November 2, 2015

So Far, So Good for the ICD-10 Transition

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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.

 

There were a few minor systems issues reported by some organizations in the industry, but these were corrected quickly. There have been a few ICD-10-CM coding questions as well, for example relating to excludes I instruction, coding challenges with external cause code selection, and a few ICD-10-PCS issues, including the definition of what constitutes a single or multiple duration forfifth-character assignment and the necessary documentation in the medical record. 

I know that some organizations and practices have sent in questions to the American Hospital Association (AHA) Coding Clinic for guidance and clarification, which is a good thing to do. Anyone can send in questions to AHA Coding Clinic and there is no cost; go to their website at www.ahacentraloffice.org.

The American Health Information Management Association (AHIMA) also has a new service called Code Check, which provides answers to coding questions, including inquiries about CPT® and HCPCS; there is a small fee for this service and you can find more information at www.ahima.org.

I also have heard of a few issues affecting outpatient orders for lab and radiology referrals and the lack of a diagnosis or code. There is a Code of Federal Regulations (CFR) § 410.32 order that states: 

“Diagnostic or other medical information supplied to the laboratory by the ordering physician or nonphysician practitioner, including any ICD–9–CM code or narrative description supplied.”

The National Center for Health Statistics this past week issued additional guidance regarding the meaning of the “Excludes I” note for the ICD-10-CM code set:

“We have received several questions regarding the interpretation of Excludes 1 notes in ICD-10-CM when the conditions are unrelated to one another.”

The Center’s answer: “If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes 1 note. For example, the Excludes 1 note at code range R40-R46 states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes. However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and bipolar disorder. In another example, code range I60-I69 (Cerebrovascular Diseases) has an Excludes 1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-.” 

The very definition of a transition is “to make a change from one state, place, or condition to another.” We are now in an era of change, so continuing to speak with staff about coding, documentation, and denials will be very important. Track and trend issues, and provide education where and when needed. Of course, with ICD-9 you would and/or should have done this also, so this may not be new with ICD-10 implementation.

Communication has been good overall with organizations, payers and providers.

So again, so far, so good!  

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Gloryanne is a coding and HIM professional with 35 years of experience. She is the past president of the California Health Information Association. Gloryanne is a member of the ICD10monitor editor board and is a popular guest on Talk Ten Tuesdays.

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