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POSTS BY TAG | ICD-10


Electronic Health Records have greatly benefited health care. However, the wide adoption of EHRs did not come without certain drawbacks, especially for providers.  Do you remember what it was like to go to the doctor 15 years ago? You’d walk in and immediately see a lifetime supply of manila folders behind the front desk staff. When the provider entered the room, they were able to sit in front of you and have an engaging conversation. Today, a majority of providers are having to type into a computer in order to meet electronic documentation requirements. Although EHRs have propelled health care forward in many ways, unfortunately, they’ve added a new burden for providers: having to code from their patient visits with standardized code sets.

What are standardized code sets?

Providers are expected to document within different sets of billing and clinical terminologies. Simply put, these are standardized vocabularies that allow representation of the same health concepts between different health information systems. You can think of health care terminologies as the building blocks that support the entire health care documentation process. They allow patient data to be transferred in a way that can be understood and consumed universally, which is necessary not only for individual patient records but also for public health reporting, statistics, and billing.

ICD-10 and SNOMED-CT

You may be wondering: why is this a problem for providers? To dive in, let’s focus on two code systems often used by providers: 

ICD-10 (International Classifications of Diseases, 10th Edition) is often used for the backbone of diagnoses. The issue is that the coding hierarchy was built for billers and therefore is not provider-friendly. A lot of the terms aren’t expressed in everyday provider language (ie - “myocardial infarction” instead of “heart attack”), and there aren’t enough codes to capture the specificity of many clinical concepts. In general, ICD-10 is appropriate to be used as the backbone for billing but lacks the specificity needed for clinical documentation. 

SNOMED-CT (Systematized Nomenclature of Medicine – Clinical Terms) is a clinical term that includes diseases, clinical findings, etiologies, procedures, and health outcomes. It was the terminology required to meet Meaningful Use Stage 2 certification standards back in 2014 and is what providers typically use to document clinically in the EHR. Although this is a more comprehensive, clinical-based terminology, it still forces providers to document using the language of the code system rather than being able to document using their everyday language. There are several complexities to each code set - such as having to post-coordinate on a term to make it more clinically specific. 

This is burdensome because providers are, on top of their growing list of patient responsibilities, now tasked with learning multiple coding languages - which was something that was previously handled exclusively by billers and coders. With the wide adoption of EHRs, it moved the clerical task of coding to the providers, which shows that EHR technology is not assisting the providers, but rather the providers are assisting the technology. Why make providers learn all of these different code languages instead of allowing them to document clinically in the way they were trained?

Are there any solutions?   

Thankfully, there are solutions that help to ease this new coding burden on providers. Here at pMD, we accomplish this on the charge capture side by making the diagnosis and charge lists extremely customizable - not only to each practice but down to the individual provider. We can rename ICD-10 and CPT terms based on the provider’s preference, float important terms to the top, and delete terms that are not necessary. By offering a highly customized pick list, we eliminate the need for providers to memorize multiple coding languages. 

There are also clinical interface terminology solutions that serve as a bridge between code sets and providers. These companies offer expansive clinical vocabularies that have multiple synonyms and ways of documenting each term (ie - “type 2 diabetes,” “t2dm” and “diabetes, type II” would all be options for documenting the clinical concept of type II diabetes mellitus). They are very helpful to providers documenting in the EHR where more in-depth documentation is required. Overall, EHRs have helped propel health care forward, but pMD helps to take the coding burden back away from providers. 

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.

ICD 10 Codes Thanksgiving


THANKSGIVING CORNUCOPIA: TURKEY, STUFFING, AND ICD-10S


With Thanksgiving right around the corner, we often associate this special holiday with giving thanks, being with family, and eating far past what's considered comfortable. For many hospitals and providers across the country, this day represents a smorgasbord of possible turkey-related hazards that can ultimately result in one of the following bizarre ICD-10 codes. Let's have a look!

