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In our last piece, the first article in a two-part series about ICD-10-PCS, we discussed excision versus resection, occlusion versus restriction, knowing when to report multiple procedures, and more. This piece, the second in that series, provides five additional ICD-10-PCS coding tips. Be sure to also reference our previous article…
  From a bird’s-eye view, the transition to ICD-10 has been a huge success with few technical glitches. However, it’s still early. Experts certainly don’t want to rain on anyone’s parade. However, they warn us that everyone must be realistic about the wave of ICD-10 denials that could hit throughout December…
On Oct. 1, 2015, health systems across the country bid farewell to ICD-9 as they transitioned to the International Classification of Diseases’ 10th Revision – ICD-10.
During recent months I have heard many references to Oct. 1 and ICD-10, but there have been fewer than expected following implementation of the new coding set. I was pleasantly surprised by the quiet. It was a good feeling, a feeling of accomplishment, knowing that all of us in the…
After two months of working full-time with ICD-10-CM/PCS, what do we know about the success of providers’ transition efforts? In general, it’s too early to tell. It will likely be 90 to 120 days from implementation before we have solid revenue cycle data to determine the financial impact of ICD-10.…
Although ICD-10 implementation has gone amazingly well, there are specialty-specific challenges arising for some practices and groups. For example, orthopedics has an incredibly large list of extremely specific codes. That can be very frustrating for physicians who must treat patients when it is not their primary or only specialty, and they may…
Once in a while, the people who monitor the ICD codes actually listen to the providers of healthcare (rarely, but once in a while). When ICD-10 first came to the fore as an upcoming entity, the major non-trauma issue everybody noted was that code I10, hypertension, eliminated identification of benign…
The American Medical Association (AMA) has asked that AAPC be added as a cooperating party in the U.S. Department of Health and Human Services (HHS) committee responsible for development and maintenance of ICD-10 codes, guidelines, and descriptions — the ICD-10 Coordination and Maintenance Committee.
In a previous article, we reviewed several important ICD-10-CM guideline changes. This month, we’ll present the first piece in a two-part series that focuses on ICD-10-PCS: the system that everyone feared would slow productivity and cause the majority of problems related to documentation insufficiencies. 
Over the course of the past three years, practice management vendors have been tasked with understanding all the nuances of ICD-10, updating their applications to meet these requirements and ensuring their clients were as prepared as possible for a successful transition.  Smaller physician practices faced unique challenges as their employees…
Under ICD-10, submitting compliant and accurate claims and minimizing the negative impact to clients’ cash flow were concerns shared by all those in the coding and medical billing community. While the transition has been relatively smooth as it pertains to our internal operations, there have been unanticipated challenges on the…
ICD-10 has been a non-event for clearinghouses, which are continuing to report little impact on their day-to-day business operations. Availity, one such entity, has encountered a few minor issues over the past month, primarily related to data not being submitted correctly by providers or payers having slightly different interpretations of…
EDITOR’S NOTE: The following is an excerpt from Dr. Moffic’s appearance on the Talk Ten Tuesdays broadcast that took place on Nov. 10, 2015.  For all he gave to us, I bet Robin Williams never imagined providing a justification for the importance of ICD-10 and the advances in our diagnostic…
Lewy body dementia is the second-most common type of progressive dementia after Alzheimer’s disease, and it is captured with ICD-10-CM code G31.83, Dementia with Lewy Bodies. G31.83 is listed in section G31, titled "Other degenerative diseases of nervous system, not elsewhere classified,” and is included in category G31.8, titled "Other…
Sherry Wilson Tina Greene As part of our efforts to track and help the industry respond to worker’s compensation challenges associated with the transition from ICD-9 to ICD-10, we will be penning a two-part series on the topic. This article is focused on the front end of post-implementation findings and…
As we begin coding inpatient rehabilitation facility (IRF) claims using ICD-10, it is prudent to review Medicare’s clarification about the use of seventh-character extension in ICD-10-CM under the IRF Prospective Payment System (PPS). Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued the following clarification related to…
Here are some lessons learned over the last year as we have prepared for an organization-wide approach to implementing ICD-10 across a very large health system in San Diego. There are three specific areas that should be considered when implementing a new coding process for hospice programs, which went into…
It has only been a month since ICD-10 has officially been implemented, and there is clearly much at risk for rural health entities that deliver healthcare services for more than 72 million people. I believe that at least half of the more than 1,300 critical access hospitals (CAHs) and 5,000…
ICD10monitor, as its name implies, will continue to monitor and report on the progress that all healthcare stakeholders are experiencing in their respective implementations of ICD-10.  Stakeholders include acute-care and post-acute care facilities, hospice and home health, physician practices, payers, durable medical equipment providers, clearinghouses, and vendors. 
