

February 2014 brought the Winter Olympics to Sochi, Russia. More recently, it seems to be the beginning of the ICD-10 Implementation Olympics in the United States. There are only 541 days (as of April 8) left before the opening ceremonies, with the passage of HR4302! As we rewind our ICD-10 implementation activities, please consider these events in your project plans. There are several events in the ICD-10 Olympics, including financial investigations, testing, education, software remediation, business operation transition, and communication. Qualifying...

No Bones about It: Fracture Coding in ICD-10 is a Challenge

Written by Kim Carr, RHIT, CCS, CDIP, CCDS, AHIMA-Approved ICD-10 CM/PCS Trainer

There are 17,045 codes in ICD-10-CM that relate to fractures. And 10,582 fracture codes are used simply to distinguish right versus left. In preparation for ICD-10, physician documentation must be assessed and gaps identified to ensure correct coding of your orthopedic encounters. According to the Coding Clinic published during the first quarter of 2013, coders can use X-ray reports to assign a code for specific site of the fracture once the provider has already diagnosed it. “If the X-ray report provides additional information regarding the site of a condition that the provider has already diagnosed,” the relevant section reads...

Feature Stories

Payers Respond to ICD-10 Delay

The questions came flying in from audience members during a recent broadcast of Talk Ten Tuesdays in which two payer representatives — Dennis Winkler from BlueCross-BlueShield of Michigan and Sidney Hebert with Humana —were interviewed. In light of the many questions that were submitted during the live broadcast, here is a sampling of those sent to Talk Ten Tuesdays, along with written comments by both Winkler... Read more...

Now Let Me Get This Straight…

It has been quite a winter and spring, hasn’t it? We really are feeling the effects of the Patient Protection and Affordable Care Act (PPACA)! First, the Centers for Medicare & Medicaid Services (CMS) gave us the inpatient changes for 2014, chief among them being:...Read more...

Is an ICD-10 Deadline Extension the Worst-Case Scenario?

As I write this on the eve of April Fools’ Day, I can’t help but wonder if the events that transpired over the last week, resulting in the passing of H.R. 4302, “The Protecting Access to Medicare Act of 2014,” really happened. With the influx of arriving emails about the details of the sustainable growth rate (SGR) patch, reality has set in, and it is time to dig through it all and get to work... Read more...

The Delay Is an Opportunity — Not a Reason to Put Off Action

As of this writing, the U.S. House of Representatives has passed the bill delaying ICD-10 until at least Oct. 1, 2015. Now you’re probably wondering what to do next. Although the answers are different for each stakeholder group, there’s one certainty: if you check out, you’ll lose out. So let’s talk about how you can make the most ... Read more...

ICD-10-PCS Character Analysis: Test Your Knowledge of Character 1

While the implementation of ICD-10-CM/PCS has been delayed until at least October 2015, you shouldn’t delay your training in and mastery of ICD-10-PCS, the more complicated of the two classification systems. In the coming months, we will use the delay to test your knowledge of each of the seven characters used to build an ICD-10-PCS code. The process of constructing codes in ICD-10-PCS is designed to be logical and consistent: individual letters... Read more...

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Dual Coding: Tracking Your Output

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...

Multiple Treating Physicians, Conflicts, Clarity, and Coding Queries

February 11, 2014 / Paul L. Weygandt, MD, JD, MPH, MBA, CCS, AHIMA-Approved ICD-10-CM/PCS Trainer and Angela Carmichael, MBA, RHIA, CDIP, CCS, CCS-P, AHIMA-Approved ICD-10-CM/PCS Trainer

Industry-wide, there is substantial interest in specialty-specific ICD-10 education for physicians. Recognizing that physicians will not, and reasonably cannot, take a broad approach to learning ICD-10 as do coders and clinical documentation specialists, education is increasingly being focused on those specific areas relevant to a given clinical practice. This is coming at a time when more and more hospital care is being coordinated by hospitalists, who typically act as the attending physician or “captain of the ship.”... Read more...

ICD-10 Date Is Final: How Are Physicians Reacting?

