Honestly, have you noticed how almost everyone around you seems “comfortable?” Most of us live and work in environments where everything is systematized, laid out as rules or policies or (the worst) “best practices.” And then, on top of the things we do to ourselves, we have local, state, and federal governments applying their own rules and policies and (dare I say it) “best practices,” except they...Read more...
Within the ICD-10-CM code set there are 21 chapters. The code range F01-F99 within Chapter 5 covers mental, behavioral and neurodevelopmental disorders. Within this chapter there are a variety of code blocks grouping mental disorders together and covering the following... Read more...
There are 20 pediatric sub-specialties recognized by the American Board of Pediatrics today, and that doesn’t include surgical or radiological sub-specialties recognized and accredited by other board agencies. Specialists, who practice exclusively at one of 183 pediatric hospitals or 68 National Cancer Institute-designated cancer centers nationwide, have unique...Read more...
Many people feel that physicians and payers are at opposite ends of the spectrum when it comes to reimbursement. I confess that I felt that way for many years, but of late, I have noticed greater and greater alignment of interests and goals. There is certainly is a great overlap...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...
July 29, 2014 / Lisa Roat, RHIT, CCS, CCDS
One of the most sophisticated reimbursement models in the United States involves hierarchical logic for grouping a coded health record into a designated payment group based upon the Medicare Severity Diagnosis Related Group (MS-DRG). This is the basis of payment used in the Medicare Inpatient Prospective Payment System (IPPS). The undertaking by the Centers for Medicare & Medicaid Services (CMS) to switch from ICD-9 to ICD-10 is a significant project, and the preliminary results have been described... 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...
August 21, 2013 / Joseph C. Nichols, MD
As the healthcare industry moves into a changing world of reform, the importance of reliable, accurate, and complete data has never been more critical. Historically, the transactional data we rely on to understand the burden or illness of the population and the risk, complexity, and severity of health conditions has been limited. In a recent article for ICD-10monitor (ICD-10 Myths Part 2: Coding Specificity),I reported on an analysis of three years of claims data representing more than 15 million professional claims. According to this analysis... Read more...
September 9, 2014 / Kimberly Janet Carr, RHIT, CCS, CDIP, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
The recent death of world-renowned actor and comedian Robin Williams came as a shock to many. Like many dealing with major depression and other mental health conditions, Mr. Williams suffered in silence. His diagnosis was just another little-known fact in a very celebrated and public life. Dr. Debra Peel, a practicing psychiatrist and founder of Patient Privacy Rights, recently stated that some “10 percent of all hospital admission patients have some type of ... 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...
July 22, 2014 / Billy Richburg, M.S., FHFMA
As expected, as usual – OK, as required by law – the Centers for Medicare & Medicaid Services (CMS) has published the proposed rules for all the various types of inpatient services and now is taking comments to incorporate into the final rule (which, also by law, should be available on Aug. 2). What is changing, assuming that most of the proposed rule carries over to the final rule? Not much, really, and nothing we didn’t expect. Here are a few key points to show... Read more...
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%...
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
June 03, 2014 / Joseph C. Nichols, MD
There is a widely held belief that ICD-10-CM is much more “granular” and will require much greater specificity. It is true that ICD-10-CM will support the reporting of much more specific and detailed information about risk, severity, complexity, comorbidities, and complications, and other key parameters of patient evaluation. There’s a little secret that is seldom mentioned, however: You can be just as vague in ICD-10 as you were in ICD-9... Read more
August 19, 2014 / Holly Louie, RN, CHBME, PCS
Recently, an article was published ridiculing ICD-10 by profiling the most obscure (and frankly, ridiculous) coding combinations that could be identified. “There’s a code for that” has become synonymous with these highly publicized codes, which cover scenarios such as turtle bites, water skis on fire, being hit by meteors, and other circumstances widely considered preposterous. Obviously, these authors are focused on things that are truly irrelevant, though entertaining... Read more
September 9, 2014 / Betty Gomez
ICD-10 may have been delayed until 2015, but many payers are continuing with their original testing schedules. That means providers can’t wait either, because if they do, they risk missing out on opportunities that may not come around again. ZirMed conducted end-to-end testing with multiple payers this past spring and during the early summer months. The results ... Read more...
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 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
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
September 9, 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.” In ICD-10-PCS sections 0 through 4, 7, 8, and 9,the fifth character defines the approach—i.e., the technique used to reach the procedure site.... Read more
How to Use Coded Data to Meet the Needs of Non-Medicare Patients
Does your clinical documentation improvement program go beyond just reporting on Medicare patients to include working folks, young men, women and children whose lives are covered by commercial payers?
How to Help Your Physicians with Their Reporting Requirements
Physicians at your facility need your help. But don't count on them to come to you for assistance. They won't, but you can.
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