Special Guest Posting by Coding Quality Specialist, Megha Patel, CCS, CPC- Official Coding Guideline Changes

Good afternoon, all.  Today, we're lucky to have a special guest post, by one of SCAN's Coding Quality Specialists, Megha Patel, CCS, CPC.  Megha has done a lot of hard work for us, compiling all the significant changes to the Official Guidelines for Coding and Reporting, beginning with the switch from ICD-9-CM to ICD-10-CM:

ICD -9 to ICD-10 Official Coding Guideline Updates

1.      10/01/2015:

ICD-9 to ICD-10 updated October 1, 2015.

·         CAD with Angina: Use combination codes for CAD with Angina, A causal relationship can be assumed in a patient with both Atherosclerosis and angina pectoris. It is not necessary to code Angina Pectoris separately.

·         Sequelae of CVA: Weakness due to previous CVA should be coded as Hemiplegia/Hemiparesis.

·         Sequelae of CVA: Hemiplegia/Hemiparesis/Monoplegia identify whether the dominant or non-dominant side of affected.  If provider didn’t documented dominant or non-dominant, the default is to assume the right side is the dominant side. If left side affected, the default is non-dominant.

·         DM with Hyperglycemia: Uncontrolled DM, Inadequately Controlled, Out of controlled, Poorly Controlled should be coded as Hyperglycemia.

·         Diabetes Ketoacidosis: ICD-10 CM does not provide a specific code for Type II diabetic Ketoacidosis. Assign code E13.10 Other Specified Diabetes with Ketoacidosis as per Coding Clinic First Quarter of 2013.

2.      03/18/2016:

·         DM with Complications Assumed relationship. The guidelines published in the first quarter 2016 issue of AHA Coding Clinic on pg. 11. According to this clarification, the subterm “with” in the index should be interrupted as a link between diabetes and any of those conditions indented under the word “with”.

** The linkage between diabetes and Osteomyelitis used to be assumed in ICD-9 but it is not assumed in ICD -10 (10/01/2015-10/01/2016 Not coded). There is no assumed relationship till October 1, 2016.

3.      10/01/2016:

·         Uncontrolled DM: Uncontrolled DM is classified by type and whether it is hyperglycemia or hypoglycemia. There is no default code for “uncontrolled DM”. Effective Oct. 1, 2016, uncontrolled diabetes can be referenced as Hyperglycemia or Hypoglycemia.

·          Hypertension with CHF: Presumes a causal relationship between hypertension and heart involvement. 

·         COPD with Asthma: COPD with asthma only coded as J44.9. If type of asthma not documented J45.909 should not be coded.  “Unspecified” is not type of asthma.

4.      10/01/2017:

·         Diabetic Ketoacidosis: October 1, 2017 updated with new codes for Diabetes Ketoacidosis (Type II). E11.10 Type II DM with Ketoacidosis w/o Coma and E11.11 Type II DM with Ketoacidosis w/ Coma.

·         COPD, Emphysema and Chronic Bronchitis all documented: Assign J449 only, because J43.9 Emphysema has Exclude 1 note (Emphysema with chronic bronchitis). J44.9 has Include note Chronic Bronchitis with emphysema. (J439 is Emphysema without Chronic Bronchitis) (J449 is Emphysema with Chronic Bronchitis).

·         COPD with Emphysema: J43.9 Emphysema assigned as Emphysema is specific type of COPD.

·         Emphysema with an Acute Exacerbation of COPD: Assign J43.9. Both codes have Exclude 1 note to each other. J439 is without Chronic Bronchitis and J449 is with Chronic Bronchitis. Emphysema is type of COPD so Acute Exacerbation of COPD is covers in J43.9.

Thanks, Megha--for doing all the heavy lifting!

