This e-Newsletter offers the most up-to-date and essential news and information about the transition to ICD-10. If you would prefer not to receive these monthly updates, you can change your email preferences in your account.
A crucial step in preparing for ICD-10 is clinical documentation improvement. Providers need help in getting their chart documentation ready to support the new level of specificity in ICD-10. If you randomly pull charts and assess the diagnosis documentation, you could get multiple different diagnoses that cover multiple different guideline issues in ICD-10. Struggling to cover too many things at once would make it difficult and frustrating to discuss with a provider. So, where do you start?
First, run a report in your computer system and sort it by diagnosis code. Next, start with your top ten and run another report listing patients that had those diagnoses appended to them. Pull 10 to 20 charts with your top used diagnosis code. Review the ICD-10-CM guidelines (if there are any) for the chapter in which the diagnosis is located. Then, review the notes for diagnosis ONLY. Look at the history and the assessment and code it under ICD-10-CM. Put together a report based on the diagnosis: how many notes could be coded under ICD-10-CM? How many notes need more specific information to code? How many notes had to be coded to an unspecified code?
Take these findings to each provider and review them to show the specificity in ICD-10-CM and what is needed in the documentation to support the diagnosis. Go through all of the notes and answer all questions. Depending on how well the provider did on the assessment, you may either perform another assessment on the same diagnosis, or move on to the next diagnosis on your "top ten" list. The facility/office should have a target percentage for the assessments that all providers should meet. Reports should be kept on each assessment to show progression of the providers.
Once the assessments begin, they should continue until the implementation date of October 1, 2013. How often they occur depends on the number of providers you have, the number of different specialties, the type of specialties, and how the providers perform. When we start to officially use the code set, then it will become part of the regular audit process.
Need help? AAPC can assess your documentation.
IN THE NEWS
The Centers for Medicare & Medicaid Services (CMS) hosted an ICD-10/Version 5010 vendor conference this past April in Washington, D.C. for software vendors, clearinghouses, and third party billers. The morning plenary session featured overviews of CMS ICD-10/Version 5010 work completed thus far; the Office of the National Coordinator (ONC) illustrating ICD-10/Version 5010's central role in health care reform; presentations given by companies both large and small from each vendor segment; and an open panel discussion with all of the presenters. The afternoon breakout sessions addressed key questions and implementation issues within each vendor segment. The day ended with a wrap-up offering a group consensus on key issues and next steps for moving forward.
Whether you attended the conference, were unable to attend, or are in search of general ICD-10/Version 5010 information, this is a great resource.
PATIENT DOB: 5/6/2010
CC: Foreign body in right ear
Katie was brought in to the office by her mother today after having put a small game piece in her right ear this morning. She noticed it after her daughter was tugging at her ear and crying. Her mother was unable to remove it herself and called the office. She was told to bring Katie right in.
Upon examination a small game piece was found to be lodged in Katie's ear. After consent from the mother, we successfully removed the piece.
PROCEDURE: The patient was restrained with a papoose device. The game piece was grasped with bayonet forceps and removed from the right ear atraumatically. Examination of the ear post removal fails to reveal any further foreign body or problems. No damage to the tympanic membrane was noted.
I told the mother to call the office if the patient began to run a fever, remain fussy, or continue to tug at the ear. The nurse will call the mother tomorrow to check up on Katie.
DIAGNOSIS: Foreign body removal, right ear.
ICD-9-CM Code: 931
ICD-10-CM Code: T16.1XXA
Rationale: It is important to note that location is very specific in ICD-10-CM and laterality is also an issue. Good documentation for specificity is required for proper code assignment. A seventh character extender is required to indicate the encounter. In this case, it is an initial encounter, so the seventh character A is appended. Dummy placeholder X's are also necessary in this case to allow the seventh character extender to remain in the seventh character place.
ICD-10 Implementation Strategies
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. They are also available in your ICD-10 Implementation Tracker on AAPC's website.
Education and Training, Phase II
Phase II of education and training is more in depth than phase I. This type of training should be geared towards digging in to the guidelines and specialty-specific issues. The size of your practice and number of different specialties will drive when this education and training needs to begin. Phase II training should be provided to coders, billers, physicians, and any other employee involved in the coding and billing cycle. This training should take 40 – 60 hours per staff member.
The ICD-10 Conversion and Mapping page shows a comparison of how ICD-9-CM codes map to ICD-10-CM codes and explains the "one-to-one" versus "one-to-many" scenarios. It is helpful in understanding the wide differences that exist between ICD-9-CM and ICD-10-CM.