Having stunned the healthcare industry with his abrupt departure from the famed Cleveland Clinic Health System (CCHS) in November 2012 for what he told the Cleveland Plain Dealer were personal reasons – adding that “we are separating on good terms” – Lyman G. Sornberger, 54, has become a man on a mission with a burgeoning private practice and a growing list of clients seeking his advice as they transition to ICD-10. Read more...
We talk about documentation and how it needs to change under ICD-10, but really, the implementation of new codes should not be why documentation needs to change. The real issue is that we don’t have complete enough documentation now, in our current environment – ICD-10 simply is shining a spotlight on our existing problems. Read more...
Few providers are aware of the risk adjustment model that is quietly emerging under the Patient Protection and Affordable Care Act (also known as the ACA). That model is known as the Hierarchical Condition Categories (HCCs), and it has been the basis for reimbursement for Medicare Advantage plans (Medicare Part C) since 2004. HCCs use data to prospectively estimate predicted costs for enrolled members during the next year of coverage. Read more...
October, 15 2013 / Kim Carr
Roseanne Barr once said that she likes facts and data because they help her think clearly. With dual coding, it is easy to rationalize the reasons and justify the means. But what really matters is the output. Dual-coding efforts must produce useful information to prepare your organizations for ICD-10. Measuring, monitoring, and tracking dual-coding data ensures that investments in time, money, and staff produce a solid return. Business intelligence gleaned from dual-coding data helps accurately measure ICD-10’s productivity, quality, and financial impacts. With dual coding already underway, now is the time to build your arsenal of ICD-10 data... Read more...
October 15, 2013 / Lisa Roat, RHIT, CCS, CCDS
Now that we are one year out from the ICD-10 implementation deadline, we have to consider that this transition is about something much larger than a change in the way we code. ICD-10 highlights the need for us to change our perspectives on how we think about the quality of our clinical documentation. In the same way focus is shifting away from volume-based reimbursement and toward value-based reimbursement, clinical documentation and coding efforts must reflect the severity of illness and quality of care. ICD-10 makes up only one part of the movement toward quality documentation. We also must consider the importance of accurately capturing hospital-acquired infections (HAIs), patient safety indicators, core measures, and physician and hospital profiling – just to name a few factors... Read more...
March 26, 2013 / Paul Weygandt, MD, JD, MPH, MBA, CPE
In a March 19 Talk Ten Tuesday poll, 466 participants responded to the following question: “How are physicians at your facility reacting to the ICD-10 transition and their role in CDI?” The responses, shown in Table 1, are unsettling. We know that the American Medical Association (AMA)-induced implementation delay from Oct. 1, 2013 to Oct. 1, 2014 created high degrees of ambivalence among physicians. Even into this year, the AMA was requesting that ICD-10 not be implemented at all. It isn’t surprising, then, that 45 percent of poll respondents felt that physicians at their facility had little or no enthusiasm for ICD-10, and another 13 percent felt that physicians have had no reaction at all... Read more...
May 14, 2013 / Janis Oppelt
“We don’t want to say this, but you may have to identify a contingency plan,” said Robert Tennant, senior policy advisor for the Medical Group Management Association (MGMA), on ICD-10-Monitor’s Talk Ten Tuesday broadcast last week. He told physician practices exactly the way it is, saying... Read more...
March 12, 2013 / Patricia Trela, RHIA
The “ostrich” approach will not work in this case, because ICD-10 is not going away. There is much to be done prior to implementation. Two different sets of ICD codes are required, one set for the IRF PAI, and another set for the UB-04.
The ICD-9-CM guidelines for assignment of codes for inpatient discharges by facilities paid under the Inpatient... Read more...
April 30, 2013 / Elizabeth Stewart, RHIA, CCS, CRCA
Between providers and payers, it appears that everyone is ready for end-to-end testing of ICD-10 transactions. But where is health information management (HIM)? A quick tour of the American Health Information Management Association’s (AHIMA’s) ICD-10 website reveals little mention of this massive undertaking. And most of the HIM professionals we meet are barely aware of the national pilot program for ICD-10 testing... Read more...
July 16, 2013 / Denny Flint
Out of the WEDI meetings, we heard that payers may be ready, but many providers will not. On Talk-Ten-Tuesday we hear experts like UnitedHealth Group’s Annie Boynton talk about more fears that providers won’t be ready to go. We see a Centers for Medicare & Medicaid Services (CMS) timeline recommending that internal testing begin on April 1 of this year, and yet in dozens of physician and staff ICD-10 workshops during the last few months, not one hand is raised when... Read more...
Podcast Date: 8/27/2013 Are any payers saying they will require ICD-10-PCS for outpatient services? Response Ratio A. Outpt Surg/ED/GI 10% B. Observation 4% C. Ancillary Services 2% D. Combination of A, B and C 33% E. Not appliccable 51%...