March 26, 2013 / Paul Weygandt, MD, JD, MPH, MBA, CPE

In a March 19 Talk Ten Tuesday poll, 466 participants responded to the following question: “How are physicians at your facility reacting to the ICD-10 transition and their role in CDI?” The responses, shown in Table 1, are unsettling. We know that the American Medical Association (AMA)-induced implementation delay from Oct. 1, 2013 to Oct. 1, 2014 created high degrees of ambivalence among physicians. Even into this year, the AMA was requesting that ICD-10 not be implemented at all. It isn’t surprising, then, that 45 percent of poll respondents felt that physicians at their facility had little or no enthusiasm for ICD-10, and another 13 percent felt that physicians have had no reaction at all... Read more...

Pressure and Progress Line the Road to ICD-10 Readiness for Payers

January 21, 2013 / Janis Oppelt

Just a year ago, the idea of actually being ready for ICD-10 implementation by October 1, 2014, seemed a distant dream, full of confusion and panic. Since then, a lot of people have done a lot of work to get the ball rolling in the right direction, and the guests on the January 13 edition of the “Talk-Ten-Tuesday” broadcast, produced by ICD10monitor, shared the progress they’re making in two important areas: payer readiness and physician education... Read more...

So Much to Do, So Little Time — IRFs Need to Prepare Now

March 12, 2013 / Patricia Trela, RHIA

The “ostrich” approach will not work in this case, because ICD-10 is not going away. There is much to be done prior to implementation. Two different sets of ICD codes are required, one set for the IRF PAI, and another set for the UB-04.

The ICD-9-CM guidelines for assignment of codes for inpatient discharges by facilities paid under the Inpatient... Read more...

End-to-End Testing: Time for HIM to Jump Aboard

April 30, 2013 / Elizabeth Stewart, RHIA, CCS, CRCA

Between providers and payers, it appears that everyone is ready for end-to-end testing of ICD-10 transactions. But where is health information management (HIM)? A quick tour of the American Health Information Management Association’s (AHIMA’s) ICD-10 website reveals little mention of this massive undertaking. And most of the HIM professionals we meet are barely aware of the national pilot program for ICD-10 testing... Read more...

Resolutions for 2014

February 18, 2013 / Billy Richburg, M.S., FHFMA

As we go through 2014, every month has a number of holidays, each of which applies to at least some of us. So it occurred to me that I could use holidays as inspiration for articles leading up to the greatest secular holiday of the year: Oct. 2, 2014! The way I see it, we all will be celebrating starting the day after ICD-10 goes into effect. I’m ignoring the fact that it probably won’t be right until sometime in 2015, but hey, the day after it’s official simply must provide some cause for celebration, don’t you think?... Read more...

WHAT OUTPATIENT SERVICE LINES ARE PAYERS SAYING THEY WILL REQUIRE PCS CODES FOR?

Podcast Date: 8/27/2013 Are any payers saying they will require ICD-10-PCS for outpatient services? Response Ratio A. Outpt Surg/ED/GI 10% B. Observation 4% C. Ancillary Services 2% D. Combination of A, B and C 33% E. Not appliccable 51%...

CMS Decision not to Engage in End-to-End Testing Presents ‘Dangerous Precedent’

June 20, 2013 / Mark Spivey

Much of the healthcare industry only discovered through announcements made during the HIMSS ICD-10 Leadership Forum this week that the Centers for Medicare & Medicaid Services (CMS) does not plan to engage in end-to-end testing – but Mark Lott, CEO of the Lott QA Group and testing director of the HIMSS WEDI ICD-10 National Pilot Program, said Wednesday that he first heard about it a couple of weeks ago... Read more...

