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.

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.

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.

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.

HIMagine That! Coding Hip Replacement in ICD-10

DONNA:  Sue!

SUE: What’s up, Donna?

DONNA:  Did you know that in ICD-10-PCS when you are coding the replacement of hip joint, you are going to need to know the composition of the implant in order to select character 6 of the code? In the Medical/Surgical, Lower Joints, Replacement table, character 6 represents the kind of implant.

SUE:  So…what’s the big deal? We already had to know that in ICD-9.

DONNA: Yeah, but in ICD-9, you could still code the hip replacement –81.51 – and if you knew the type of implant, you could assign the additional code – you know, one of the codes in the 00.73 – 00.77 range.  But in ICD-10-PCS, if you don’t know the type of device or implant, you can’t complete the code.

ICD-10 Essentials for Busy Physicians – Spinal Stenosis, HNP, Vertebral Fractures

As promised last time, I am going to show you what’s up in ICD-10 when it comes to documentation and coding for spine diagnoses that can end up being treated surgically by an orthopedic  surgeon or neurosurgeon, but may be seen by many other primary care physicians along the way. The family of diagnoses I am going to cover briefly are: herniated nucleus pulposus (commonly called a ruptured disc), spinal stenosis, and pathologic vertebral fracture.

Disc herniation or degeneration, spinal stenosis

Diagnosis coding and documentation of disc herniation (aka displacement), disc degeneration, and spinal stenosis are not that much different for ICD-10 . It is simply a variation on the theme I have been repeating all along, especially for musculoskeletal system codes: there are more codes mainly because there are unique codes for anatomic sites not specified in ICD-9. Sometimes there is more clinical detail as well.

HIMagine That! A back-and-forth take on the real world of HIM

Coding and documentation veterans Sue Belley and Donna Smith take a break from hospital visits and client consultations to trade tales about coding mishaps, ICD-10 enigmas, the latest regulatory twists, and why it’s nearly impossible to get physicians to document diagnoses in correct coding terminology. A back-and-forth take on the real world of HIM.

Sue:    So Donna, I’ve been doing some investigating….

Donna:   Here we go again.

Sue:    I’ve been thinking about the coder having to identify the type of contrast agent used in cardiac caths and other fluoroscopic procedures for ICD-10-CM coding.

Donna:   (places hands over ears) La la la – I can’t hear you!

Sue:   This is no time to be burying your head in the sand!  I remember all the caths we did when I was a coding manager. The type of contrast used wasn’t in our cardiac cath report, and besides, coders don’t have to worry about contrast in ICD-9.  If coders spend a lot of time looking for a relatively miniscule thing in the whole scope of coding, it’s going to be bad for productivity!

Donna:   So what do you think would fix this, Sue?  It sounds like a documentation issue, but it’s not the sort of question you take to the physician. Contrast is usually documented in the procedure flow note, which coders don’t need to review today. Rather than querying the physician or searching through the note, we need a way to bring the contrast type into the cardiac cath report.

ICD-10 Essentials for Busy Physicians who would Rather be Doing Something Else – Arthritis and Back Pain

This blog is nominally for rheumatologists. They are the ones who end up treating long-term sufferers of painful musculoskeletal conditions, especially those with autoimmune origins. But since a significant number of people suffer from arthritis or back pain, and most of them see most of you for various reasons, this basic ICD-10 information may be of interest.

Arthritis — Rheumatoid et al

It is still fashionable to get worked up about the number of ICD-10 codes, stating that, contrary to every other aspect of the information age, more is worse. People who have jumped on this bandwagon tend to use examples of codes that are statistically rare and of no relevance whatsoever to most physician practices (external cause codes for exotic animal bites and wildly improbable boating accidents, etc.). They leap blithely from their favorite silly ICD-10 code to the conclusion that ICD-10 contains no new clinically relevant detail.

ICD-10 Essentials for Busy Cardiologists who would Rather be Doing Something Else

Angina, chest pain, coronary artery disease, acute MI, atrial fib, CHF, mitral and aortic valve disease. These are the bread and butter and jam of cardiology practice. ICD-10 makes documentation and coding for cardiology easier and more efficient. The updated codes contain useful combinations of conditions and use current clinical definitions.  I will only highlight a few in this blog—combination codes for coronary artery disease with angina, acute MI codes, and the updated classification of valve disease. For a discussion of CHF coding and documentation in ICD-10, see my earlier blog on this subject .

The ICD-10 Grouper Transition

I get this question from our Financial Impact Analysis users:

We would like to be able to look at the ICD-10 codes [defining a DRG] and identify codes where additional specificity could help improve our reimbursement .

I suspect they are not happy with my answer: Since the first round of ICD-10 groupers will be replications of the ICD-9 groupers, there are no cases where additional ICD-10 specificity can improve reimbursement. That won’t happen until we start creating ICD-10 groupers that use the distinctions available in ICD-10. When the ICD-9 groupers were defined, they could not be any more nuanced than the ICD-9 code set around which they were built. As long as the ICD-10 groupers are merely a transliteration, they, too, are limited by ICD-9’s specificity.