Remember, you can always download the full text of the ICD-10-CM guidelines on our website, at http://hccuniversity.com/asset/154d663f-95bf-4a59-a1fd-a6e4eb7c8477

Coding Clinic Clarifies Diabetes and Complications, Ketoacidosis, and Anti-MAG Polyneuropathy

Apparently the Q1 2016 "clarification" of diabetes with associated conditions confused many people.  In Q2, 2016, Coding Clinic furthers their clarification by stating:

"The subterm "with" in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word "with." The physician documentation does not need to provide a link ..... These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.... For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related."

Coders will have to look to the Index and/or the code description for the term "with" in order to make the determination whether or not the physician must specifically link the diabetes to the complication.


Coding Clinic also addressed Ketoacidosis in Diabetes.  They noted that physicians should be queried if they do not specify the type (i.e. Type 1 or Type 2) of diabetes.  In most cases, when a physician does not state the type of diabetes, the default is Type 2, due to coding rules.  However, ketoacidosis occurs most frequently in Type 1 diabetes. Therefore, when the physician fails to state what type of diabetes the patient has, the physician is to be queried.   This presents problems when coders are reviewing a chart note that is months old, since addenda or late entries should generally be made within a 'reasonable' time frame.  It's especially important to inform physicians that they must state the type of diabetes when documenting ketoacidosis, to avoid coding problems later.

Finally, Coding Clinic was asked what the correct code assignment for Anti-MAG (anti-myelin-associated glycoprotein) polyneuropathy is.   Coding Clinic instructed that code G62.89, Other specified polyneuropathies, should be used.

Most of the other Coding Clinic entries for Q2 were related to procedural coding.

Given the ongoing confusion about diabetic complications, I think that we can expect more Coding Clinic comments on diabetes in the future.

Although Coding Clinic has provided a lot of instruction about the documentation requirements for diabetic complications, physicians don't usually access the Index when documenting in a medical record.  Short descriptions in EMRs don't always provide enough information for physicians to know whether or not linkage exists in the description or index.  Given these limitations, it cannot hurt for physicians to include the causal relationship in their documentation when present.

Coding "Cardiac Dysfunction" in ICD-10

I was recently asked how to code "diastolic dysfunction" in ICD-9.  The inquirer asked if it should be coded as "heart failure, NOS based on something she had read.

In 2009, Q1, Coding Clinic noted that you could not assume heart failure in a patient with diastolic dysfunction, and that it should be coded as 429.9, heart disease, unspecified.  

The term dysfunction is very non-specific, and runs the gamut from very mild, to extremely severe.  There may be minimal dysfunction present, or life threatening dysfunction.  As with a lot of documentation, there's simply not enough information there to select a specific diagnosis code.  Therefore, the best you can do is choose a non-specific code, that is not more severe than the documentation.

In ICD-10, "heart dysfunction" is indexed to I51.89--Other ill-defined heart diseases.  This seems like it follows similar logic, and it makes sense--ill defined documentation corresponding to an ill defined heart disease.

New Video on Roadto10.org

CMS has published a new, post implementation video on their website, Roadto10.org.  Per the announcement:

In this Centers for Medicare & Medicaid Services (CMS) ICD-10 video, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) discuss the unique characteristics and features of the ICD-10 coding system. Topics include:

• What is a valid code
• Guidelines for coding and reporting
• Coding process and examples: 7th character, unspecified codes, external cause codes, laterality
• How to submit coding questions
• Resources for coders 

Visit the Medicare Fee-For-Service Provider Resources webpage for a complete list of Medicare Learning Network resources on ICD-10.

CMS Posts Revised Instructions for Billing Services On or After 10-1-2015

CMS Medlearn Matters (MLN) has re-issued SE 1408 - Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492.  Although this is a FFS guidance, it was referenced in the September 2015 Encounter Data Processing System Newsletter, for guidance on submission of claims/encounters on or after the 10-1 transition date to ICD-10.  There are two important new pieces of information included:

v  The submission of Inpatient Home Health Services (Part B) services—type of bill 32X * (use the thru date)

v  The submission of DME claims that span dates of service before 10-1 and on or after 10-1 (use the from date)

I think there will be a number of DME claims like this, so the update is important.