I have told you about some of my pet peeves before, and below is another. How many of you reading this article hate Convention A.11 when it comes to PCS guidelines? Come on and admit it: you are silently chuckling about it now! What is A.11?
The healthcare clearinghouse industry has not seen a substantial increase in call volume or cases related to the recent implementation of ICD-10, but as a group, the Cooperative Exchange anticipates that as activities ramp up over the next few weeks, this may change.  Clearinghouses are finding that their numbers are…
Notably, we are in a transition phase now as it pertains to ICD-10, and getting through that phase is going to take some time, perhaps even a few months.
Various industry agencies, organizations, payers, providers, and physicians are reporting that there has been a reasonably smooth start for such a gigantic undertaking as the recent implementation of ICD-10. Like all momentous challenges, there have been some hot spots, some notable failures, some minor toe-stubbing, and some smooth sailing. Keep…
Claims appear to be moving along the I-10 with little congestion in the early going following implementation of the new code set. This week’s update will cover Wisconsin Physician Services (WPS), First Coast Service Options, and CGS Medicare and its local coverage determination (LCD) issues and resolutions. Overall, it appears…
America’s healthcare system has been submitting ICD-10 claims at the rate of 4.6 million daily since the conversion to the new coding set took effect Oct. 1, according to the Centers for Medicare & Medicaid Services (CMS). The rate of claim denials is 10.1 percent of all claims being processed,…
Some sectors of the healthcare industry are experiencing more success than others in adjusting to the Oct. 1 implementation of ICD-10, but home health agencies and hospice facilities are enjoying a relatively seamless transition thus far, an industry sector leader reported this week.
The implementation of ICD-10 for auto casualty has been dependent on what happens with the Centers for Medicare & Medicaid Services (CMS) and the rest of the healthcare industry.  The only states that have a dependency are states such as Pennsylvania and Florida, which use the Medicare rates for payment…
We have been living with ICD-10 for nearly 30 days now, and I think things are going fairly well. What I would like to discuss is coder productivity and accuracy in the hospital setting.   I was a bit concerned when I was told that offshore coders are only coding…
EDITOR’S NOTE: The following is a rough transcript of comments made by Jill Finn during the Oct. 12, 2015 broadcast of Talk Ten Tuesdays. The HATA (Healthcare Administrative Technology Association) practice management members as well as our members from organizations like the AMA (American Medical Association) and UnitedHealthcare have been…
Now that ICD-10 is a reality in U.S. healthcare, providers are finding that Oct. 1, 2015 didn’t bring with it the doomsday scenario they thought it might – but they also know that ICD-10-related challenges that aren’t apparent now may manifest themselves in the coming months.  The latest data from…
EDITOR’S NOTE: Dr. Anon is a U.S. physician based overseas who wishes to remain anonymous. Following implementation of ICD-10, what has happened in the coding world as it pertains to outsourcing? The answer is simple: chaos. For those of you old enough to remember, I am not describing a Get…
Many healthcare organizations recently have contracted with coding vendors to provide ICD-9 coding assistance, in part to allow in-house coders to undergo ICD-10 training and participate in dual coding. Some of these vendors employ U.S.-based coders only. However, it’s becoming more common for companies to employ a mix of both…
The healthcare industry may have finally flipped the switch to ICD-10, but many of us know that the hard work has only just begun.  For example, during the first week following implementation, H.I.M. ON CALL has spent considerable time gathering feedback from its coders, monitoring productivity, and keeping lines of…
Astute coders comparing this year’s ICD-10-CM guidelines with those in their 2015 books might be surprised by several changes.  Unmarked and made with no fanfare, the changes are worth noting.   A recent line-by-line comparison by AAPC ICD-10 education staff verified changes mostly in Section I. They include the addition…
EDITOR’S NOTE: The following is the final installment of a two-part series dealing with early signs of challenges facing physicians in their adoption of ICD-10. Many physicians are confused as to when to report the seventh-character extension. Physicians are confusing CPT® guidelines with ICD-10 guidelines. CPT and ICD-10 are two…
After months, and, in some cases, years of training, coders have finally begun to code in ICD-10. However, just because ICD-10 officially went live on Oct. 1, doesn’t mean that coder training should cease. In fact, just the opposite is true.  Remedial training will be critical during the first six…
EDITOR’S NOTE: This article is the first installment in this two-part series. ICD-10 has finally been implemented!
