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EDITOR’S NOTE: Laurie Johnson is covering the two-day meeting of the federal Coordination and Maintenance meeting taking place Wednesday and Thursday at CMS headquarters in Baltimore. Johnson filed this report on yesterday’s proceedings and will file a report on Day 2, wrapping up later this afternoon. Complete coverage will be…
Deb Grider, AHIMA Certified Clinical Documentation Improvement Practitioner Holly Louie, RN, CHBME; Laurie McBrierty, and Laurie Johnson, FAHIMA AHIMA-Approved ICD-10-CM/PCS Trainer

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I am looking forward to attending the ICD-10 Coordination and Maintenance Committee meeting at the Centers for Medicare & Medicaid Services (CMS) headquarters this week. Our AAPC members are very anxious to see the changes that will be in the code set this year. As you know, we have had…
It is time to perform an assessment of your facility or practice in order to evaluate your ICD-10 progress and to uncover potential issues that might affect productivity, risk, or cash flow. Also, by conducting an assessment, you can identify opportunities for improvement, additional training needs, documentation assistance, or operational…
This is a very exciting time to be in the field of clinical documentation improvement (CDI), with so many emerging opportunities beyond just reviewing for major complications and comorbidities (MCCs) and complications and comorbidities (CCs). CDI programs are growing into so much more than just a mechanism for reviewing documentation…
In February, the Healthcare Billing and Management Association (HBMA) surveyed its members seeking information on current claims statuses as well as their experiences with ICD-10 implementation. Many responses were as predicted, some were consistent with other industry reporting, some confirmed what we already knew, and there were some surprises. This…
Rose T. Dunn, MBA, RHIA, CPA, FACHE, Melanie Endicott, MBA/HCM; CDIP, FHIMA; Pam Jodock; Laurie Johnson, AHIMA-Approved ICD-10 Trainer; Stanley Nachimson; and Jacqueline J Stack, BSHA, CPC, CPC-I, CPB, CEMC, CFPC, CIMC, CPEDC

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In its recent outbreak, the Zika virus, a mosquito-borne illness, has spread to more than 20 countries in South and Central America since May 2015. During a Feb. 1 news conference, Dr. Margaret Chan, director general of the World Health Organization (WHO), acknowledged just how serious the situation has become,…
At this point, most clinical documentation improvement (CDI) programs are well-versed in the topic of malnutrition. New and old programs alike acknowledge that malnutrition is under-documented and that appropriately establishing this diagnosis for the patient can improve severity-of-illness metrics.
The third international consensus definitions for sepsis and septic shock were published on Feb. 22 in the Journal of the American Medical Association (JAMA), and the Internet went wild with discussion.
The federal ICD-10 Coordination and Maintenance Committee (C&M) is scheduled to meet March 9 and 10 to discuss proposed changes to the new coding system that became effective last October.
Chuck Buck and Holly Louie, RN, CHBME

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Functional quadriplegia (R53.2) is defined as “the inability to move due to severe disability or frailty caused by another condition without physical injury or damage to the brain or spinal cord,” describes Richard Pinson, MD. This oft-overlooked secondary diagnosis may have significant impact on the final MS-DRG, relative weight, length…
Joseph Nichols, MD Old habits die hard – but hopefully, not too hard. That’s one way to summarize a recently published white paper by Joseph C. Nichols, principal of Health Data Consulting. The paper, titled Data Value: Breaking Old Habits, shines a spotlight on the ways the healthcare industry historically…
EDITOR’S NOTE: The following is a personal reflection by the author and does not necessarily reflect the views of the Healthcare Billing and Management Association of which she is president. The story I am going to relate in this article could borrow a line from the classic 1989 comedy “When…
On Feb. 5, Hollywood Presbyterian Medical Center experienced an electronic health record (EHR) outage that began due to ransomware. This type of malware had shut down the hospital’s internal computer system and communication devices, with only a software “key” capable of reopening the internal data files. The hospital has reported…
Gregory Adams, MBA, FHFMA, Evan M. Gwilliam, DC, MBA, BS, CPC, CCPC, CCCPC, CPC-I MCS-P, CPMA; Laurie Johnson, AHIMA-Approved ICD-10-CM/PCS Trainer; Scot Nemchik, CCS; Stanley Nachimson; and H. Steven Moffic, MD Guest Co-Host: Holly Louie, RN, CHBME

