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July 31 brought good news to the healthcare community with the announcement from the U.S. Department of Health and Human Services (HHS) that Oct. 1, 2015 is the new implementation date for the much-awaited ICD-10 coding set.
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…
Estimated costs ranging from $1.1 to $6.8 billion for HIPAA-covered entities, sums associated with delaying the adoption of ICD-10 beyond October 2015, appear to have played a significant role in the formulation of the final rule that was posted yesterday in the Federal Register by the U.S. Department of Health…
We’ve got a date! Much of the healthcare industry was stunned on March 31, when Congress announced that due to passage of the Protecting Access to Medicare Act of 2014, ICD-10 could not be implemented before Oct. 1, 2015. Things looked dismal, as though all hope was lost for a…
As you prepare for the newly announced Oct. 1, 2015, ICD-10 compliance date, now is the time to evaluate and redefine your clinical documentation value chain. A value chain is a series of activities that are performed in order to deliver a valuable product or service for the organization.
The Workgroup for Electronic Data Interchange (WEDI) is inviting providers, health plans, vendors and clearinghouses to participate in this important survey to help monitor progress as the ICD-10 implementation date moves forward, according to a news release published on Monday. The final submission deadline is Aug. 21, 2014. Click here…
On a late Thursday afternoon, with the last minutes ticking down on Major League Baseball’s non-waiver trade deadline, the U.S. Department of Health and Human Services (HHS) posted a final rule regarding ICD-10 implementation in the Federal Register. While the outcome of today’s trades might end speculation regarding how the…
The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance…
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…
Not everything you read about ICD-10 is true. I know, it’s shocking. Sarcasm aside, I feel it is an important point to make since there is a lot of information floating out there about ICD-10 and it takes a level of discernment to ascertain what is the truth and what…
EDITOR’S NOTE: The American Health Information Management Association (AHIMA) recently announced the appointment of David S. Muntz, CHCIO, FCHIME, LCHIIME, FHIMSS, as its first advisor to the board of directors. Muntz began this volunteer, non-voting position at the July 10 board meeting. Muntz, the senior vice president and CIO of GetwellNetwork,…
It has been an ongoing struggle to keep physicians, hospitals, and others motivated in the ICD-10 implementation process. From my experiences with my own clients, I gauge that about 50 percent of providers are continuing to forge ahead with their implementation projects, while the other 50 percent have completely stopped…
As an integrated healthcare system, Kaiser Permanente is in a unique position when it comes to testing ICD-10. In order to become ICD-10-compliant, the company must test from the position of both a provider (caregiver) and a payer (insurance plan). During the coming months, Kaiser Permanente is targeting to test…
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…
Chronic diseases are having a massive effect on our healthcare system and our society. According to testimony provided to the U.S. Senate Finance Committee last week, chronic disease care accounts for 93 percent of all Medicare spending. That figure is really something we cannot ignore, and the ICD-10-CM code set…
EDITOR’S NOTE: John Showalter, MD, chief medical information officer for the University of Mississippi Medical Center, told Talk Ten Tuesdays audience members last week that his facility will be prepared to roll out ICD-10 by October 2014. Talk-Ten-Tuesday followed up with Dr. Showalter.
ICD-10 testing isn’t going away — for the most part, it’s not even being delayed. That’s why many payers, including Medicaid, are taking advantage of the additional time before implementation to conduct more end-to-end testing. What does this mean for providers, payers, and clearinghouses? And how can these groups work…
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."  For 10 of the 16 ICD-10-PCS sections, the third character defines the root operation – the…
Several months have passed since we got the news about the latest postponement of implementation of the ICD-10 code set. For a large part of the industry, after the shock wore off, the next emotion was relief. Many welcomed the delay, which eroded the fears and anxiety that had been…
Sitting in the audience at the June 10 National Committee on Vital Health Statistics (NCVHS) quarterly Subcommittee on Standards meeting, I listened attentively to the wide range of presentations on the effect the ICD-10 delay has had (and will have) on the healthcare industry. As I listened to testimony, I…
There are wide-reaching benefits to clinical data and patient care within the core of the ICD-10-CM/PCS code set, and that is why supporting ICD-10 is the right thing to do. As a health information management (HIM) leader and professional for more than 35 years, I’m extremely passionate about the move…
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was…
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…
Given the recent extension of the ICD-10 compliance date, many hospitals are stepping back and re-evaluating project plans and timelines to use this time to improve their transition readiness.
