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

CMS Clarifies “ICD-10 Families” and Offers Guidance on ICD-10 Flexibilities

The latest from CMS and AMA on July 6, 2015 is a bit confusing – I agree. But a clarification was released yesterday.

In case you missed the July 6, 2015 release, CMS and the AMA announced an effort to work together to help Part B providers under the Physician Fee Schedule prepare for ICD-10. CMS recognized some physician and other professional providers need additional help. To assist in the transition, CMS announced “Medicare review contractors will not deny physician or other practitioner claims billed under Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. Continue reading

ICD-10: After the Thaw

If you have the slightest inclination to freak out about ICD-10 because change makes you nervous, please ignore this blog.

Okay, now for the rest of you: the code sets have been frozen for more years than is good for them, and once we get to “thaw” the code sets, they need to be updated. How can that be, you say? ICD-10-CM/PCS is brand spanking new. No, not exactly—not new, unused. New and unused are not the same thing. Putting meat in the freezer does not make it fresh—it lets you put off cooking it for a while. Continue reading

HIMagine That! Queries for ICD-10

Donna: You know Sue, I think that people are really stepping up their ICD-10 game as we enter the home stretch.

Sue: The way I look at it, they’ve been stepping up their game for the last five years!

Donna: So true. Still, I’ve received a lot of emails lately from coding and CDI professional requesting assistance with ICD-10 queries that they can use to ensure they have ICD-10 ready documentation.

Sue: So what kinds of queries are they asking about? Continue reading

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

CHALLENGE QUESTION

A 37-year old male with a long-standing history of the diagnosis of gender identity disorder is currently undergoing counseling and medical therapy in an effort to work toward physically modifying his body to better match his psychological gender identity. The patient is scheduled to undergo an orchiectomy penectomy and surgical construction of a vagina in the near future.

Assign the ICD-10-CM code for the diagnosis of gender identity disorder.

What ICD-10-PCS code will be used for the procedure of a surgical construction of a vagina using autologous tissue procedure for this patient? Continue reading

Physicians and Coders: No More Unspecified Care

The team I work with has done an enormous amount of work translating medical necessity policies from ICD-9 to ICD-10. And we have had many discussions regarding the codes that represent “unspecified” care in ICD-10. Should they stay in the translations – or go? Is ICD-10 specific enough to cover all care and coding contingencies now?

Unspecified Defined

An internet search (don’t you love being able to search so easily?) revealed:

Un-spec-i-fied: (adjective) meaning “not stated clearly or exactly”. Synonyms: unnamed, unstated, unidentified, undesignated, undefined, unfixed, undecided, undetermined, uncertain… Continue reading

HIMagine That! Coder Agreement

Donna: Sue, what results are you hearing about ICD-10 coder agreement as sites get ready to implement October 1, 2015?

Sue: What do you mean by “ICD-10 coder agreement?”

Donna: Well, as hospitals are in the homestretch of their ICD-10 preparation activities, one of the things they’re doing is having all of their coding staff code the same cases in ICD-10 so they can compare results. Continue reading

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

CHALLENGE QUESTION

A 37-year old male was found unresponsive in a bedroom at his home by a family member. Paramedics arrived and found the patient pulseless and not breathing. The patient’s skin was cool and cyanotic. The family member said the patient had been using Oxycodone for long-standing back pain for the past two to three years. A prescription bottle for the drug was found at the scene. The patient was transported to a nearby Emergency Room where he was pronounced dead. The Emergency Room physician recorded the diagnoses of: Continue reading

ICD-10: One Small Step for Health Care—Politics Can Take a Hike

If no further weird politics intervene, we will be able to use ICD-10 codes for real, finally, beginning October 1, 2015.

This experience has been emotionally draining for everyone. For years now we have worked in good faith toward what should have been a modest, straightforward and totally un-newsworthy goal—upgrading an old transaction infrastructure. Imagine this headline: “Old Wiring in the Basement Replaced.” That’s about how exciting ICD-10 implementation should have been. Continue reading

Revenue Neutrality in ICD-10: How Will You Know?

No one likes surprises, especially when it comes to financial performance. In order to reduce unexpected results, many hospitals and payers have decided to address the issue up front. You can call it risk reduction, revenue neutrality, or negotiated reimbursement, but in all cases the goal is to reduce the financial impact ICD-10 has on your organization. Continue reading

HIMagine That! The 3M Client Experience Summit

Donna: Hi Sue! I had a great week at the 3M Client Experience last week! How about you?

Sue: Me, too! It was so nice meeting customers face-to-face and hearing about the cool and interesting things they’re doing in their organizations. Continue reading