You can review the update on the CMS website, here.

* The type of bill 32X is not exclusively used for this type of service. This is only for Part B only Medicare  members who are in an inpatient hospital setting, receiving Home Health services there. 

Updated "Ask a Coder" questions on HCC University!

We've added 9 new questions, most about ICD-10, to the Ask a Coder section on HCCUniversity.com.  In addition, most of the older questions have been updated to include ICD-10 information.

On the Full Encounter Data/ICD-10 page, we've added an updated CMS Encounter Data Processing System (EDPS) Newsletter, which reminds physicians and DME suppliers that ICD-9 and ICD-10 cannot be billed on the same claim/encounter.  If there are services both prior to and on or after 10-1-15, you must split them and put them on separate claims.

For hospitals, the discharge date determines which coding system applies to the whole claim.  So, if a patient is admitted on 9-20-15, and discharged on 10-1-15, all services will be billed under the ICD-10 coding system.

Finally, remember you can ask risk adjustment related coding questions by submitting an email to coding@scanhealthplan.com.

Stay tuned for more exciting news from HCCUniversity.com!

CMS ICD-10 Ombudsman and Coordination Center Available

I received the email below from CMS today, and thought I would share it with you.

CMS has established a coordination center and an ombudsman to help providers

 through this difficult transition to ICD-10. These are fantastic resources for providers,

so that they can resolve issues once they've exhausted their attempts to find the right

code for a situation.  It's reprinted below, and we hope you find it helpful.

Because of CMS formatting that I can't change, it does appear a little funny on our site, but the information is so useful, I hope you'll look past that.

News Updates | October 7, 2015

ICD-10 Ombudsman and ICD-10 Coordination Center Here to Support Your Transition Needs It’s important that you know help’s available if you have problems with ICD-10: ICThe ICD-10 Ombudsman, Dr. Bill Rogers, can be your impartial advocate You can contact the ICD-10 Coordination Center ICD-10 Ombudsman Dr. Rogers, a practicing emergency room physician, is known to many of you   already. Since 2002, he has been the Director of the Agency’s Physicians  Regulatory Issues Team, assisting physicians, other practitioners, and medical societies in identifying and simplifying Medicare policies and regulations. His role  as ombudsman will be to be a one-stop shop for you with questions and concerns  and to be your internal advocate inside CMS. ICD-10 Coordination Center The Coordination Center is a dedicated group of Medicare, Medicaid, and    information technology systems experts drawn from across CMS. They have  the full support of the entire CMS staff to address any issues quickly and   completely. First-Line ICD-10 Information and Support For general ICD-10 information, we have many resources on our                CMS ICD-10 website and Road to 10 webpage. Contact the MAC for Medicare claims questions. Your MAC                             is your first line for Medicare claims help. MACs cannot                                     respond to questions about Medicaid or Commercial health plans. If you have a Medicaid claim question contact your State Medicaid Agency. If you have a commercial or private health plan claim question               , please contact your health plan directly. Keep Up to Date on ICD-10 Visit the CMS ICD-10 website and Roadto10.org for the latest news and  resources, including the ICD-10 Quick Start Guide. Sign up for  CMS ICD-10 Email Updates and follow us on Twitter.

Using Diagnoses From Prior Encounters

One of the most common questions we get is whether or not a diagnosis from an earlier encounter can be used for a current encounter.

Standard coding advice has always been that a diagnosis cannot be "pulled forward" to a new encounter. Coding Clinic, Q3, 2013 has addressed this issue.  In part, the Coding Clinic advice says:

"Conditions documented on previous encounters may not be clinically relevant on the current encounter.... However, if the condition is not documented in the current health record, it would be inappropriate to go back to previous encounters to retrieve a diagnosis without physician confirmation."

Coding Clinic indicated this advice applies to both ICD-9 and ICD-10 coding.  We hope this advice will clear up this frequent question.

