EDITOR’S NOTE: Janice Tarlecki, MBA, RHIA, CCS, is the director of advanced education at Ciox Health. Janice has over 14 years of health information management experience (HIM) experience, with concentrations in acute-care coding, clinical documentation integrity (CDI), recovery audit appeals, coder development, and coder performance improvement. ICD10monitor publisher Chuck Buck recently conducted an interview with Tarlecki, excerpts of which follow below.
Why is it important to take these new code changes seriously?
It is extremely important to for coders, but we have to think of opportunities for documentation improvement and physician documentation. For simplicity, we want to minimize errors and maximize output. For many of this year’s code changes, we already see the documentation in record, but previously had no way to capture specificity or show the severity of the patient’s illness. For example, we will not have a code for end-stage heart failure.
In the past, we have been focused on resource-driven methodologies, but we now also focus much of our time on value-based methodologies, (wherein) both outcomes and costs are driving forces. Consequently, the importance of our coding accuracy is driving data accuracy that is used to measure the value of patient care and impacting quality rankings – and (this) in turn also affects the bottom line.
There has been considerable reporting on the new codes for heart failure and myocardial infarctions. What are these new codes and how many are there?
The new additions to the heart failure category, I50, allow for the capture of additional types of heart failure. We have seen documentation for these different types of heart failure, but never had a way to capture them before. We now need to consider documentation for high-out heart failure, right ventricular heart failure, end-stage heart failure, biventricular heart failure, and left ventricular heart failure – and (to) realize the code on a claim to capture the specificity of the type of heart failure. Prior to these new changes, the focus has been mainly on left ventricular dysfunction (diastolic and systolic) of the heart. In FY 2018, we will have codes to capture right and/or left heart failure. In addition, we have tabular and index changes to include stages of heart failure (stages A-D) based on the American College of Cardiology and American Heart Association Stages of Heart Failure.
I should note (that) these stages should not be confused with the New York Association Classification of Heart Failure (stages I-IV) that we also commonly see in medical record documentation. It is also important that we pay attention to the index and tabular changes, as the instructional notes and inclusion terms … will help guide us to the right codes. For example, reduced ejection fraction (HFrEF) has been added as inclusion terms under code category I50.2 (systolic heart failure). We can even use some of the new codes in combination with other heart failure codes. For example, there is an instructional note to “code also end-stage heart failure, if applicable, I50.84,” for codes I50.2 (systolic heart failure), I50.3 (diastolic heart failure), (and) I50.4 (combined systolic and diastolic heart failure).
The new code additions to acute myocardial infarction (MI), category I21, allow us to code type 2 MIs. There is even a new code that allows up to capture “other types of MI”, I21.A9, and has inclusion notes for type 3, type 4a/4b/4c, and type 5 MIs, as well as myocardial infarctions associated with revascularization procedures. Similar to the new addition of the heart failure codes, the new MI codes are accompanied by many important instructional notes that need to be considered when assigning them.
In retrospect, Coding Clinic has published quite a few references this year prepping us in anticipation for FY 2018 code changes.
How many new procedure codes are there for FY 2018, and what are they?
There are approximately 3,562 new procedure codes.
We have read about new codes for body parts. Can you explain what those are? And what are qualifier values and how will they be used?
We have the addition of new body part values such as the common hepatic duct, diaphragm, and omentum. For example, let’s take a look at the body part options for the omentum in FY 17 ICD-10-PCS Table 0DS or 0DB. On inspection of the tables, you will see that the greater omentum (S) and lesser omentum (T) are body part values. In FY 2018, you will notice these are no longer options, and we only be able to utilize the omentum (U) body part value as it is the only available option.
I’m sure many coders will be happy to see this level of specificity gone from the PCS tables. If we compare to other PCS tables for FY 2017, we do have options for “omentum,” only without the level of specificity for greater or lesser omentum. In this example, we can see the body part values were streamlined for clarity and usefulness of coded data. You will also see these changes reflected in the body part definitions table.
In terms of new qualifier values, we will have values that will allow us to code the removal and revision of biventricular external heart assist systems.
What are the compliance issues associated with the new codes?
In general, these changes can affect reimbursement as well as publicly reported quality rankings. If we are not utilizing new codes correctly, they can also have an impact on data that is utilized for public health surveillance, research, and future modifications to ICD-10.
Scot Nemchik and Janice Tarlecki both with Ciox Health, will be conducting a three-part webcast on the new ICD-10 code changes Aug. 16, Aug. 23 and Aug. 30. The three-part series is being produced by ICD10monitor.