Category Archives: Coding Best Practices

Improving coding accuracy; complete and accurate coding; computer-assisted coding; CAC; remote coding; web-based coding; APR-DRGs; DRGs; diagnosis related groups

Coders and Computers, People and Machines

The bi-annual public meeting at CMS headquarters of the Coordination and Maintenance Committee is where interested parties come to propose changes to the U.S. version of the International Classification of Disease. Until the most recent meeting on September 18 and 19 this meant ICD-9, —now all proposals are exclusively for future updates of ICD-10-CM/PCS.

Discussion during these meetings centers on whether a proposed change would be useful to coders, whether additional instruction needs to be added for coders, and whether a distinction would be clear or confusing to coders. The reason for this is obvious: If new codes or coding instruction (which includes index entries, instructional notes in the codebook, and the official coding guidelines themselves) are incorrect or inconsistent, the resulting coded data is useless. Continue reading

Under the Streetlight

Towards midnight, a cop comes upon a guy crawling around on his hands and knees under a streetlight. The cop asks, “What are you doing?” “Looking for my car keys.” The cop thinks maybe he can help, so he asks, “Exactly where were you when you dropped them?” The guy looks up, considers and points into the dark, halfway down the block. “Somewhere there.” The cop asks, “Then why are you looking here?” Answer: “The light is better here.”

We’ve developed a tool that lets a payer or provider input the number of claims they submitted or processed under MS-DRGs or APR-DRGs in one year. The tool then computes estimates of the changes in reimbursement that might occur if those claims were coded in ICD-10. It also provides a table by DRG of all estimated shifts to other DRGs under ICD-10, their probability of occurrence, and projected reimbursement change. For some of those shifts, we provide a clinical explanation of the coding reason behind the shift and, when possible, improved ICD-10 coding practices that would avoid the shift. Continue reading

HIMagine That! Coding Variance from ICD-9 to ICD-10

Donna: Sue, I have been reviewing data files with ICD-9 codes translated to ICD-10 to determine if there are DRG changes between the two coding systems.

Sue: Well, Donna, what have you found?

Donna: As you would suspect, there are some variances from the MS-DRG assigned using ICD-9 codes to the MS-DRG assigned using the ICD-10 codes. But that is not the most interesting finding in my review. The issues I have come across are some strange pairings of ICD-9 codes that do not translate well into ICD-10.

Sue: I have heard that there are some variances in a small number of cases. I think one of the most common is when there is an anemia caused by a malignancy. This causes the MS-DRG to change from the anemia MS-DRG to the malignancy MS-DRG. Almost everyone has heard of this change, though, so describe what other things you are finding. Continue reading

Highlights from the CMS July APC Update

The July APC update is out, and I’m sure many of you have already installed it and find the changes 3M made valuable for you.

With this update out, we now get to look ahead to 2014. This week CMS published the proposed rules for the Hospital Outpatient Prospective Payment for next year. There seem to be a number of notable changes coming up for hospitals in 2014. I would like to highlight a couple of them. Continue reading

Coding All-Stars, Step Right Up!

This week, Julia Palmer, Project Manager with the Consulting Services Business Unit of 3M HIS joins HIMagine That’s Sue Belley to introduce the 3M Coding Challenge.

Things are really kicking into high gear in the world of healthcare information management. Inpatient and outpatient coders, CDI specialists, and professional staff are ramping up their preparations for the ICD-10 transition by doing everything from engaging ICD-10 through dual coding to measuring the financial and productivity impact of ICD-10.

In response to this, 3M is launching an ICD-10 coding challenge. We will post ICD-10 scenarios each month. Those entering correct answers will be entered in a drawing for prizes. Then we’ll report back each month and talk about what we’ve learned from the response. This is a chance for you to dig in, roll up your sleeves, and test your skill at solving ICD-10 scenarios.  Take a look below for an idea of what the scenarios, answers, and commentary will look like. Continue reading

Setting the Record Straight on Therapy Functional Reporting G-Codes

No one likes feeling like they are making a mistake, especially when dealing with something as important as accurate coding. Recently, a certain set of codes (the Therapy Functional Reporting G-Codes [non-payable]) and the way some hospitals’ billing systems process them have left many coders scratching their heads. Here, I’ll do my best to set the record straight.

In January 2013, CMS introduced 42 Therapy Functional Reporting G-codes (non-payable). These G codes are to be reported in conjunction with therapy services (physical, occupational, and speech). CMS also introduced seven complexity/severity modifiers to be used with these G codes. Continue reading

HIMagine That! Queries in ICD-10

Sue:    So Donna, read anything good lately?

Donna:    Well, I did come across something that got me thinking. Did you see there is a new AHIMA Practice Brief, “Guidelines for Achieving a Compliant Query Practice”?

Sue:    I sure did. What about it?

Donna:    Well, it reminded me it might be time to think about ICD-10 queries. What do you think? Is too early to start querying for ICD-10 documentation specificity?

Sue:    I think that adapting queries should be done as part of your ICD-10 Implementation timeline. If you are going to start dual coding in October 2013, then the queries should be compatible with the ICD-10 language. Continue reading

HIMagine That! Falling Down the Rabbit Hole with TTOs

Donna:   Sue! I fell down the rabbit hole again.

Sue:        Okay, Alice. What’s up?

Donna:   I’m buried in ICD-10 code translation and this time I’m trying to figure out how to translate the ICD-9 code for TTOs to ICD-10.

Sue:        TTO…tell me what that is again?

Donna:   Trans-tracheal-oxygenation. Continue reading

ICD-10 MS-DRG Shifts, Part 2 – Depression

The third most reimbursement-lowering impact across nearly all DRGs, after Malignant hypertension and Uncontrolled diabetes, concerns ICD-9 codes 296.20 Major depressive affective disorder, single episode, unspecified and 311 Depressive disorder, not elsewhere classified.

296.20 Major depression, is a CC, so it will increase reimbursement for any case it is attached to – sometimes dramatically. 311 Depression NEC, is not. 311 is coded on about 1 in every 20 records – 296.20 only about a tenth as frequently.

Both codes translate to F32.9, Major depressive disorder, single episode, unspecified, in ICD-10. This means that if nothing changes between now and October 1, 2014, two distinct types of patients, those who are diagnosed with major depression, and those who are diagnosed with unspecified depression, will be captured in the ICD-10 data using the same code. How should F32.9 be defined in MS-DRGs? Should it be a CC or not? Like 296.20, with whom it shares an almost-identical code title, or like 311, which is ten times more frequent? Minimizing the impact of the shift to ICD-10 dictates the latter – better to lose the CC on 5 out of every thousand records than add a CC to 50. Continue reading

Technology and the HIM Professional – a Mutually Beneficial Relationship

Kudos to the AHIMA Convention Planning Committee for doing such an outstanding job with the 2012 AHIMA Annual Convention & Exhibit, which ended this past Thursday. There were jam-packed days full of numerous presentations on data governance, the EHR, privacy and security, ICD-10, and CAC technology, to name a few.

One very informative presentation was delivered at the AOE luncheon by Lisa Knowles, Cleveland Clinic Health System’s Coding Director, and Michelle Dougherty, AHIMA Foundation’s Director of Research and Development. They delivered initial findings from a 3M-sponsored research project titled, “The Role of the HIM Professional and Technology in Ensuring Data Quality.” This is important research for our profession. The results demonstrate that technology can greatly assist the HIM coder in improving productivity as well as accuracy in code assignment.  It also highlights the all-important role the HIM coder plays in the coding process.  Technology can’t do it alone—accurate code assignment requires the skilled HIM professional play a key role in validating the codes generated by technology. Continue reading