CMS Posts New ICD-10 Clinical Content

CMS continues to post clinical content, common ICD-10 codes and coding vignettes for providers.  The latest is OB/ GYN, and it can be viewed here. 

One problem with some of CMS content in the past--they assumed that physicians understand documentation requirements, and all content tells physicians what to code for what disease.   The site has been beefed up, and there are Clinical Documentation tips now

I strongly recommend this site for clinicians and coders alike--coders and physicians must follow the same rules when coding--and all of those rules are based on clinical documentation and the ICD-10 Official Guidelines for Coding and Reporting, available free of charge on the National Center for Health Statistics website.  All other ICD-10 content is there as well at www.cdc.gov/nchs.

Although the guidelines are long, physicians can read only those specialty specific guidelines that they normally treat, along with the section on Outpatient Coding (all physician coding uses the outpatient guidelines, regardless of where the services were rendered).

And remember, SCAN contracted providers can send coding questions to us at: Coding@scanhealthplan.com.

The SCAN Tools Team

Updates!

With the ICD-10 implementation date just around the corner, we at SCAN, and you as our Provider partners are working very hard.  There's so much information to filter through, it sometimes seems impossible to keep up with.

CMS has posted their DRAFT CPT/HCPCS filtering list.  What is on the list is not hugely problematic, but what's missing (Modifiers) is.  As you know, modifiers alter the meaning of the CPT/HCPC codes, and inclusion of some of those modifiers may be important.  Health Plans have until August 21st to comment.  You can rest assured that we're studying the list, and will make comments to CMS in a timely manner.

CMS also posted another important file: The updated CMS-HCC and Rx-HCC files.  As you know, CMS posted a draft file a little over a month ago--they've now taken it down and replaced it.  They are not calling this the final ICD-10 mapping, so we'll be sure to monitor the CMS website and post updates here.

We've posted a number of new Q and As on the Ask-a-coder page.   In addition, we've completely new Helpful Links page.  All of the links are now categorized, making it easier for you to find exactly what you're looking for.

Just as an FYI--when we have special or time sensitive posts to HCCUniversity.com, we usually send out an email blast.  These are sent infrequently, and usually no more often  than once a month.  If you'd like to be added to our growing list of HCCUniversity readers, please send your name and email address to coding@scanhealtplan.com, and we'll be sure to add you.

That's it for today.  As we get closer to ICD-10, we 're sure to hear things from CMS that are of importance to you. We'll pass them along here, on HCCUniversity.com and through our email blasts.


Stacey Hernandez, CCS-P          

ICD-10 Clinical Documentation Improvement Document

For those of you tasked with training and/or coding in ICD-10, there's an excellent resource on the American Health Information Management Association (AHIMA) website.  It's a 72 page document on clinical documentation improvement for ICD-10.  In other words, it's a guide to helping both coders and clinicians understand the documentation requirements for a number of ICD-10 codes.

While encoders and crosswalks may be able to point you in the right direction, all coding is done based on the documentation in the medical record.  This guide can help you understand the documentation requirements for a number of diagnoses and services.

The document is accessible to both AHIMA members and non-members in their body of knowledge, and can be downloaed here.

ICD-10 Webcast for Internal Medicine and Family Practice Posted

This morning, CMS posted a new webcast, aimed at primary care physicians on their Roadto10.org website:  

An AHIMA-certified coder presents training focused on unique ICD-10 clinical documentation needs and hot topics for each medical specialty. The five webinars will follow the same outline and objectives catering to each medical specialty with specific examples.

• Physician Perspective/clinical impact of ICD-10
• Documentation requirements for certain conditions
• Documentation changes and new concepts
• Use of “unspecified” in ICD-10

This webcast features Dr. Maggie Gaglione, a board certified internist and bariatrics specialist, a physician in private practice in Virginia.  Per Dr. Gaglione:

“Comprehensive documentation is key to identifying and assigning the best diagnosis code. By doing our part, and focusing on how we document our patients’ condition we put the foundation in place to drive value based quality and improve the health of populations served.”