Fancy yourself the deep-frying kind? Take caution when submerging that hefty turkey or you'll end up in the emergency department with one of the following codes:

X10.2 contacts with fats and cooking oils
Codes T20-T25 burns and corrosions of external body surface, specified by site

The overindulging type? Gravy piled on top of mashed potatoes piled on top of turkey piled on top of stuffing with 5 dinner rolls and 3 pieces of pie can likely result in:

R14.0 abdominal distension
R14.2 eructation (belch)
R14.3 flatulence
K30 functional dyspepsia (indigestion)
R12 heartburn
Z72.820 sleep deprivation

You've been given the distinct honor of carving the turkey this year! Just be sure to lay off the wine, lest you desire an injury relating to:

W26.0XXA contact with knife
W29.1 contact with electric knife

You've opted for a vegetarian Thanksgiving and have the opportunity to visit with the turkey whose life you've spared. While your efforts are noble, the turkey, who you've dubbed Liberty Gobblestein, is none-the-wiser and without hesitation, turns on you. The following ICD-10s would likely be reported:

W61.43 pecked by a turkey
W61.49 (other contact with a turkey)

The non-billable turkey codes mentioned above are required to be reported alongside the place of occurrence:

Y92.7 farm as the place of occurrence
Y92.71 barn as the place of occurrence
Y92.72 chicken coup as the place of occurrence
Y92.74 orchard as the place of occurrence

So this year, remember to enjoy the festivities with some level of caution. When in doubt, steer clear of hot oils, sharp objects, and live turkeys. Happy Thanksgiving, from all of us here at pMD!

 

Related Articles:
A Collection of Holiday Icd-10 Mishaps
ICD-10 Halloween Edition: The Mysterious, The Spooky, and The Bizarre

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.

Happy Halloween, health care aficionados! On this day of candy, costumes, and frights, be on the lookout for some of these bizarre halloween-related incidents that may require ICD-10 codes. But I wouldn't get too comfortable with these codes just yet. Rumor has it that the latest revision to the International Classification of Diseases, or ICD as we fondly know it, is underway and the final ICD-11 will be released sometime in 2018. By this time next year, you could be looking at a new list of these unusual ICDs.

W49.01 - Hair causing external constriction, initial encounter
While wigs are a great addition to any Tina Turner, Cher, clown, or heavy metal ensemble, remember to double check the sizing before placing on head.

R44.1 - Visual hallucinations
It's not real, it's not real, it's not real.

X99.2 - Assault by sword or dagger
Your eight-year-old sure looks adorable in that knight costume but that plastic prop could do some real damage.

Z62.891 - Sibling rivalry
They can't both be Elsa from Frozen. It just won't end well.

W54.0 - Bitten by dog
You may love the idea of putting fido into a hot dog costume but he may have other ideas.

W22.02 -Walked into lamp post, initial encounter
Removing face masks while walking around at night might save you from bumping into those pesky lamp posts that may or may not have come out of nowhere.

Y93.D2 - Injury due to activity, sewing
Last-minute unicorn onesie costume alterations may result in injury.

R46.1 - Bizarre personal appearance
It's Halloween. Who doesn't this apply to?

Y93.D - Injury due to activities involving arts and crafts
Watch that hot glue gun when bedazzling your costume.

K03.81 - Cracked tooth
Trade in those Smarties and Jaw Breakers for Milky Ways and taffy.

Y93.75 - Injury due to activity, martial arts
Give sugar to your tiny ninja at your own risk.

Y04.1 - Human bite, initial encounter
It's all fun and games until someone takes their Twilight costume too literally.

A28.1 - Cat-scratch disease
See a black cat? Don't let it cross your path. Don't engage.

R10.84 - Generalized abdominal pain
...regretting that twentieth Reese's peanut butter cup...

If you'd like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.
Last month, my colleague Lindsay shared some information on the end of CMS’s one year ICD-10 grace period. To recap, as of 10/1/16 CMS will no longer accept unspecified ICD-10 codes on Medicare fee-for-service (FFS) claims when a specific one is warranted by the medical record. CMS also removed 305 existing ICD-10 codes and added 1,900 new codes.

So, reimbursement is directly tied to coding specificity now more than ever. The problem is that knowing exactly which ICD-10 code to use when treating a patient that’s been "struck by a dolphin (W56.02XA)" can be difficult, especially using a paper-based system. In fact, the transition to ICD-10 in October 2015 drove many groups to move to mobile charge capture systems like pMD, as they felt there were just too many codes to keep up with on paper. But what do this year’s changes mean? What else can groups do to make sure they are being as comprehensive and specific as possible with their coding?