With the initial shock of the latest ICD-10 delay behind us, now is the time to leverage it as opportunity to ensure that coders are fully prepared for the transition. Coder training and readiness is a critical element of ICD-10 success. The additional time will give coders the ability to…
EDITOR’S NOTE: This article marks the beginning of a series of articles on clinical documentation improvement by clinical service. Changes associated with switching from ICD-9-CM to ICD-10-CM/PCS typically are reviewed in total and discussed service by service. When reviewing by individual services, the variances between the two classification systems will…
As soon as Congress announced the latest ICD-10 implementation delay, healthcare industry leaders from across the country rallied together to face the facts (not to mention their collective disbelief and disappointment) and figure out how to move forward. First there was the April 30 ICD-10 Summit organized by the Workgroup…
New York Yankees legend Yogi Berra once coined a phrase that seems to fit our present situation: “It’s déjà vu all over again!” The political fastball that none of us saw coming was whacked out of the proverbial ballpark a few weeks ago, with the implementation date of ICD-10 having…
EDITOR'S NOTE: The following article by Mandy Willis, originally published in the June 17, 2014 edition of the ICD10monitor eNews, is reprinted as the U.S. ramps up its response to the Ebola crisis here and in West Africa. Along with being a perpetual optimist, I’m also an information junkie, and…
Battered and bruised yet intact, like a dazed boxer entering a late round against an unrelenting challenger, the interim final rule for implementing ICD-10 by October 2015 limped into the federal Office of Management and Budget (OMB) last Friday.
Based on theory, it would seem that ICD-10-PCS root operations could be assigned correctly with relative ease; however, practical application sometimes intersects with coding scenarios that make one question the selection of the appropriate root operation. Hands-on ICD-10-PCS practice continually reinforces that only with the practical application of theory can…
At numerous meetings since the ICD-10 delay was announced, the chasm between large and small providers, entities, and practices has been evident. Obviously, some small groups are well ahead of the pack and some large groups are lagging, but the profound discrepancies keep reappearing. Stanley Nachimson recently commented on the…
EDITOR’S NOTE: Rhonda Buckholtz is testifying today before the National Committee of Vital Health Statistics. It appears that the coding industry is much more ready for ICD-10 than previously believed, and the cost to prepare is proving less expensive than was claimed by other sources, recent AAPC studies indicate.
The short answer to the question posed in the headline is this: it isn’t always easy, but definitely doable. The more important question is, how do you get physicians to learn once they show up? After all, attendance doesn’t always equal learning. This article will provide several tips to increase…
During the past few weeks I have spent time revising project plan timelines and milestones to give organizations more to prepare for ICD-10 – which in most cases is very much needed. All the physicians I have spoken to since the latest delay was announced are indicating that they are…
The primary benefit of the latest delay in the implementation of ICD-10 is that it allows ample time for additional preparation and testing. One element of preparation that should be on each provider’s to-do list is dual coding and clinical documentation improvement (CDI). The process and scope of any dual…
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.”    For 15 of the 16 ICD-10-PCS sections, the second character defines the body system—the general physiological system or anatomical region involved. 
