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POSTS BY TAG | ICD-10

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.

Roses are red, violets are blue, and when you eat too many chocolates... CMS has an ICD-10 code for you! Valentine’s Day is coming up and no holiday is without strange incidents. We at the Charge Capture Blog have put together another edition of how ICD-10 can bring even more color to this beloved Hallmark holiday.

I51.81 - “Broken-heart syndrome”, or Takotsubo syndrome
Sometimes, love just hurts. This has never been truer than for the “broken-heart syndrome,” caused by intense emotional or physical stress accompanied by heart attack-like symptoms.

V96.01 - Balloon crash injuring occupant
Hot air ballooning gone wrong. If you end up in the hospital with this diagnosis, you’ll at least have a great Valentine’s Day story for your friends and family.

R00.2 - Palpitations
Are you in love or do you have an irregular heartbeat disorder? It’s not always easy to tell, but maybe you should go see a doctor.

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!

The holiday season is upon us and we at the Charge Capture Blog want to wish you a very happy holiday and a wonderful new year. We won’t sing you carols or send you any baked goods, but we will give you some holiday-themed ICD-10 codes to keep you on track with your ICD-10 transition.

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.)

W11.XXXA - Fall on and from ladder, initial encounter
It’s easy to get a little overeager at the Christmas tree lot. Consider this a warning when you’re trying to string lights on a ten-foot tree in your living room.

W55.32XA - Struck by other hoof stock, initial encounter
The unfortunate casualty of the popular and morbid holiday song, “Grandma Got Run Over by a Reindeer."

T63.79 - Toxic effect of contact with other venomous plant
This is what happens when you would rather eat the mistletoe than kiss the person you’re under it with. Not a good sign for either party involved.

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!

We wish you a very happy Thanksgiving from your friends at the Charge Capture Blog! To celebrate this gastronomic holiday, and to also encourage you to keep up with your ICD-10 preparation, we’ve found five ICD-10 codes that you may encounter this Thanksgiving.

W61.42XD - Struck by turkey, subsequent 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.

W29.0 - Contact with powered kitchen appliance, subsequent encounter
Some kitchen appliances are only brought out a couple of times a year, and not everyone is so adept at using them properly. This diagnosis code applies to casualties from can-openers, mixers, blenders, and garbage disposals.

K21.9 - Gastro-esophageal reflux disease without esophagitis
This might be one of the most common side effects of Thanksgiving, as the holiday is synonymous with "heartburn and indigestion."

W52.XXXA - Crushed, pushed or stepped on by crowd or human stampede, initial encounter
If you are brave (and crazy) enough to participate in the Black Friday sales that now start on Thanksgiving Day, you might experience this unfortunate ICD-10 code.

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!