Reclassification of Codes for Transient Cerebral Ischemia

July 9, 2013 / Lauri Gray, RHIT, CPC

Transient cerebral ischemia is defined as a temporary loss of blood flow to an area in the brain. In ICD-9-CM, codes for transient cerebral ischemia are classified under circulatory system diseases and are found in Chapter 7, Diseases of the Circulatory System. Conditions classified as transient cerebral ischemia are listed in category 435 and include basilar artery syndrome (435.0), vertebral artery syndrome (435.1), subclavian steal syndrome (435.2), and vertebro-basilar artery syndrome (435.3)... Read more

Maintaining Positive Cash Flow in a Post-ICD-10 Environment

February 07, 2014 / Andy Tolep, CCS, CPC

With only eight months to go, now is the time to ensure that your hospital or practice maintains a positive cash flow after ICD-10 goes live. A critical initiative will be to understand payers’ expectations regarding the processing of ICD-10 claims. To start, create a spreadsheet that includes all the payers to which you billed accounts with dates of service in 2012 and 2013. For each payer, you will want to track the following items:... Read more

Procedure Classification Systems: ICD-10-PCS Represents a Long-Term Solution

April 1, 2014 / Angela Carmichael

Hospital inpatient procedure reporting is governed primarily by the Uniform Hospital Discharge Data Set (UHDDS) reporting criteria, in addition to payer-specific guidelines. The UHDDS indicates that all “significant procedures” should be reported in the short-term, acute-care hospital setting. It defines “significant procedures” as those that meet any of the following criteria: being surgical in nature, carrying a procedural or anesthetic... Read more

ICD-10 Guidelines that Chiropractic Physicians Should Remember

December 13, 2013 / Evan M. Gwilliam, DC, CPC, NCICS, CCPC, CCCPC

Depending on the publisher, there are about 30 pages of guidelines in the ICD-10-CM code set. The bulk of these guidelines, from section 1.C, are chapter-specific. Chiropractic physicians typically use codes from just four or five of the 21 chapters available in ICD-10-CM. These include, but are not necessarily limited to, the codes from Chapter 6 (Diseases of the Nervous System), Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue), Chapter 18... Read more

CMS Hammers Home Message: No ICD-10 Implementation Delay, No Enforcement Delays

July 23, 2013 / Janis Oppelt

If leaders from the Centers for Medicare & Medicaid Services (CMS) have said it once, they’ve said it a hundred times: The October 1, 2014, implementation date for ICD-10 will not change, and the healthcare industry must be ready or face the consequences. In fact, CMS’s attorneys have advised the agency that it cannot provide enforcement delays as it did for the 5010. This is just one of the messages that CMS representatives stressed during a July 15 agency listening session... Read more

Career Step

Career Step has over 20 years of experience successfully training healthcare professionals. This experience in online adult learning has been combined with the ICD-10 expertise of YES HIM Consulting, Inc. in the development of The ICD-10 Solution, which is... Read more

100 Tips for ICD-10-PCS Coding: Tips 91-100

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

Building an ICD-10-PCS Foundation for Radiology Procedures

March 26, 2013 / Donna Richmond, BA, RCC, CPC

When October 1, 2014, rolls around, the ICD-10-PCS (procedural coding system) will replace the ICD-9-PCS currently used for inpatient procedures. Code assignments under this system will be very different for all inpatient coding professionals, starting with the idea that they will need to “build” a seven-character code—either for medical-surgical procedures or ancillary services, which include imaging, nuclear medicine, and radiation oncology... Read more

The Various Procedures of the Medical & Surgical Root Operations

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

New Series Explores I-10 Doomsday Scenarios

September 17, 2013 / Mark Spivey

Popular culture is rife with doomsday scenarios for the end of the world, ranging from televangelist Pat Robertson, who predicted the end of the world in the 1980s, to the Heaven’s Gate cult followers in San Diego, who predicted of demise of the world when the Hale-Bopp comet appeared and they subsequently committed suicide. Could there be a possible doomsday scenario in store for healthcare providers when, at the stroke of midnight... Read more

My View from the Road: Same-o, Same-on

February 27, 2014 / Denny Flint

What’s the view from the road, Chuck? What’s the view from the road? I’ll tell you the view from the road. It’s the same view as this time last month, and this time the month before that, and this time last year. I feel like Bill Murray in “Groundhog Day.” Every day I wake up and go to work and nothing, I mean nothing has changed. I’m tired of delivering the same tired old content that HAS absolutely NO IMPACT. (Convert your top codes... Read more

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