Although narrow in scope, results from the ICD-10 National Testing Week conducted early last March revealed that the Centers for Medicare & Medicaid Services (CMS) accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent, according to CMS. The normal FFS Medicare…
(WASHINGTON: June 5, 2014)---The Senate today voted 78-17 to confirm Sylvia Burwell as the new secretary of the Department of Health and Human Services (HHS), replacing outgoing Secretary Kathleen Sebelius. In her new role, Burwell will assume ownership of the unwieldy ICD-10 initiative that has stalled four times as the…
One thing you can say for certain about ICD-10 is that it is making a substantial impression—or at least its popular Twitter hashtag, #ICD10, is. More than 400 million impressions have been generated by approximately 16,000 individuals posting 135,000 tweets since the first tweet ever chirped. Those and other statistics…
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…
One of the challenges of the previous October 1, 2014, deadline was the “rush factor” that seemed to cause organizations to circumvent the details of testing all systems, which could overwhelmingly affect their level of success. In addition, during the WEDI Conference in Hollywood, Calif., on May 12-15, participants once…
On April 1, 2014, when the Protecting Access to Medicare Act of 2014 (Pub. L. No. 113-93) was enacted, most of us were caught off-guard. Along with once again patching the SGR methodology for physician payment, ICD-10 implementation was delayed at least until October 1, 2015. On May 1, CMS…
One hundred and forty characters in Twitter; seven (spaces) characters in the procedure coding system (PCS) of ICD-10; and, in between, a variegated universe of tweets, tweeters, and followers give rise to the notion that the use of social media, notably Twitter, the electronic lingua franca, might be fostering a…
WASHINGTON, D.C. — CMS official Denise Buenning, whose rallying call last month that “the delay is not a killer for ICD-10” ignited healthcare’s social media universe, has stepped down from her post to take a position with nonprofit CAQH, an association of health plans and trade associations.
The majority of us in healthcare were a little shocked by the political events in the latter part of March that once again delayed implementation of the ICD-10 code set. Let’s take a look at how the delay occurred and what it means to some of us, as the politics…
It has been a very bumpy ride since early April, when ICD-10 was delayed once again. Ironically, I was in the U.S. Virgin Islands when I received the news, training physician groups in St. Croix and St. Thomas. The training I was conducting centered on documentation for ICD-10 as part…
I know many ICD10monitor readers personally; some are clients, some are colleagues, some are friends, and some are competitors. If you are in one of these groups (and I like the clients, colleagues, and friends), you know that I often have a lot on my mind and I generally talk…
EDITOR’S NOTE: This is the third of a three part series on tips for memorizing ICD-10 codes. Read Part 1 and Part 2 This article continues the series that aims to provide assistance in “memorizing” ICD-10-CM – maybe not to the exact code, but the process will get you close.…
Yet another postponement of ICD-10 implementation has brought about negative postings and comments regarding the decision to delay, along with skepticism about any future implementation, in light of all of the dollars already spent in preparation. Larger entities and hospital systems are financially shaken, as they had large budgets set…
Leveraging data analytics is a great way to identify areas for coding improvement and target opportunities for ICD-10 education. Organizations can use this strategy to evaluate General Equivalence Mappings (GEMs) of claims data, thus identifying high-risk areas and mitigating potential decreases in case mix index (CMI) and corresponding financial impacts.…
According to the online survey conducted during ICD10monitor’s Talk-Ten-Tuesday broadcast on April 8, the majority of healthcare respondents (59 percent) plan to revise their ICD-10 timelines in response to the latest implementation delay. Others are staying the course (23 percent) or waiting to determine next steps until a new deadline…
Tim McMullen, JD, CAE Practice management systems (PMS) are a vital component to the healthcare industry, and providers rely on them to make sure proper ICD-10 claims can be submitted to payers. Too often these providers’ voices have not been “at the table” when important decisions are made. Well, no…
Transitioning to ICD-10 has been a challenge to providers due to resources, time, and monetary restraints. Various providers (or organizations) performed an initial assessment and were rushing to do the following: Determine what is needed to be compliant on October 1, 2014; Determine how can we ensure that we will…
Implementing ICD-10-CM and PCS in the Property and Casualty (P&C) and Workers Compensation (WC) industries is similar to that of healthcare insurers. Even though these payers are non-covered entities under the Health Insurance Portability and Accountability Act (HIPAA), the plans were to implement with the rest of the United States…
I feel I may be in danger of developing some sort of mental health disorder as a result of the rollercoaster that is ICD-10. I’m sure I’ve experienced every emotion possible, from elation to the depths of depression and sorrow. The latter was just a matter of days ago with…
Like a parishioner striking a lone church bell in a town square to herald the start of services, the Centers for Medicare & Medicaid Services (CMS) recently announced that it would issue an interim final rule signaling its intention to make October 2015 the new deadline for the implementation of…
In releasing the 2015 Inpatient Prospective Payment System (IPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) is proposing October 2015 as the new deadline for the implementation of ICD-10. References to the deadline can be found on page 648 and again on pages 1065 and 1074. Could…
A straw-poll vote by attendees at the Workgroup for Electronic Data Exchange (WEDI) ICD-10 Emergency Summit indicated favor for 2015 as the implementation date for the new code set.