Efforts to fix what has been identified as the first significant issue to emerge under ICD-10 — medical necessity — appear to be underway with Medicare Administrative Contractor (MAC) NGS reporting that it will update its local coverage determination (LCD). The LCD issue surfaced earlier this week, when Laurie Johnson,…
The topic of medical necessity surfaced in the form of National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) during yesterday's ICD10monitor.com broadcast, "ICD-10: Five Days in Ten." The first to report on the issue was Laurie Johnson, MS, RHIA, FAHIMA, who made the discovery Monday, saying that her "eyes…
The Centers for Medicare & Medicaid Services (CMS) is monitoring the progress America’s healthcare industry is making with the implementation of ICD-10 – but it’s also standing by with a series of contingency plans should there be any significant disruption.
Tony Broyles Tripp Cox In the recent ICD10monitor article ICD-10 is Risky Business, Holly Louie states that “the best way to fix claim errors is to not make them in the first place.” Since the Oct. 1 implementation of ICD-10 has passed, how will your organization know when and where…
The first significant glitch of the ICD-10 era seems to be connected to physician office scripts, as reported during ICD10monitor's War Room live broadcast today. That's the assessment from healthcare consultant and educator Laurie Johnson, MS, RHIA, FAHIMA, who monitored the broadcast.
After multiple delays, ICD-10 is now the national (and to some degree, international) standard for the definition of each patient’s health state.    While there are many different standards in other areas, this is the only standard of its kind for the definition of patient condition that is nationally mandated…
It now has been a few days since ICD-10-CM/PCS was implemented, and these first weeks and months certainly are bringing some excitement and intrigue. 
EDITOR’S NOTE: The following is part one of a two-part series dealing with challenges facing physicians in their adoption of ICD-10. The day finally came and went. I must admit, I am relieved there were no more delays in ICD-10 implementation. It is time to move forward. But ICD-10 anxiety…
Early reports from the first full day of ICD-10 indicate that some of the nation's practice management system (PMS) vendors are giving a thumbs up to implementation of the new coding set — although, of course, they're still waiting for the ultimate verdict: adjudication of claims.  "Our experience is positive…
The operative report is truly a goldmine of information. This is true in ICD-9, and it will be even more important in ICD-10, when coders will need to look for more specific anatomical information, as well as additional details about the procedure itself. They’ll need to read each and every…
The potential for a perfect storm of ICD-10 being implemented and the federal government shutting down on the same day – Oct. 1, less than a week away – is stirring major concerns among providers nationwide. The majority of questions fielded by Centers for Medicare & Medicaid Services (CMS) Principal…
Although many got a laugh (or were completely confused) by former Secretary of Defense Donald Rumsfeld’s infamous convoluted answer to a question, it seems it was prophetic of where we are on the road to ICD-10. “There are known knowns; there are things we know we know. We also know…
The years of preparation, planning, and work are about to pay off: ICD-10 is here. On this coming Thursday, Oct. 1, 2015, the national standardized coding system goes live. For payers, system remediation, end-to-end testing, financial impact analyses, staff training, and risk analysis/contingency planning should be done. But the real…
While the term “countdown” has debatable origins, scholars have attributed it to events as different as space shuttle launches, New Year's celebrations and Cambridge University rowing races, most healthcare insiders agree it now applies to ICD-10. Although many providers have counted down the time remaining until the ICD-10 transition, we…
We are now within two weeks before ICD-10 implementation begins on Oct. 1, 2015. Going through your readiness checklist is a daily process, and at this point we all must ensure that there is nothing forgotten or skipped. The ICD-10 countdown checklist should include several key activities and areas, including…
As we head into the final stretch of ICD-10 preparations, it’s important to review the ICD-10-CM guidelines, some of which include significant changes that affect code completion/validity and sequencing. In fact, many of these changes are ripe for audit and compliance challenges. In this article, I’ve summarized some of the…
EDITOR’S NOTE: Stanley Nachimson, founder of Nachimson Advisors, LLC, is the recipient of the 2015 Ten Leadership Award from ICD10monitor. Nachimson was recognized for his decade-long industry leadership in the adoption of ICD-10. Nachimson is co-chair of the WEDI-SNIP ICD-10 Testing Workgroup. He has been co-chair of the HIMSS ICD-10…
EDITOR’S NOTE: The following is transcription of a segment on Talk Ten Tuesdays by H. Steven Moffic, MD, speaking on the subject of workplace stress and burnout, occasioned by the impending conversation from ICD-9 to ICD-10. Dr. Moffic is nationally renowned and award-winning author, and has blogs published by Behavioral…
September 16, 2015

Lollapalooza 092015

By
https://youtu.be/QO7bUSUBm44
EDITOR’S NOTE: The looming implementation of ICD-10 is bringing symptoms of workplace stress and burnout for healthcare professionals. So ICD10monitor recently asked nationally renowned psychiatrist H. Steven Moffic, MD for some timely advice. Dr. Moffic is an award-winning author and has blogs published by Behavioral Healthcare and Psychiatric Times.