At pMD we’ve been focused on providing tools to help our practices comply with the new, stricter coding guidelines. Here are some of the ways that we’re helping users of our mobile charge capture software:

Smart Search
The number one tool that pMD offers to help providers with their diagnosis coding is a dynamic, smart code search functionality that makes it fast and easy to find what they’re looking for. Flipping through a code book to search for specific codes is tedious and can increase charge capture lag. More often than not, the provider knows exactly what diagnosis they are treating the patient for and will happily select the most specific code if it’s intuitive and easy to find. In pMD, diagnosis codes are searchable by both a custom “nickname” and the long description, so providers searching for DVT and Deep Vein Thrombosis will both be able to quickly find what they’re looking for.

Education
pMD charge capture also offers reporting capabilities to view the group’s usage of diagnosis codes by frequency and by provider. This report can help analyze group-level and provider-level trends as it relates to codes that are no longer considered specific enough. Many of our practices have used this report to identify members of their team that might require additional diagnosis coding education.

Automation
In addition to selecting the most specific code warranted based on the documentation, certain diagnosis codes also require an additional or supplemental code be included on the claim when applicable. In some cases two or more codes may be required to fully describe a condition. For example, if billing a charge for a patient that has Type 1 or 2 Diabetes with CKD (E10.22 or E11.22), you are also expected to include the diagnosis code for the CKD stage (N18.1-N18.6).

It can be hard for providers to identify which codes actually require additional information, and even when they do know, it’s easy to forget to apply both codes to a charge. Based on the diagnosis entered on a visit, pMD can prompt the provider to select another corresponding diagnosis code. This ensures greater accuracy on charges, particularly for specific diagnosis codes that require additional information for billing.

Arming yourself with the tools you need to comply with CMS’s stricter ICD-10 coding guidelines may not be able to help you avoid getting struck by marine mammals (W56.32XA), but it can help you avoid claims denials.

Around this time last year, many medical practices were feeling pretty stressed out; there was a lot uncertainty around the ICD-10 transition. What was going to happen on October 1st, 2015? Would claims stop being paid? Did practices need to set aside funds to keep their businesses afloat? Would the payers be ready? Was an ICD-10 code for a "burn due to your water skis catching on fire" (V91.07) or "getting hurt at the opera" (Y92.253) really necessary?

October 1st, 2015 came and went, largely without a lot of incident. Practices started using ICD-10 codes (to varying degrees), and much of the gloom and doom that was predicted seemed to never come to pass. A lot of this was due to the one year ICD-10 "grace period” that CMS put in place, which stated that they would not deny claims as long as the ICD-10 codes used were in the correct family of codes. This grace period that has been so helpful in easing this transition is coming to an end at the end of this week, and practices are starting to brace themselves.

Some of the most common questions we’ve received from practices that we work with are listed (and answered!) below.

What is changing on October 1st?
The period of “ICD-10 flexibilities,” or the ICD-10 grace period, is ending. CMS will no longer accept unspecified ICD-10 codes on Medicare fee-for-service (FFS) claims when a specific one is warranted by the medical record. CMS is also removing 305 existing ICD-10 codes and adding 1,900 new codes (this number is much higher than most years due to a coding freeze).

What’s a real example?
During the grace period, in order to bill diagnoses for Hodgkin’s Lymphoma, for example, providers were able to choose from the family of C81 codes, including the most general code, “Hodgkin’s Lymphoma, unspecified, unspecified site (C81.90).” This code would have been accepted by CMS even if the clinical documentation supported a more specific code. After October 1st, providers will be required to be more specific, using codes like “Lymphocyte-rich classical Hodgkin lymphoma, spleen (C81.47)” that describe the nature of the lymphoma and the body part.

Will these flexibilities be extended or phased in?
In new guidance released at the end of August, CMS states that the ICD-10 flexibilities will not be extended past October 1st, 2016, and will not take a phased approach to coding at the highest level of specificity.

Can I still use an unspecified ICD-10 code?
Yes, but only when the clinical documentation does not support a more specific diagnoses.

What can I do to prepare?
Run historical reports to identify the usage of unspecified and header codes over the past year. If there are unspecified or header codes that are used in high frequency, work with providers to identify other options to replace those codes when the documentation supports a higher specificity.

It may end up that October 1st, 2016 is a much more important date to remember than its predecessor a year ago. Many practices are gearing up for the denials and rejections that could be coming their way, and searching for ways to educate their providers on these new, stricter rules.