June 20, 2013 / Mark Spivey
Much of the healthcare industry only discovered through announcements made during the HIMSS ICD-10 Leadership Forum this week that the Centers for Medicare & Medicaid Services (CMS) does not plan to engage in end-to-end testing – but Mark Lott, CEO of the Lott QA Group and testing director of the HIMSS WEDI ICD-10 National Pilot Program, said Wednesday that he first heard about it a couple of weeks ago... Read more...
July 9, 2013 / Lauri Gray, RHIT, CPC
Transient cerebral ischemia is defined as a temporary loss of blood flow to an area in the brain. In ICD-9-CM, codes for transient cerebral ischemia are classified under circulatory system diseases and are found in Chapter 7, Diseases of the Circulatory System. Conditions classified as transient cerebral ischemia are listed in category 435 and include basilar artery syndrome (435.0), vertebral artery syndrome (435.1), subclavian steal syndrome (435.2), and vertebro-basilar artery syndrome (435.3)... Read more
October 23, 2012 / Janis Oppelt
Fiscal year 2013 began on October 1 for the inpatient prospective payment system (IPPS) along with its expanded versions of Medicare quality initiatives, including the Hospital Acquired Condition (HAC) Program. As you know, present on admission (POA) reporting figures into the determination of whether a condition is hospital-acquired or not. Medicare no longer assigns an inpatient hospital discharge to a higher paying MS-DRG if a selected condition... Read more
September 10, 2013 / Lynn Cleasby, RHIT
As many of us have started delving into ICD-10-CM diagnosis coding, we have realized there are many lessons to be learned from the coding of these same disorders currently used in ICD-9-CM. We soon realize the ICD-10-CM coding system has expanded significantly in the specificity of codes and changes made to include new combination codes. We also recognize how the coding of these disorders in ICD-10-CM may further impact the reimbursement... Read more
July 30, 2013 / Evan M. Gwilliam, DC, CPC, NCICS, CCPC, CCCPC
On December 21, 2012, some say, the Mayan Calendar predicted the end of the world. Something similar happened a decade ago because of Y2K. People all over the world decided to throw parties during their last moments on Earth. Perhaps September 30 is a good day for coders and clinicians to get together and have one big last hurrah. There could be a heartfelt goodbye to ICD-9; perhaps, a moment of silence. Then, at the stroke of midnight... Read more
July 23, 2013 / Janis Oppelt
If leaders from the Centers for Medicare & Medicaid Services (CMS) have said it once, they’ve said it a hundred times: The October 1, 2014, implementation date for ICD-10 will not change, and the healthcare industry must be ready or face the consequences. In fact, CMS’s attorneys have advised the agency that it cannot provide enforcement delays as it did for the 5010. This is just one of the messages that CMS representatives stressed during a July 15 agency listening session... Read more
Career Step has over 20 years of experience successfully training healthcare professionals. This experience in online adult learning has been combined with the ICD-10 expertise of YES HIM Consulting, Inc. in the development of The ICD-10 Solution, which is... Read more
November 26, 2013 / Lolita M. Jones, RHIA, CCS
ICD-10-PCS represents a major departure from ICD-9-CM procedure coding, and as such, many coding specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM). In order to ease the transition from one code.... Read more
March 26, 2013 / Donna Richmond, BA, RCC, CPC
When October 1, 2014, rolls around, the ICD-10-PCS (procedural coding system) will replace the ICD-9-PCS currently used for inpatient procedures. Code assignments under this system will be very different for all inpatient coding professionals, starting with the idea that they will need to “build” a seven-character code—either for medical-surgical procedures or ancillary services, which include imaging, nuclear medicine, and radiation oncology... Read more
March 19, 2013 / Rebecca DeGrosky, RHIT
In the Medical and Surgical section (first character 0), there are 31 root operations with standardized terminology and no procedure names, no diagnostic information, and no eponyms. So far, we have covered 24 of them, and today will bring us to the remaining ones. We have gone over the notion that a fracture reduction is the root operation reposition, and that there is no appendectomy listing in ICD-10-PCS. Coders... Read more
September 17, 2013 / Mark Spivey
Popular culture is rife with doomsday scenarios for the end of the world, ranging from televangelist Pat Robertson, who predicted the end of the world in the 1980s, to the Heaven’s Gate cult followers in San Diego, who predicted of demise of the world when the Hale-Bopp comet appeared and they subsequently committed suicide. Could there be a possible doomsday scenario in store for healthcare providers when, at the stroke of midnight... Read more
Time marches swiftly toward ICD-10, and soon we’ll be talking in terms of weeks, instead of months, about the mandatory implementation date. Well before October 1, 2014, most hospitals will need to conduct end-to-end testing of their coding and billing systems under ICD-10. Here’s the bad news: Many facilities have not begun the enormous work it will take to successfully report a multitude of ancillary services under the ICD-10 coding system... Read more
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