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
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
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
A 65-year old female was seen as an outpatient by her internist for monitoring of her hypertension and type 2 diabetes mellitus. During the course of the visit, the patient told her physician that she had been feeling sad and depressed as of late. After discussion, the patient agreed to a trial of antidepressant medication therapy. Prescription renewals for enalapril and metformin along with a new prescription for the antidepressant were sent to the patient’s pharmacy electronically. The diagnoses for the visit were hypertension, type 2 diabetes mellitus and depression. Assign diagnoses codes for this outpatient encounter. Continue reading
Blog by Sue Belley
A man from a small village in Guinea, West Africa, presented to his village health clinic with a severe headache, vomiting, diarrhea and severe pains in his back. He was initially thought to have malaria, but upon transfer to a special unit at a hospital in Conakry he was diagnosed with Ebola. The patient went on to develop disseminated intravascular coagulopathy, SIRS and shock. The patient was treated with intravenous fluid and electrolytes, vitamin K, oxygen and blood pressure support. He eventually succumbed. Assign codes for this inpatient encounter and sequence appropriately. Continue reading
The small nation of Papua New Guinea was an early adopter of ICD-10, inspired by its neighbor Australia. In the remote provinces of New Guinea, an ICD-10 codebook is considered a precious object. One codebook is granted to each village and entrusted to the care of the village coder, who is held in the highest esteem by the people. The account that follows gives us yet another example of the quiet heroism of the ICD-10 coder.*
There were two warring tribes deep in the hinterlands of Papua New Guinea, one that lived in the valley and the other high in the mountains. One day, the mountain people invaded the valley, and as part of their plundering of the people, they kidnapped an ICD-10 book from one of the villages and took the codebook with them back up into the mountains. Continue reading
Posted in ICD-10
Donna: Hey, Sue – what were your takeaways from the AHIMA Clinical Coding meeting held in New Orleans?
Sue: I really enjoyed the presentation by Dr. Jon Elion. He offered great clinical perspective on some of the diseases that can cause the most difficult documentation and coding conundrums – you know, like malnutrition, encephalopathy, CHF, malignant hypertension . . .
Donna: So interesting! He noted that there is no specific code for hypertensive urgency. If this is documented and there is no current or impending organ failure, one should not query for malignant hypertension in this scenario – instead, it is just reported as unspecified hypertension.
Sue: Which presentation piqued your interest? Continue reading
In my May blog, I talked about the cost of non-compliance versus the cost of implementing ICD-10. My hypothesis: human nature is the real cost driver in health care – not code set changes. A recently released study by OIG revealed that physicians increased the billing of all E/M (Evaluation and Management) services from 2001 to 2010 (the years studied). The higher the level of E/M codes assigned, the greater the reimbursement. CMS found that E/M services are 50 percent more likely to be paid in error than other Part B services. Why? Because they are coded to a higher level which results in more money paid to the provider – physician and non physician alike. CMS identified the root cause of the overpayments – no surprise here, coding error and poor documentation. Continue reading
In Part 12 we looked up unused ICD-9 codes in your policy in the 9-to-10 GEMs cluster table. If we found a code in there, it would lead us to one or more translation alternatives, each of which consists of two or more ICD-10 codes which have to appear on the patient’s record together in order to convey the same meaning as the ICD-9 code.
Here again is one of the examples we looked at:
806.00 Closed fracture of C1-C4 level with unspecified spinal cord injury
for which the GEMs provides four alternative translates, all clusters. Here is the first one: Continue reading
Results of some recent studies evaluating the percentage of coder agreement in ICD-10 both intrigued and concerned me. It was a topic of conversation at three national conferences I attended recently, during which several of the speakers addressed the topic.. One study identified was the HIMSS “ICD-10 National Pilot Program: Outcomes Report,” released in October, 2013, which details findings from 200 patient records coded by two independent ICD-10-CM/PCS AHIMA Approved Trainers. The average accuracy between the two coders was 63 percent. These results made me wonder if the study’s outcome was due to a lack of ICD-10 coding knowledge or something else. Continue reading