Category Archives: ICD-10

International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10); ICD-10-CM, ICD-10-PCS; ICD-9-CM; ICD-10-CM Clinical Modification; inpatient coding standard; granular; granularity; specificity; GEMs; general equivalence mappings; transition to ICD-10; new coding rules; coding regulations

Study Validates the Value and Utility of Risk-Adjustment for Stratifying Complex Patients

Introduction by Norbert Goldfield, MD, and Richard Fuller

Increasing value, or more precisely, improving outcomes from health care spending, a recurring theme of the C&ER blog, is intrinsically linked with risk-adjustment. If we can’t accurately compare patients, then we can’t determine if we are paying too much for their care. We cannot be certain if their health outcomes deviate from what we should expect. As governmental and private payers increasingly employ both managed care and prospective payment programs with more complex patient populations, the need for accurate risk-adjustment grows exponentially since cost variation across patients is greater. This variation is often greatest in pediatric populations, which range from healthy kids to some of the sickest individuals insured by government programs. Continue reading

Taking a Closer Look at the November ICD-10 Coding Challenge


A 49-year old female arrived in the trauma ED via helicopter in cardiac arrest after sustaining a stab wound to her upper torso. The patient was attacked by an unknown assailant with a knife (found at the scene) as she was walking to her car in a parking lot. The patient was unable to be resuscitated and expired. The Emergency Department physician documented the following diagnoses:

1. Penetrating laceration of anterior left thorax with near complete laceration of thoracic aorta
2. Hemopneumothorax

Assign diagnosis codes for this Emergency Department encounter. Continue reading

HIMagine That! Inter-Rater Reliability

Donna: Sue, have you heard people using the buzz word inter-rater reliability in the context of ICD-10?

Sue: Isn’t that a statistical formula used to determine agreement or consensus between two raters or judges?

Donna: Yes, but HIM professionals are using the term, not the formula, to compare the agreement rate between two or more coders coding a case in ICD-10. Continue reading

What Can an 18th Century Botanist Teach Us about 21st Century Healthcare?

Carl Linnaeus’s Systema Naturae, the taxonomy of living things he developed in the 18th century to classify living organisms, named only about 10,000 species of organisms, including roughly 6,000 plants and 4,000 animals. Linnaeus, a Swedish botanist, is reported to have stated categorically that there couldn’t possibly be more than 10,000 different plants in the whole world.

Even super smart guys like Linnaeus don’t know what they don’t know—there are currently 250,000 named plant species and 350,000 distinct species of beetles alone. The current estimate of the total number of species in the world is about 8.7 million. In other words, we have no idea how many kinds of living organisms there are, but we know we don’t know. And thanks to Linnaeus, we have a system that allows us to record what we learn as we learn it. Continue reading

Taking a Closer Look at the October ICD-10 Coding Challenge


A 70-year old man presented at an Ambulatory Surgery Center for an upper GI endoscopy to be evaluated for the cause of his recent complaints of some dysphagia. The patient received Midazolam 6mg IV and Fentanyl 100 mcg IV and Benzocaine spray was applied to the back of his throat. After obtaining informed consent, the endoscope was passed under direct vision. It was introduced through the mouth and advanced to the second part of the duodenum. A small hiatal hernia was present. A mild Schatzki ring was found at the gastroesophageal junction at 35 cm. A TTS dilator was passed through the scope. Dilation with at 15-16.5-18 mm x 240 cm CRE balloon (to a maximum balloon size of 18 mm) dilator was performed with mild treatment effect. The esophageal body mucosa appeared mildly corrugated. Biopsies were taken from the upper and lower esophagus. At that point, the patient went into cardiac arrest. We quickly removed the endoscope and began resuscitative efforts. The patient was emergently transferred to the local hospital. Postprocedure diagnoses: Schatzki ring, hiatal hernia, cardiac arrest. Continue reading

The Impact of ICD-10 on Reimbursement: What’s Realistic?

HFMA Reg 2On a beautiful fall day in upstate New York, I joined a group of healthcare financial executives at the HFMA Region 2 Fall Institute. Meeting hot topics included change management, the CMS Two Midnight rule, big data, and Medicaid updates.

Attendees also learned about the impact of ICD-10 on reimbursement in my presentation “ICD-10: Determining the Realistic Reimbursement Impact on MS-DRGs and APR DRGs.” While ICD-10 may impact many areas of the revenue cycle after October 1, 2015, including the DNFB and cash flow, my presentation focused on analyzing the potential shift in reimbursement by comparing claims coded in ICD-9 and ICD-10. Continue reading

HIMagine That! ICD-10: What’s in it for Physicians?

Donna: Hey Sue, I have a new goal!

Sue: And what would that be?

Donna: I want to get the word out to physicians about the real benefits of ICD-10. You know, address the “what’s in it for me” aspect.

Sue: Well, I think you need to debunk some of the myths around ICD-10. For example, the one about the huge volume of codes that ICD-10 brings – 145,000 of them, that will make it “impossible” for physicians to find a specific code. Continue reading

Follow-up: August Coding Challenge on Ebola

Since writing about coding of the Ebola virus disease in ICD-9 and ICD-10 for last month’s Coding Challenge, an interesting conundrum has come to light that I want to share with you.

It turns out there are two different codes that can be assigned to Ebola virus disease in ICD-9 depending on the way Ebola is located in the ICD-9 Alphabetic Index. Continue reading

Will you pass Meaningful Use Stage 1 for Natural Language Processing?

The MU of NLP. Haven’t heard of that yet? Well, it’s a new concept and I think it’s going to become as standard and important as Meaningful Use of EHRs. As important as MU is for EHR adoption and in fully evolving healthcare from the paper era, the true revolutionary advances are going to come from making sense of all of the digital data being collected in an electronic health record.

So, what are the Stage 1 requirements for meeting Meaningful Use of Natural Language Processing? The criteria are twofold. The first part is the criteria for establishing a fully integrated NLP platform with your clinical workflows. The second part is meeting two key use cases. Continue reading

ICD-10: A Common Language for Monitoring Ebola and Other Global Health Threats

As the fourth American Ebola patient, a physician serving in West Africa, was flown to the U.S. for emergency care this week, I was reminded that public health also wins from the implementation of ICD-10.

According to World Health Organization (WHO), the latest Ebola outbreak has killed almost 2,300 people in five West African countries. Medical workers have been hit hard by the Ebola epidemic. As of late August, more than 240 healthcare workers had developed Ebola and more than 120 had died. Continue reading