When talking with practitioners at the sharp end of health care there is concern about the unintended results of policies that create penalties or rewards to encourage change. Take, for example, the familiar Hospital Readmissions Reduction Program, a major cost containment initiative for CMS. There is argument over the structure of the penalties, the lack of a positive financial reward, accuracy of the risk-adjustment, what constitutes a readmission – but there is little argument that it has grabbed the attention of the hospital community and has elicited a response over and above terse denunciation of the policy.
In some ways the structure of the payment incentive works. It makes a single entity accountable; the penalty is sizeable enough to warrant action, but not too big to cause instant extinction for a failing provider. Continue reading
In Part 7 you started with an ICD-9 policy list, and using the “10-to-9 singles map with reverse index” you found all the single ICD-10 codes whose meaning is included in one or more of the ICD-9 codes on your list. In other words, you found all the single codes in ICD-10 that can say what the codes on your ICD-9 policy list say. You wrote those down as a new ICD-10 version of your policy.
In the process, you may have come across … Wait. Is there a hand raised in the back of the class? Yes?
“When you had us write down each ICD-10 code we found using the reverse index, you did not have us write down the ICD-9 code it came from.” Continue reading
Blog by Julia Palmer and Sue Belley
The results are in for the latest scenario in the ICD-10 coding contest! Check out the correct ICD-10 codes and an explanation for the scenario from 3M consultants.
A thin, white, 45 year old woman was brought to the Emergency Department after being found unconscious outside of her home. There was anecdotal evidence that the woman might have been outside as long as 1 hour while the temperature was 6◦F. She was wearing a light jacket but no hat or gloves. Blood work revealed a blood alcohol level of 100 mg/100ml. The patient was transferred for inpatient care with a diagnosis of hypothermia, frostbite of bilateral fingers, and acute alcohol intoxication.
Assign the ICD-10-CM diagnosis codes. Continue reading
We are ready to start translating policies. The first step is easy to do, but difficult to believe in. When I “got it,” it was like one of those optical illusions where the cube suddenly turns inside out. I’ve watched other people see the light. I’m going to try to make that happen for you.
Reminding us of our objective: You have a list of ICD-9 codes we are calling a “policy.” This list means something. Whether or not you can express the meaning in English, there is a scientific way of inferring its meaning. If you take a large set of patient records, and you find each record which has one or more codes on the policy list, then the set of patients you have found defines the meaning of the policy. For example, if the list is a complete set of ICD-9 diabetes diagnoses, then the patients it finds are, insofar as possible with ICD-9, all those with diabetes. Your objective is to re-write the policy list in ICD-10 so that, if the same set of patients were to be coded in ICD-10, application of the list to those records would find the same set of patients. This is not always possible, but the recipe I’m advocating generally keeps the discrepancy rate below 1%. Continue reading
I’ve spent years reading healthcare rules, regulations, and laws (I know what you are thinking – better you than me!). Often, it’s necessary to connect the dots with the regulations to clearly see their purpose. Lately, everyone in the industry is talking about ‘documentation compliance.’ Actually it’s nothing new – some providers have struggled with documentation for years. I admit, when I worked in the hospital, charting was not the favorite part of my day either. But CMS has been dogged in its documentation improvement efforts which have routinely been ignored by some.
On 12/13/13 CMS released Transmittal 495, CR 8394, which became effective 1/15/14. According to CMS, “Any provider referred (to OIG) as a potential recalcitrant provider case should be an ‘outlier,’ meaning a provider who has been the least receptive to changing and has a significant history of non-compliance. Continue reading
Guest blog by Senthil Nachimuthu
The normative release of the HL7 Common Terminology Services version 2 (CTS2) functional specification is about to be completed, and that made my latest expedition to the Alamo city especially enjoyable. This month, the HL7 Working Group Meeting (WGM) was in San Antonio, Texas. The HL7 CTS2 Service Functional Model (SFM) outlines the ‘functional capabilities’ of the next version of HL7 CTS v1.2. If you are new to CTS2, it’s a joint project between HL7, OMG and others under the umbrella of Healthcare Services Specification Project (HSSP), where HL7 publishes the functional specification and OMG publishes the technical specification. I’m a co-author of the HL7 CTS2 SFM and am pleased to see that the standard is about to be published. It’s nice to see the editors and co-authors of the standard in person at the HL7 meetings after talking to them on conference calls week after week. Continue reading
Sue: Donna – just think in nine months the I-10 baby is gonna be born!
Donna: Well, at least we won’t have to decide on a name.
Sue: Right! But, you know how first-time parents go to classes to practice before the baby comes?
Donna: Yes… What are you getting at?
Sue: I’m saying that hospitals should be developing plans to have their coding professionals practice coding their medical records well before this baby’s due date.
Donna: I totally agree! There are so many benefits to practicing. Continue reading
Last week I was fortunate to attend the annual meeting of the Office of the National Coordinator (ONC) for Health Information Technology (HIT) in Washington, DC. The theme for the day was “Transforming Healthcare One Connection at a Time,” indicating a focus on how HIT is impacting the healthcare delivery system through innovation and interoperability.
The agenda for the meeting included remarks from the new National Coordinator, Karen DeSalvo, as well as appearances by the Secretary of Health and Human Services, Kathleen Sebelius, the Secretary of State for Health of the United Kingdom, Jeremy Hunt (via webcast), and the Acting Surgeon General, Rear Admiral Boris Lushniak. All of these heavy hitters spoke broadly about HIT and its impact. DeSalvo cited her experiences in New Orleans, recalling, “(Hurricane) Katrina brought home to me that the EHR is not just an important tool in health care delivery, but also in public health.” Continue reading
Guest blog by Charlie Bernstein
Remember when your Electronic Health Record (EHR) system was first implemented? Taking advantage of all of the new productivity tools, your organization probably built some customized problem lists. These custom problem lists made it possible to standardize on the codes you use for various departments, conditions, and regulatory submissions.
Now that the ICD-10 clock is ticking down, think back to the hours spent creating those custom lists in ICD-9. Since you developed the lists yourself, expecting an EHR vendor to convert them to ICD-10 for you isn’t really possible. Custom problems lists are just that, custom. How would they know what codes you want on the list for ICD-10? Continue reading
Yes, this blog post is about population health, accountable care and the changing economics of healthcare payment. But first, a little bit about ice hockey from Walter Gretzky, father of Wayne “The Great One” Gretzky.
When Wayne was a young boy, Walter encouraged his son’s interest in hockey. In the family’s back yard he built an ice rink, the Wally Coliseum, where he taught Wayne and the neighbor kids to skate. Wayne was obsessed with hockey. Walter recalls seven-year-old Wayne’s fascination during a televised hockey match. On a pad of paper, the boy traced the path of the puck as it careened across the ice. To Walter, the lines on the notepad were scribbles. But to Wayne the pattern showed the places on the ice where the puck was most likely to be at any given time. The intersections, as he called them.
That was part of the Great One’s strategy, to know where the puck was most of the time.
In a way, the same strategy applies to accountable care and population health management. Continue reading