You can view this webcast here.

CMS Offers New ICD-10 Content

As part of their ongoing "Road to 10" series, CMS has posted a newly released webcast on ICD-10 documentation and coding concepts for cardiology.  You can access this webcast here, on the webcasts page of The Road to 10: The Small Physician Practice's Guide to ICD-10 website.


An AHIMA-certified coder presents on the webcast, which focuses on unique ICD-10 clinical documentation needs and hot topics for cardiology:

• • Physician perspective/clinical impact of ICD-10
• • Documentation requirements for certain conditions
• • Documentation changes and new concepts
• • Use of "unspecified" codes in ICD-10

In addition to the newly posted Cardiology webcast, you can find webcasts geared toward Orthopedic Surgery, OB/GYN and Pediatrics.   There will soon be a Family Practice/Internal Medicine webcast as well.  

In addition to these specialty geared webcasts, the website contains a wealth of ICD-10 related information, including a guide to building an action plan, and templates that you can use with that action plan.

We encourage you to visit the website for authoritative information on ICD-10-CM.

ICD-10 Rural or Urban; It Impacts All Providers (+playlist)

This CMS video discusses the impact of ICD-10 Implementation on all providers.

For physcians and other treating clinicians, one of the most important considerations is documentation.  If you accurately and concisely document a disease, then you have the best chance of you or your coder finding an appropriate ICD-10 (or ICD-9) code.

I hope this video is helpful.

Proposed 1 Year Delay in ICD-10 Implementation

On Tuesday, April 17, 2012, the Department of Health and Human Services published a proposed rule, entitled " Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD–10–CM and ICD–10–PCS Medical Data Code Sets"

The proposed rule can be downloaded at: http://www.gpo.gov/fdsys/pkg/FR-2012-04-17/pdf/2012-8718.pdf

In addition to a proposed delay in the compliance date for ICD-10 (to October 1, 2014), there are proposals for a Unique Health Plan Identifier, and an identifier for entities that currently cannot obtain an NPI.

Comments on the proposed rule are being accepted until May 17, 2012 at 5:00pm EST.

2012 ICD-10 CM Codes Published

The National Center for Health Statistics has published the 2012 ICD-10 codes.  You can view and download the files HERE.

New CMS ICD-10 Implementation Handbooks

CMS has developed  Implementation Handbooks and related templates to help providers and payers in transitioning from ICD-9 to ICD-10.  We'll be posting the handbooks and templates on HCC University, but in the meantime, you can download them from the CMS website at:

ICD-10 Implementation Handbooks

New Presentation Posted on HCC University

We've just posted a new presentation on HCC University--ICD-10 and GEMs 101.  This presentation will give you an overview of the ICD-10 coding system, and the General Equivalent Mappings, a dictionary which maps the current ICD-9 system to ICD-10.   Go to Presentations to review.

We'll be posting more ICD-10 related presentations and materials over the next few months.

What else would you like to see on HCC U?  Leave us a comment, or send an email to coding@scanhealthplan.com.

CMS Physician Conference Call for ICD-10 Implementation

Date:  08/03/2011

Time:  1:00 - 3:00 PM  EASTERN TIME

Subject:  ICD-10 Implementation Strategies for Physicians National Provider Call

Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare fee-for-service (FFS) providers

NOTE:  YOU MUST REGISTER IN ADVANCE FOR THIS CALL. SEE BELOW.

The Centers for Medicare & Medicaid Services (CMS) will host a national provider call on "ICD-10 Implementation Strategies for Physicians." Is your office preparing for a smooth transition to ICD-10 on October 1, 2013? CMS subject matter experts will discuss ways that physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding. A question and answer session will follow the presentations.