Here at pMD, hospitals and medical practices have been utilizing ICD-10 prompts within our electronic charge capture software. This feature proactively asks providers in real-time for more specific information when selecting an ICD-10 code that requires it. While no one really knows what type of crackdown CMS is going to employ later this year, our customers have put their trust in us to be forward thinking and give them the tools they need to make sure they are compliant.   
Happy ICD-10 Day! The day that many people thought would never actually arrive is finally here, as real as ever. Our team has been working hard this week to support any last minute charge capture customers as they get their codes up to speed and ICD-10 compliant. To provide some comedic relief over the last year during ICD-10 preparation, we’ve written a series of blog posts covering the most absurd ways to embarrass yourself over the holidays, à la ICD-10. As the ICD-9 chapter comes to a close and the ICD-10 era begins, we bring you a “best of” our most silly, but oh-so-real ICD-10 codes.

THANKSGIVING
W61.42XA - Struck by turkey, initial encounter
Thanksgiving isn’t the best day for turkeys around the country. If you find yourself confronted with a live turkey, you may want to rethink your Thanksgiving strategy.

W22.02XA - Walked into lamppost, initial encounter
The Thanksgiving Day Parade is a tradition that draws thousands of people to the streets to watch the floats and marching bands go by. But be careful, after a few too many cups of hard apple cider, those lampposts can jump out from nowhere!

WINTER HOLIDAYS
Z63.1 - Problems in relationship with in-laws
An issue so ubiquitous they had to create a real diagnosis for it. (Don’t tell my mother-in-law I said that.)

V80.73A - Animal-rider or occupant of animal-drawn vehicle injured in collision with streetcar
Those San Francisco trolleys have a mind of their own, and Santa and his reindeer claim they weren’t at fault. What’s more unbelievable, there’s an ICD-10 code for that!

VALENTINE'S DAY
S61.230 - Puncture wound without foreign body of right index finger without damage to nail
Bret Michaels said it best: Every rose has its thorn. And nothing kills a romantic evening like an injury from a dozen beautiful roses.

G44.82 - Headache associated with sexual activity
If you have this health problem, happy Valentine’s Day to you!

CINCO DE MAYO
Y93.49 - Activity, other involving dancing and other rhythmic movements
Dancing too aggressively to the Mariachi band. Likely to be related to F10.982, alcohol use.

R14.3 - Flatulence
After eating that entire super burrito, you may be sleeping on the couch tonight.

Earlier this month, Centers for Medicare and Medicaid Services (CMS) made a surprising announcement that drew a sigh of relief for many medical practices across the country. It was not the total elimination of ICD-10 that some people had been (or perhaps still are) dreaming of, but the new ICD-10 grace period was a compromise of sorts intended to help ease the transition for physicians and help reduce disruptions in payor reimbursement.

CMS has granted a 1 year grace period for ICD-10 billing codes that are sent out on Medicare claims beginning on Oct. 1. During the grace period, claims will not be denied based solely on the specificity of ICD-10 diagnosis code submitted, as long as the code is from an appropriate family of codes. How do you know if the code is in the correct code family? CMS has released a document to help answer many questions about how to best submit ICD-10 codes on claims. The American Medical Association (AMA) was a driving force behind this new flexibility around ICD-10 code submission.

The new grace period doesn’t just stop at ICD-10 codes - it also affects the Physician Quality Reporting System (PQRS) as well. Health care professionals who are eligible to report on PQRS value-based modifiers will not be penalized during the 2015 reporting year for failure to select a specific enough modifier; the code just has to be from the appropriate family. CMS will still apply a negative payment adjustment to any eligible professionals who do not report the required number of PQRS measures this year.

Even with this grace period, the reality is that practices still do have to submit ICD-10 and PQRS codes and they should be submitting them accurately. Practices who have already implemented ICD-10 into their electronic charge capture system may not need that extra buffer, and it will be business as usual when the clock strikes Oct. 1.

We are less than 100 days away from the moment when the current ICD-9 diagnostic classification system will be replaced by the staggeringly extensive new ICD-10 coding system. On October 1, medical practices will no longer be able to submit ICD-9 codes on claims for reimbursement from payors. The transition to ICD-10 has been a long, long time coming and has been a heated topic within the medical community: the preparation, rumors, disagreements, agreements, education, procrastination, sleepless nights, jokes - we’ve seen and heard it all as we’ve transitioned our charge capture customers to ICD-10. If we use the five stages of grief model to classify what the medical industry has gone through, I think we’ve finally come to the final stage: acceptance. Well, most of us, anyway.