ASSOCIATION NEWS The Electronic Healthcare Network Accreditation Commission (EHNAC) and the Healthcare Billing & Management Association (HBMA) have announced a collaboration to accredit medical billers in the areas of privacy, security, confidentiality, cybersecurity, business best practices and technical operations. 
In these final few weeks prior to ICD-10 implementation, your coding countdown checklist should include several key and critical points to consider. The appropriate steps along this countdown path are important to follow and observe. Make sure you have coding/physician queries on that list.
Have you reviewed your Medicare Administrative Contractors’ (MACs’) new local coverage determinations (LCDs) that include ICD-10 codes instead of ICD-9 codes? Do they include the full range of ICD-10 codes that map from the ICD-9 codes in current or former policies? Some of them don’t, warns JoAnne Glisson, senior vice…
Sometimes people do their homework with setting up a new system, and sometimes they don’t. Sometimes, even when those people do their homework, it may not be adequate, and billions of dollars of avoidable wasteful spending occurs.    But too often “they” won’t listen. 
The countdown continues leading up to the immovable ICD-10 implementation deadline of Oct. 1, 2015. We are down to a couple of weeks to go. Providers across the country are facing the cold reality that delaying is no longer an option. For those who have lived through this for 40 years,…
And so it begins…. It appears that ICD-10 implementation is moving forward on Oct. 1, 2015. It is important to have facility guidelines in place for ICD-9-CM as well as for ICD-10-CM/PCS at the time of implementation. These guidelines frequently are requested by auditors and should be maintained by version…
We are now in the final few weeks before ICD-10 implementation, and it’s critical that coding and health information management (HIM) professionals take the appropriate steps along the way. You need to review your final checklist before Oct. 1 arrives – and to make sure you have in your checklist…
With only 30 days left until ICD-10 implementation, many in the healthcare industry are starting to get nervous. There are ways to ensure that you are prepared on time, but practices need to move fast. Here’s how you can make it happen.
I cannot believe it is finally here. After much debate and two delays ICD-10 is about to become a reality. Many of us are meeting this challenge with excitement and a bit of apprehension. I must admit the fear of the unknown right now is causing me a bit of…
In this age of electronic health records (EHRs) and big data collection, data analytics continues to pique curiosity. With the simple click of a button, organizations can analyze and cross tabulate essentially any data they collect, including productivity data as well as data that is financial or clinical in nature.