• The following topics will be discussed:
• ICD-10 requirements and resources overview
• Implementation strategies for physician offices
• Update on coverage conversion activities
• National ICD-10 implementation issues
• Update on bill processing, including claims that span the implementation date
• Update on Home Health Agency Home Health Resource Grouper

How to Register:

  

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

  

Please note: If you plan to request continuing education credit from your professional organization and if this organization requires proof of registration, you will personally need to register so that you receive a confirmation e-mail.

  

Registration will close at 1:00 p.m. ET on August2, 2011, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

  

To register for the call participants need to go to: http://www.eventsvc.com/palmettogba/080311

Fill in all required data.

Verify that your time zone is displayed correctly in the drop down box.

Click "Register".

You will be taken to the "Thank you for registering" page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation e-mails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.

If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business days before the event.

On the day of the call, please dial in at least 15 minutes before call start time.

Presentation Materials:

Presentation materials for the August 3 call will be available on http://www.cms.gov/ICD10/Tel10/list.asp#TopOfPage in the "Downloads" section no later than 24 hours before the conference call. Remember to download the presentation materials from the CMS site prior to the teleconference.

  

Continuing Education Credits

 Continuing education credits may be awarded by the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) for participation in CMS National Provider Conference Calls.

  

Continuing Education Information for American Academy of Professional Coders (AAPC)

If you have attended or are planning to attend a CMS National Provider Conference Call, you should be aware that CMS does not provide certificates of attendance for these calls. Instead, the AAPC will accept your e-mailed confirmation and call description as proof of participation. Please retain a copy of your e-mailed confirmation for these calls as the AAPC will request them for any conference call you entered into your CEU Tracker if you are chosen for CEU verification. Members are awarded one (1) CEU per hour of participation.

Continuing Education Information for American Health Information Management Association (AHIMA)

AHIMA credential-holders may claim 1 CEU per 60 minutes of attendance at an educational program. Maintain documentation about the program for verification purposes in the event of an audit. A program does not need to be pre-approved by AHIMA, nor does a CEU certificate need to be provided, in order to claim AHIMA CEU credit. For detailed information about AHIMA's CEU requirements, see the Recertification Guide on AHIMA's web site.

  

Please note: The statements above are standard language provided to CMS by the AAPC and the AHIMA. If you have any questions concerning either statement, please contact the respective organization, not CMS.

CMS Announces Preparing for ICD-10 Implementation Call

Yesterday, CMS announced the next conference call in their series on ICD-10:  Preparing for ICD-10 Implementation in 2011.  The call will take place on Wednesday, January 12, 2011.  According to CMS, subject matter experts will review  information on the transition to ICD-10 and discuss implementation planning and preparation strategies for the current year   As with all of the industry calls, a question and answer period follows the presentation.

You must register no later than 1:00pm Eastern Time on January 11, 2011: Register For ICD-10 Implementation Call


Presentation materials for the January 12 call will be available Here in the downloads section no later than 24 hours before the call.  You can also find information on the site regarding CEUs. Both AHIMA and AAPC members will earn 1 CEU for participation in the call.


According to the announcement, the agenda will be:

·         Planning for transition to ICD-10 –A call to action

·         Implementation for services provided on and after October 1, 2013—No grace periods or delays

·         Date of service implementation requirements

·         Tools for converting codes – 2011 General Equivalence Mappings (GEMs)

·         Partial freeze of ICD-9-CM and ICD-10 code updates, except for new technologies and diseases

·         Use of unspecified codes in both ICD-9-CM and ICD-10

·         Updating payment and coverage policies for ICD-10

·         Differences between ICD-9-CM and ICD-10

·         Internal planning groups and organizational strategies

·         Awareness, educational strategies and assessing training needs

·         Implementation plan development and impact assessment

·         Determining vendor readiness

·         Coding gap analysis—What needs to be done for your coding staff

·         Assessing quality of medical record documentation

·         Developing an ICD-10 budget

·         Consequences of poor preparation

Just a reminder--If you are unable to participate in the call, all of the CMS ICD-10 conference materials (slides, call MP3s, call transcripts) are posted on HCC University in the Tools section as soon as they become available.