Despite that fact that the ICD-10 train seems to be full steam ahead, many opponents just aren’t ready to give up on their efforts to delay the nationwide transition. The American Medical Association (AMA) has been leading a campaign to institute a two-year grace period during which claims cannot not be denied due to inaccurate or unspecified ICD-10 codes. As a result, CMS just announced that providers would not be penalized for one year for coding errors if claims are submitted within the 'appropriate family.' Additionally, Sen. Bill Cassidy (R-LA) recently drafted three ICD-10 related amendments to the $153.2 billion FY2016 Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) appropriations bill.

These delay efforts only serve as distractions from the ICD-10 preparation that most practices across the country have invested in. Some practices are in a better position than others for the upcoming change. Many medical groups are still using paper billing sheets to record their services done outside of the clinic - in hospitals, nursing homes, dialysis units - instead of using an electronic charge capture system. And when the diagnosis coding system switches over to ICD-10, those paper sheets will become even more inefficient for physicians and billers, and will exacerbate any delayed and/or lost revenue.

Practices using an electronic charge capture system will be able to transition their codes automatically and seamlessly (if they haven't done so already,) and can easily make ongoing code updates to their diagnosis list. There are numerous ways you can prepare your group for ICD-10, but great charge capture software will have a tremendous positive impact come October 1.

Happy Cinco de Mayo from the Charge Capture Blog! To have a little fun with the upcoming ICD-10 transition on October 1, we’ve put together some ICD-10 codes to commemorate the Mexican military victory at the Battle of Puebla on May 5, 1862. Here are some incidents you may encounter today, as explained through ICD-10 codes.

W21.19XA - Struck by other bat, racquet or club, initial encounter
When piñatas become hazardous. Make sure you trust the person you’re blindfolding and letting loose with a bat.

W21.02XA - Struck by soccer ball, initial encounter
The most popular sport in Mexico is also a popular activity on Cinco de Mayo. It’s all fun and games until someone takes a soccer ball to the head. ¡Ay!

F10.982 - Alcohol use, unspecified with alcohol-induced sleep disorder
For many, this celebration inspires a few too many tequila shots, margaritas, and cervezas - and ultimately passing out.

Y93.49 - Activity, other involving dancing and other rhythmic movements
Dancing too aggressively to the Mariachi band. Likely to be related to F10.982, alcohol use.

R14.3 - Flatulence
After eating that entire super burrito, you may be sleeping on the couch tonight.


Here's What You May or May Not Have Missed This Week:


• The Federal Communications Commission embraced net neutrality rules on Thursday. The vote will ensure that health technology and telehealth companies won't face higher costs for Internet fast lanes. These new regulations will prove critical for the growing digital health sector that relies on moving large quantities of data quickly. Source

• CMS announced results of its week-long ICD-10 end-to-end testing period on Wednesday, stating that it accepted 81% of claims that were submitted. The testing period included 661 billing companies, clearinghouses, providers, and suppliers, who submitted approximately 15,000 claims in total. The testing periods are designed for providers to determine whether ICD-10 codes submitted to Medicare will be accepted under the new program. Source

• A survey released this week found that few physicians practices are, in fact, on track with their ICD-10 implementation. Navicure, a health care billing and payment vendor, conducted the survey, which showed only 21 percent of physician practices feel they are on track with preparation efforts. The majority of respondents stated they paused their ICD-10 preparation efforts when the last delay was announced last October. Source

On The Front Lines:


Apple gained 0.06 percent of market share in the mobile battle against Android this week, increasing their win streak to three weeks in a row. Apple is also gaining attention worldwide as Swedish telecom manufacturer, Ericsson, is now suing Apple for reportedly infringing on 41 percent of its patents that are used in iPhone and iPads. Apple stated that Ericsson "seeks to exploit its patents to take the value of these cutting-edge Apple innovations."


FINAL RESULTS:


iOS: 90.61%
Android: 9.39%

Each Friday, Signor Goat reports the latest from the week in health care alongside the front lines of the iOS-Android wars among pMD's charge capture physician users. Check back next Friday for your dose of our little medical corner of health care news.