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EDITOR’S NOTE: In this new series, Scot Nemchik and Sabrina Yousfi will identify ICD-10 “coding culprits” and offer practical advice and insights for addressing issues as they arise.  ICD-10 implementation was a hugely important event, but not catastrophic, as some anticipated. For the most part, we in the healthcare industry…
EDITOR’S NOTE: The confluence of two national events last week inspired the following interview with H. Steven Moffic, MD, Talk Ten Tuesdays’ celebrated resident psychiatrist: Valentine's Day on Sunday, Feb. 14 and last Tuesday’s New Hampshire presidential primary, which resulted in a GOP victory for presidential hopeful Donald Trump. A…
Today, February 16, the Centers for Medicare & Medicaid Services (CMS) is holding a New Technology Town Hall Meeting at the CMS Headquarters in Baltimore.
Radiculopathy can be an unpleasant condition, but diagnosing, documenting, and coding for it does not have to be. It just takes a little research. As you know, the brain communicates with the body via the spinal cord, which is protected by the bones of the spinal column, called vertebrae. Nerve…
EDITOR’S NOTE: The confluence of two national events last week inspired the following interview with H. Steven Moffic, MD, Talk Ten Tuesdays’ celebrated resident psychiatrist: Valentine's Day on Sunday, Feb. 14 and last Tuesday’s New Hampshire presidential primary, which resulted in a GOP victory for presidential hopeful Donald Trump. A…
Vicky Mahn-DiNicola, RN, MS, CPHQ, Seth Avery, JD, CPA; Kimberly Carr, AHIMA-Approved ICD-10-CM-PCS Trainer; Ronald Hirsch, MD, MD, FACP, CHCQM; Laurie Johnson, AHIMA-Approved ICD-10-CM/PCS Trainer; Joseph C. Nichols, MD, AHIMA-Approved ICD-10-CM-PCS Trainer

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Recently I served as a panelist for Talk Ten Tuesdays, ICD10monitor’s weekly Internet program. The program covers a variety of topics, but ICD-10 is its primary focus.   The experience got me to thinking: we are already seeing, ICD-10 can provide us some rich data, and this directly ties to…
“Patient with transaminitis, keep watching labs.” “Patient’s liver enzymes extremely elevated, keep in ICU.” Physicians may have seen these notes before. But transaminitis and “extremely elevated liver enzymes” do not equate to shock liver or acute and subacute hepatic failure without coma. 
EDITOR’S NOTE: President Barack Obama is asking Congress for more than $1.8 billion in emergency funding to combat the Zika virus here and abroad it was announced yesterday,  We have a code!
ICD-10 went into effect Oct. 1, 2015 and, so far, everything seems to be going pretty well. There are a few areas, however, that continue to give clinical documentation improvement (CDI) specialists and coders headaches. One of these problems is Acute Myocardial Infarction (AMI) documentation. In ICD-10 there is a…
Rose T. Dunn, CPA, FACHE, FHFMA, Gloryanne Bryant, AHIMA-Approved ICD-10-CM/PCS Trainer; Deb Grider, AHIMA-Approved ICD-10-CM/PCS Trainer; Laurie Johnson, AHIMA-Approved ICD-10-CM/PCS Trainer; H. Steven Moffic, MD; and Stanley Nachimson

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ICD-10 training is rapidly becoming the sort of buzzword that gets everyone rolling their eyes and having nightmarish visions of death by a thousand PowerPoints. It’s true that the subject matter can be dry, and people are rapidly transitioning into training fatigue. That fatigue will lead to complacency and finally…
Congestive heart failure (CHF) is the inability of the heart to pump an adequate volume of blood to meet the metabolic requirements of tissues – or the ability to only do so at elevation in the filling pressure. CHF can be caused by coronary artery disease, hypertension (HTN), rheumatic fever,…
In business as well as in life, it’s always interesting to look back on what was critically important a year ago to see if those things are as big a deal now as they were then. Back in January 2015, one of the hot topics in healthcare was the transition…
The statistics are striking: Between 2002 and 2013, heroin overdoses in the United States increased by 286 percent, according to a Centers for Disease Control and Prevention (CDC) report. In 2013 alone, more than 8,200 Americans died due to a heroin-related overdose.  
Ana Croxton; Jill Finn; Laurie Johnson, AHIMA-Approved ICD-10-CM/PCS Trainer; Holly Louie, RN, CHBME; and H. Steven Moffic, MD