The shocking announcement that ICD-10 implementation has been delayed again received a variety of responses, ranging from elation to “I told you so” to complete frustration. Although we don’t know if and when another implementation date will be confirmed, we do know that many providers have made major progress toward…
EDITOR’S NOTE: This is the second of a three part series on tips for memorizing ICD-10 codes. Read Part 1 and Part 3 This article continues the series that aims to provide assistance in “memorizing” ICD-10-CM – maybe not to the exact code, but the process will get you close.…
Ask most patients what ICD-10 is and you will get the same look that I get from family members when I describe coding to them – that baffled, deer-in-headlights look. But when you explain how a code can translate their complaints and conditions into an alpha-numeric code for payment, it…
After Congress passed and President Obama signed into law the “doc fix” legislation on April 1, the “reset button” was pressed on the giant countdown clock displaying the number of days remaining for providers to get ready for ICD-10, with Oct. 1, 2015 being the new deadline. Centers for Medicare…
WASHINGTON, D.C. — “The delay is not a killer for ICD-10,” the Centers for Medicare & Medicaid Services’(CMS’s) Denise Buenning told members of the American Health Information Management Association (AHIMA) during a Wednesday meeting. Speaking before an audience of several hundred at the AHIMA ICD-10 Summit, Buenning acknowledged that the…
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.
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…
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…
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.…
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…
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…
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…
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: The uncompensated care payment (taking…
With the healthcare industry already reeling from shock waves sent last week by the president signing legislation delaying the start of ICD-10 for at least one year, the announcement yesterday that Health and Human Services Secretary Kathleen Sebelius was stepping down after a five-year stint in the Obama Cabinet was…
Congress has stirred up a hornet’s nest by delaying ICD-10 implementation, and the hornets are those in the healthcare industry who have been diligently preparing for the launch of ICD-10 on October 1. This includes not only healthcare providers, suppliers, and vendors but also the Centers for Medicare & Medicaid…
The American Heath Information Management Association’s (AHIMA’s) Margarita Valdez yesterday said that members of the organization felt that they had enough votes to halt HR 4302 from becoming law when the bill came up for vote on the U.S. House of Representatives floor on last Thursday.
Readiness surveys conducted during the past two years showed that the industry was so challenged with competing initiatives that there simply was not enough time to complete all of the necessary preparations for ICD-10. The magnitude of the project was simply overwhelming. In fact, it was so difficult to engage…
While there are those who have vigorously campaigned for the delay of ICD-10 due to fears of risk to physician practices, costs, financial disruptions, lack of meaningful testing, etc., there are many others who feel just like the title of this article indicates. It seems that most in the latter…
In 2009, the U.S. Department of Health and Human Services (HHS) published the first ICD-10 final rule requiring the adoption of the new code sets for services rendered on and after Oct. 1, 2013. This was after representatives of the industry requested that this date be moved back from the…
Although ICD-10 implementation experts gained momentum to meet the ICD-10 compliance date of Oct. 1, 2014 after a delay was announced in 2013, they are once again in limbo. If you’ve been entrenched in ICD-10 since January 2009, when a scheduled implementation was first announced, do your best to maintain…
Readiness surveys conducted during the past two years showed that the industry was so challenged with competing initiatives that there simply was not enough time to complete all of the necessary preparations for ICD-10. The magnitude of the project was simply overwhelming. In fact, it was so difficult to engage…
While there are those who have vigorously campaigned for the delay of ICD-10 due to fears of risk to physician practices, costs, financial disruptions, lack of meaningful testing, etc., there are many others who feel just like the title of this article indicates. It seems that most in the latter…
In 2009, the U.S. Department of Health and Human Services (HHS) published the first ICD-10 final rule requiring the adoption of the new code sets for services rendered on and after Oct. 1, 2013. This was after representatives of the industry requested that this date be moved back from the…
Although ICD-10 implementation experts gained momentum to meet the ICD-10 compliance date of Oct. 1, 2014 after a delay was announced in 2013, they are once again in limbo. If you’ve been entrenched in ICD-10 since January 2009, when a scheduled implementation was first announced, do your best to maintain…
Without fanfare or a Rose Garden ceremony, President Barack Obama signed into law the Protecting Access to Medicare Act of 2014 as expected Tuesday afternoon. The president’s signature on the bill prevents a scheduled 24-percent cut to Medicare physician payments, which would have kicked in on April 1. The legislation…
April 2, 2014---As expected President Barack Obama this afternoon signed into law the Protecting Access to Medicare Act of 2014 that prevents a scheduled 24 percent cut to the Medicare physician payments and delays for at least one year the implementation date for ICD-10.
