Do you have pet peeves? I have many, including those sun-catchers that folks hang on their rear-view mirrors, which on a sunny day blind the drivers behind them. So, what is my PCS pet peeve? Let us discuss the root operations of restriction and occlusion. By PCS definition, “restriction” refers to the partialclosing of an orifice or tubular body part that includes both ... Read more...
On June 4, a new bill titled “Protecting Patients and Physicians Against Coding Act of 2015” (H.R. 2652) was introduced by U.S. Rep. Gary Palmer (R-AL) in the U.S. House of Representatives. With 35 co-sponsors as of June 10, the bill proposes a two-year ICD-10 grace period to allow physicians and healthcare providers to transition to the new coding set with no further implementation delays...Read more...
Earlier this month, the Healthcare Billing and Management Association (HBMA) surveyed members in an effort to assess their experiences regarding commercial payer, Medicaid, and HIPAA-exempt plan ICD-10 readiness. Fifty-four member companies...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...
August 19, 2014 / Paul Weygandt, MD, JD, MPH, MBA, CPE
Recently I was asked to respond to physician criticism of the transition to ICD-10. While there are legitimate concerns regarding the costs of the transition, the majority of issues being raised by physicians of late reflect a lack of knowledge about the system. Such criticism reminds me of the now-infamous quote from Nancy Pelosi, the U.S. House of Representatives Minority Leader in 2010, regarding President Obama’s landmark healthcare legislation... 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...
January 5, 2015 / Tim McMullen, JD, CAE
There’s been an industrywide concern among healthcare providers during recent months about the lack of knowledge on what to expect in testing from payers. To help facilitate ICD-10 testing during the remaining transition period, the Cooperative Exchange (CE) will gather information on payers regarding their testing parameters. This is a value-add for Cooperative Exchange clearinghouse clients and all providers and clearinghouses... Read more
December 15, 2014 / D’Arcy Gue and Thomas Grove
ICD-10 is supposed to be about better disease management and more accurate medical diagnoses and treatment reports. But for many in the healthcare world, ICD-10 is all about money. The federal government wants ICD-10 in order to help our healthcare system save money. ICD-10’s promises of more precise and complete data for research, fraud and abuse investigations, and payment determinations is expected to cut costs significantly. For providers, it’s a lot simpler. Many smaller providers don’t want ICD-10 at all, because converting from the antiquated ICD-9 coding system costs money... 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...
December 8, 2014 / Mark Spivey
Despite a decline in participation and some lingering issues still affecting providers, Centers for Medicare & Medicaid Services Provider Billing Group Director Diane Kovach told Talk-Ten-Tuesday listeners last week that she was pleased with the results from the second of four scheduled acknowledgement testing weeks being planned and coordinated by the agency. “Overall,” Kovach said, “the testing went really well.” Only two things were being scrutinized during the testing week that recently ended prior to the Thanksgiving holiday: the ability of providers to submit claims containing ICD-10 codes to CMS... 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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