What is the difference between delirium and encephalopathy? This is a common discussion among coders and clinical documentation improvement (CDI) professionals alike. Usually when a question like this comes up, the solution is simple: check the literature. Unfortunately, the information is somewhat contradictory, so we continue the debate while Recovery…
When ICD-10 implementation becomes a reality on Oct. 1, 2015, clinical laboratories will continue to experience challenges related to the submission of test requisitions, no matter how prepared they are internally. Administrative problems that exist under ICD-9 will not go away; in fact, they could worsen under ICD-10 if the…
It looks like ICD-10 will indeed keep on trucking, with the American Medical Association (AMA) now on board and the Centers for Medicare & Medicaid Services (CMS) having made an announcement regarding a transition period. Not only was this important to reassure folks that there would be no turning back with…
As organizations continue to search for ways to mitigate coder productivity loss following implementation of ICD-10, they also must consider methods to monitor and enhance coding accuracy. After all, productive coders are only effective when those coders assign accurate and complete codes. A low DNFB doesn’t denote coding compliance, nor…
The risks associated with the changeover to ICD-10 on Oct. 1 have been numerous and varied. Will there be increased allegations of false claims? Did the recent Centers for Medicare & Medicaid Services (CMS) clarification regarding “families” of codes alleviate concerns? Will the change really create a surge in improper…
Despite countless hours of ICD-10 coder training and practice time on the part of their staffs, coding managers often lack access to objective measurements of real-world coder proficiency with ICD-10. While training systems test coders with scenarios and check-the-box exams, organizations often struggle to predict how their coders will perform…
With ICD-10 just two months away, the question I’m asking providers is this: When was the last time you watched the 1999 American comedy Office Space? Not just because we could all use a little more levity in our lives — though that’s certainly reason enough. Rather, it’s because Office…
Sherry Wilson Tina Greene There are less than three months left for effective transition planning prior to the ICD-10 implementation deadline, and there are still unknowns regarding which states are adopting ICD-10 for workers’ compensation. Providers either will need to transition fully to ICD‐10 and/or be required to support both…
Recently, the Healthcare Administrative Technology Association (HATA), the national association for the practice management system (PMS) industry, released the results from a survey on PMS vendors’ ICD-10 readiness as of July 1, 2015.
With the recent Centers for Medicare & Medicaid Services (CMS) announcement of a “grace period” related to ICD-10 coding specificity for Part B physician claims, there is a spotlight on unspecified ICD-10 codes. But how much will health information management (HIM) leaders need to worry about unspecified codes? According to…
If you’re part of a small practice, you’ve no doubt found the past few years in the healthcare industry to be a little overwhelming at times, to say the least. With mounting regulatory challenges, escalating costs, and fewer reimbursements, providers are feeling real strain. And now, with the looming ICD-10…
As I recently traveled around the country interacting with representatives from various clinical documentation improvement (CDI) programs, I began to notice various patterns. What differentiates successful programs from those that struggle in mediocrity or falter and sometimes disintegrate? One factor in particular: an active and expert physician advisor.  An uninvolved…
EDITOR'S NOTE: The following article constitutes a transcript of comments recently made exclusively to ICD10monitor.com by a former representative of an offshore coding entity who requested to remain anonymous. With ICD-10 go live on the horizon and the predicted production drop, many of you have found or are scrambling to…
For years and years, there has been a national shortage of coding professionals – and by that I mean professionals who are well-educated, trained, credentialed, and experienced.
Summer is the most popular time for tying the knot and other celebrations that tend to see people get carried away and sometimes end up with the need for a little medical attention. So to help you prepare for the wonderful season of love, marriage, and the chaos that follows,…
DEVELOPING STORY The Centers for Medicare & Medicaid Services issued new guidance late Monday in an effort to clarify the agency’s joint statement issued on July 6 regarding an agreement reached with the American Medical Association.
A recent announcement from the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) was certainly a welcome surprise to most of us. There were actually three items involved: the announcement, the additional guidance document, and a letter to Medicare providers.  Everyone I’ve talked to has…
I would like to propose that there are two sides to the revenue coin when considering the impact of ICD-10. The first revenue impact, and the one felt more immediately, will be the impact on cash flow (and, correspondingly, revenue). Now, why will there be an impact on revenue? Well,…
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…
It looks like ICD-10 will indeed keep on trucking, with the American Medical Association (AMA) now on board and the Centers for Medicare & Medicaid Services (CMS) recently having made an announcement regarding a transition period. Not only was this important to reassure folks that there would be no turning back…
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, doctors are focused on the here and now.…
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…
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…
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…
“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 & Medicaid Services (CMS) announced last Monday…
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…
With Oct. 1, 2015, and the final implementation date for ICD-10-CM rapidly approaching, Inpatient Rehabilitation Facilities (IRFs), like all healthcare providers, should be in the final stages of preparation and training for the changes in coding requirements.  While most IRFs have been preparing for the transition for some time, it’s…
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,…
A bill to provide a safe harbor period for the transition from ICD-9 to ICD-10 by allowing healthcare providers to submit claims in both ICD-9 and ICD-10 was introduced today in the House. Today’s action caps a week of policy flurry and set off with the announcement on Monday of…
It looks small – a coding change – but its impact will be far-reaching. Because ICD-10 readiness involves communication between parties, everyone has to change together. To make this change easier for everyone, the industry needs to ensure that the right tools are in the hands of the people who…
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…