Question of the Month

In the past two weeks, I've received or been asked some variation of the following question:

"Now that CMS is postponing ICD-10 implementation, can I stop or slow down my work on ICD-10?"

First, CMS has not postponed ICD-10, they are considering "postponing compliance for some entities"--postponing compliance (i.e., they won't penalize you for a given period of time) is different than postponing implementation.  At this point, we don't know who is affected, or for how long.

ICD-10 is coming. Although the compliance period may stretch past October 1, 2013, the Department of Health and Human Services (HHS) and CMS have not indicated a cancellation.  Understanding the impact of ICD-10 on your organization is still critical.  There is much to be done, and physicians, their staff, and hospitals must begin (continue) to assess how their current documentation and systems must change and improve in order to meet the realities of ICD-10.

I was reading an ICD-10 article the other day, and I was struck by something.  The ICD-9 was implemented in 1979.  That year, the Nobel Prize in Physiology or Medicine was given to Allan M. Cormack and Godfrey N. Hounsfield for their development of CT Scanning!  Although CT scanners are still a useful tool today--the state of medical knowledge and technology has grown by leaps and bounds in those 33 years.  ICD-9 as a coding system is too limited to have grown with it.   In order to keep pace with the science of medicine, we must move to ICD-10.

Don't stop now---don't even slow down.  There's too much work to be done.   We know it can be overwhelming.  Start with your top 10 diagnosis codes in ICD-9--and look at the possible equivalent codes in ICD-10, using a tool like the 2012 General Equivalence Mappings.  Will your current documentation support an appropriate code in ICD-10? If not, what changes are needed? Simply defaulting to a "not otherwise specified" code may not be enough.

In an Internal Medicine practice, there are large areas with a lot of impact--Diabetes, CVAs, acute MIs--all of these have many increased codes, and complexity.  Taking a look at your documentation now will help you understand where you need to make changes to support the codes that best describe your patient's illnesses.

As to the compliance postponement---we'll be monitoring HHS and CMS websites daily.  When more information becomes available, we'll be sure to post it here.

Recent Coding Clinic Decisions

Coding Clinic has been very busy the last few months.  A number of questions addressed have implications for everyday coding:

Coding Clinic (Q3 2011) was asked what the correct coding for a diagnostic statement of depression and anxiety.  Coding Clinic advised that the correct coding was 311 and 300.00, NOT 300.4, because the physician had not established a linkage between the two conditions.

Coding Clinic (Q3 2011) was also asked about the clinical significance of obesity or morbid obesity, when the physician does not do any further assessment, monitoring or care for the condition.   Coding Clinic indicated that these patients are at increased risk of certain medical conditions, and that they should be coded when documented by the physician.

The question of a diagnostic statement of "pneumonia with hemoptysis" was raised. Coding Clinic (Q3 2011) pointed out that hemoptysis is a Chapter 16 code, and as such should not be coded if it was integral to a disease process.
Finally, in Q4 2011, Coding Clinic was asked how a diagnosis of chemotherapy induced pancytopenia was coded.  The questioner was advised to code 284.11, Antineoplastic chemotherapy induced pancytopenia.  Further, the questioner was told that it was unnecessary to code E933.1, Antineoplastic and immunosuppressive drugs, since it was inherent in the title of 284.11.  However, providers could choose to capture this information if they wished.

We'll continue to monitor Coding Clinic rulings, and provide you information here.

New Presentation on HCC University

There's a new presentation and quiz on HCCUniversity.com!  Check out Documentation for Ophthalmology coding.  This presentation should help Ophthalmologists and Optometrists understand ICD-9 coding requirements.  Go Here and scroll down to the first downloadable presentation!

New Tools on HCC University!

We sometimes receive diagnosis codes that are unlikely, based on the place of service.  These codes represent conditions that are of such severity that they usually require hospitalization.  We've prepared several short handouts to help physicians and other clinicians understand the correct use of these codes.  Most of them can be printed on a half sheet of paper (we recommend an eye catching color like yellow or bright blue for impact) to share with your clinicians. 

Choose from:

Sepsis Fact Sheet

Acute MI Fact Sheet

Unstable Angina/Acute Coronary Syndrome Fact Sheet

Acute Respiratory Failure Fact Sheet

Acute CVA Fact Sheet

Download them now on the Tools Page.  Scroll down to "Downloadable Tools".

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.

A Very Frequently Asked Question

We frequently are asked about "where CMS says" one thing or another.  First, you have to remember that CMS can't and won't address every possible situation.  By applying common rules and logic, you can usually know what CMS would do in a given situation.  One question we get a lot is:

Our doctors want to know why they can’t just write “250.40 –diabetes with renal manifestations” in the record and code 250.40—and where CMS says they can’t do this.

Our answer to this question is as follows:

CMS doesn’t write the rules for ICD-9 by themselves—and it would be impossible to write a rule for each and every possible situation that can occur.  The Official Coding Guidelines make it clear that a diagnosis must be supported by the medical record, and must affect the care of the patient.

The rules for ICD-9 are written by the four cooperating parties – the American Health Information Management Association, the National Center for Health Statistics, the American Hospital Association, as well as CMS.  All official interpretations not found in the coding guidelines are the responsibility of the American Hospital Association, via Coding Clinic.

A short diagnosis code description (like diabetes with renal manifestations) is just that—a description.  The word “manifestations” is not a diagnosis, it’s a category of conditions, and the physician is required to describe what disease in that category exists.  A physician can no more support an ICD-9 code by writing the description than they can support an E/M code by writing its description. 

Writing “Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family” does not support a 99214, it’s a description of a 99214. Similarly, in order to support a diagnosis, the physician must document what’s wrong with the patient.

So, with diagnosis coding, the physician must document in the medical record what is actually wrong with the patient--not a category of what's wrong with the patient.

Do You Need Free CEUs?

Who doesn't need free CEUs?  Well, there are 12 CEUs available on the CMS website for AAPC members.  You can check them out here at the Medicare Learning Network.

The Medicare Learning Network offers courses on everything from the CMS 1500 form to PQRI and E-Prescribing.