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Jill Finn Ana Croxton At the four-month mark of ICD-10 implementation, practice management vendors are continuing to look for trends and potential issues for their clients. Several things currently being tracked are the overutilization of unspecified codes, claim submission, and payment productivity – and whether payers have implemented some, part,…
Can you believe we now have been using the ICD-10 code set here in the United States for four months? Time flies. I often receive technical questions from my colleagues and peers about ICD-10 coding – yes, even before implementation, and certainly after. Even with years of experience and skill,…
There have been several articles published recently about the latest public health crisis to attract the world’s attention: the Zika virus, which is currently spreading in South America, Central America, and the Caribbean.
Melissa Walton-Shirley, MD, Robert S. Gold, MD; Laurie Johnson, AHIMA-Approved ICD-10-CM/PCS Trainer; Nathan McWilliams, MPA, RHIA; and H. Steven Moffic, MD

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To date, most accounts of ICD-10 implementation are good ones. Claims are processing, providers are being paid, denials are minimal; it was all much ado about nothing. Or was it? For some unlucky practices and organizations, things did not (and are not) going quite so well. 
The past few years we have focused closely on getting ready for ICD-10. In most cases, the transition to ICD-10 was successful. We had a few bumps in the road, but overall, things went well. What’s next? Now we need to shift the focus to improve coding and clinical documentation…
EDITOR’S NOTE: This is the first in a two-part series on coding hypertension in ICD-10. In this installment, Rhonda Buckholtz provides a clinical context for hypertension. Understanding clinical conditions and relationships is an important component of coding. With many code assignments currently being paid in accordance with quality measures and…
The federal mandate for conversion of medical record-keeping to a purely electronic format for the purposes of developing statistics and its associated tracking of quality of healthcare delivery and billing for services (known as value-based purchasing) is virtually complete in the United States. 
Lyman Sornberger, Allen R. Frady, Betty Gomez, Laurie Johnson and Stanley Nachimson

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After all this time, functional quadriplegia is still a dysfunctional medical diagnosis. Around this time in 2008, the Patriots’ perfect season was soon to be ended by the Giants in Super Bowl XLII, and Patrick Swayze would be diagnosed with pancreatic cancer. By the end of the year we would…
In nearly every ICD-10-CM category there is an option for an “other specified” condition. What do these mean, and how are they properly used?
In December, the movie “Concussion” was released.  It tells the intriguing story of an investigation into repetitive concussion injuries and the National Football League (NFL).
During the transition to ICD-10, external cause codes – the codes that capture specific details about an injury or health event – received a bad reputation.
Health plans nationwide are touting widespread success in the implementation of ICD-10, according to comments made by three health plan representatives during the most recent edition of Talk Ten Tuesdays, the weekly Internet broadcast hosted by ICD10monitor.com.
EDITOR’S NOTE: Nationally renowned psychiatrist H. Steven Moffic, MD, a frequent guest on Talk Ten Tuesdays as its resident psychiatrist, provided audience members with a recap on mental health stories that made headlines this year during the most recent edition of the weekly Internet broadcast. Here is a transcript of…
In some quarters of healthcare, 2015 was the year of the big malaise. Although former President Jimmy Carter never actually uttered the word in his July 1979 speech about a “crisis of confidence,” his comments ultimately become known as the “malaise speech.”
The organization representing the healthcare clearinghouse industry has declared the much-anticipated implementation of ICD-10 a “non-event,” according to a statement issued this week. The assessment was based on the Cooperative Exchange’s view that “good ICD-10 planning, education, testing, and industry collaboration” resulted in a smooth transition for most healthcare providers…
So, how are we physicians coping with denials?  Despite the many apocalyptic predictions regarding the ICD-10 transition, for healthcare organizations and the nation, ICD-10 has moved along rather swiftly to date. By now, most of us have seen the Centers for Medicare & Medicaid Services (CMS) October statement, which noted…
Chiropractors use many of the same diagnosis codes as other providers that treat conditions of the nervous system, skeletal system, and muscular system. However, there is one diagnosis that’s unique to chiropractic doctors. It is the so-called vertebral “subluxation.” It is the diagnosis that justifies the performance of a chiropractic…
If you don’t read anything else this holiday season, read this. Documentation improvement is at the heart of any successful ICD-10 coding program, and in this article I will highlight eight key areas of focus about ICD-10 and clinical documentation improvement (CDI).
We all have one: a beloved holiday flick that inspires us to deck the halls, snuggle up, and press play. Whether you’re a die-hard fan of a Christmas classic, or you prefer the elven shenanigans of Will Ferrell, here’s one holiday treat everyone should enjoy: the coder’s complete ICD-10 list…
The newly supported ICD-10 code concepts for heart diseases, announced in a Nov. 13 letter from the American Health Information Management Association (AHIMA) to the National Centers for Health Statistics, will lead to tremendous improvement in data accuracy for these conditions.  
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…
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…