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

Counting down the top 5 blogs of 2015

Happy New Year to all our readers! Before the ball drops in Times Square, catch up on five of our most read blogs of the year: Continue reading

Taking flight: How the right metrics can improve computer-assisted coding

Recently, I boarded a Delta Boeing 757 plane. The plane held 180 passengers with a cruising speed of 517 mph. My flight to Portland, Oregon lasted just under two hours, of which I slept for more than an hour. By contrast, Wilbur Wright covered 852 feet in 59 seconds on that day in 1903 when the Wright brothers completed the first four sustained flights with a powered, controlled airplane.

It’s hard for the modern day traveler to imagine that the airplane and way of life we understand today wasn’t always the case. What enabled the evolution of the aviation industry from the first recognized flight of the Wright brothers to the kind of aviation travel we have today? Continue reading

CMS releases clarifications regarding NCDs and LCDs

I feel a bit like January, 2000 – much ado about little. Looks like (so far) ICD-10 is a go. I’m not saying there haven’t been bumps in the road, or that there are no obstacles we have yet to recognize, but I think I can say, “so-far-so good.” Something I have spent the last few years deeply involved with is the translation of the National Coverage Determinations (NCDs) to ICD-10. On November 20, 2015, CMS released information regarding feedback on some of the NCD translations and issues discovered in some of the LCD policy translations prepared by the MACs. Continue reading

Coast to coast with ICD-10

We’re now almost two months into ICD-10. I’ve been, literally, coast to coast during that time and have asked everyone how their transition is going. To my surprise, regardless of where physician practices were in their preparation when ICD-10 was delayed last year, everyone that I’ve visited with was well prepared for this year’s Oct. 1 implementation.

Many practices used the extra time to work on dual coding, testing of clearinghouses, reviewing new LCD policies, etc. Some groups were glad the implementation date was pushed back, but equally as many were not, having to retrain coders and providers on the new code set. As mentioned last month, there have been a few bumps, but the only consistent comment I hear is about coder productivity and documentation. Continue reading

ICD-10 coding challenge: Legionnaire’s disease

CHALLENGE QUESTION

An outbreak of Legionnaire’s disease has plagued residents of the South Bronx area of New York City this summer. At least 12 people have died from the disease and greater than 100 have been sickened by it. The source of the infection has been linked to water cooling towers in the area.

Assign the ICD-10-CM code for Legionella pneumonia. Continue reading

ICD-10: No news is good news

It seems that wishes are not just for fairy tales, they can come true after all. So far, it looks like the wish for an uneventful ICD-10 transition is a reality. Even the month-end report from CMS was fabulously dull.

The bottom line is, coding issues are historically a tiny percentage of the total claim denials, and that is just as true for ICD-10 as for ICD-9. Historically, total claim denials run around 10% of total, and of those, 2% are due to incomplete or invalid information of any kind, including things like provider ID. Both the 10% and the 2% statistic remained stable across the transition to ICD-10. Continue reading

ICD-10: One month in

October 1, 2015 has come and gone. I didn’t really expect everything to come to a screeching halt, as warned during the anticipation of Y2K. I did, however, expect that by the middle of this month, we would have some horror stories about claims issues with regard to the transition from ICD-9 to ICD-10. I’m still waiting. I’m sure there have been individual issues, but scanning list serves, web sites, CMS, etc., I haven’t seen any systemic issues with regard to claims payment in the professional, Part B world. Insert sigh of relief here. Continue reading

HIMagine That! ICD-10 fallout?

Donna: Hey, Sue! We haven’t talked since AHIMA. Did you get back in time for ICD-10 go-live?

Sue: Yes, I was in my office, bright and early on October 1. I couldn’t wait to see how it was going to go!

Donna: Well, I talked to a lot of people at AHIMA and it was clear the general mood was one of excitement. Finally, we’re able to move forward with ICD-10 after all these years of preparing and practicing.

Sue: I heard pretty much the same thing. One HIM director captured it perfectly when she said, “Bring it on!” I think everyone was confident, anxious to get going and ready to deal with the fallout, if any. Continue reading

ICD-10: Keep up the calm

Keep calm and carry on…that was the title of the first thing I ever wrote, in early 2010, about the hype surrounding ICD-10. Less than six months after the CMS final rule for implementation of ICD-10 on October 1, 2013, the engines of hysteria were already churning out alarmist rhetoric.

In a moment of nostalgia, I went looking for that article. Here are a couple of examples of ICD-10 sound bites that were popular in 2010, and my reaction to them. Continue reading

Value-based care is more than the new ICD-10

I’ve heard value-based care called “the new ICD-10.” I understand the comparison, at least in reference to regulatory disruption. But aside from the CMS willpower behind value-based care, I don’t see a lot of similarities.

I think of ICD-10 as a new language that requires translation within every system using ICD codes. All system users need some level of literacy training. Value-based care is this and more. It is like moving to another state—even another country—where the customs, geography and idioms of speech are entirely different. Continue reading