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…
Take a deep breath – we now have the implementation of ICD-10 delayed one more year from Oct. 1, 2014. Will you be ready when Oct. 1, 2015 arrives? Take the time now to learn what you need to be documenting in your specialty by adding details of granularity. If…
EDITOR’S NOTE: This is the first of a three part series on tips for memorizing ICD-10 codes. Read Part 2 and Part 3 One of the biggest complaints about moving to ICD-10-CM is that people have memorized many ICD-9-CM codes – and there is concern that ICD-10-CM can’t be memorized.…
Never let it be said that the implementation of ICD-10 has not been exciting. ICD-10 is still a critical project that will continue to require our full attention. One of the areas of implementation that seems to create the most anxiety is translation. So let’s talk about it. You’ve probably…
I’m writing this article on Friday, March 28, so I have no real insight into what might happen next week into what might happen next week as the U.S. Senate votes on the House-approved “doc-fix” legislation that includes a controversial paragraph that would extend the ICD-10 implementation date to Oct.…
Politics and policy intersected yesterday when the U.S. Senate took up the House proposal from last week and voted to approve H.R. 4302, the Protecting Access to Medicare Act of 2014. Language in the bill, tucked among other provisions, effectively delays the implementation of ICD-10 by one year.
The U.S. Senate today passed H.R. 4302 to extend the Sustainable Growth Rate while at the same time delaying the implementation of ICD-10 by one year, pushing the mandatory compliance date back to Oct. 1, 2015.
The fix is in. The U.S. House of Representatives today voted to extend the deadline for implementing ICD-10 by one year, pushing the mandatory compliance date to October 2015. The Senate is expected to vote tomorrow.
“Like finding four-leaf clovers, the chances of hiring trained, credentialed, and experienced coders in 2014 are extremely poor,” wrote Torrey Barnhouse, the founder and president of TrustHCS, in his article that appeared in the March 18 edition of ICD10monitor e-news. “New approaches are needed to solve health information management’s (HIM’s)…
EDITOR’S NOTE: The following is Part I in a continuing series of frequently asked questions that chiropractors have concerning the implementation of ICD-10. Do you remember those bands from the 1970s and 80s who only came up with one great hit? You know the songs word for word when you…
Nicolet Araujo, RHIA with Brian Alesi, legislativeassistant to Rep. Dana Rohrabacher (CA-48). EDITOR’S NOTE: Yesterday on “Talk-Ten-Tuesday,” Margarita Valdez, the principal representative of AHIMA with the United States Congress, told audience members that 200 representatives from 45 affiliated state organizations arrived on Capitol Hill for the association’s 12th annual Hill…
The American Health Information Management Association (AHIMA) today is alerting its members that the Sustainable Growth Rate (SGR) draft legislation includes legislative language for a one-year delay in ICD-10 implementation to Oct. 1, 2015. Congress is expected to consider the SGR bill tomorrow, according to AHIMA. ICD10monitor will continue to…
Contrary to public opinion, ICD-10 is not a coding problem. Clinical documentation improvement (CDI) will be as affected as coding, if not more so. The true challenge in the transition to ICD-10 is ensuring that documentation meets the level of specificity and granularity required to achieve optimal reimbursement, meets all…
One of the common themes we hear about the level of clinical documentation needed to support ICD-10 is that it is a major administrative burden that results in large cost impacts on providers. We have heard that this “unfunded mandate” is causing undue financial hardship and detracting from good patient…