Mentors
For more information please click on Mentors. You will be directed to the actual link for a detailed summary of the program along with contact information.
Saturday, April 21, 2012
Tuesday, April 10, 2012
ICD-10 and Medical Device Companies - By Machelle Morningstar,CPC, CPC-H, CEMC, COSC, PCS
International Classification of Diseases, 10th
Revision (ICD-10) is right around the corner, at about 18 months out, to
implementation on October 1, 2013. With this in mind, it is important for
medical device companies to be thinking ahead.
Companies need to be considering such issues as whether their current
coding guidance anticipates ICD-10 codes, both PCS (for procedures), as well as
CM (for diagnoses). Are there actual
ICD-10-PCS codes that describe their technologies, in detail, or just a basic
generic-type device qualifier for their product(s)? Another issue to consider is physician
documentation, does it answer the questions needed for complete PCS or CM
coding, in that do physicians know the additional information needed to provide
a complete and accurate code in ICD-10?
These issues will be addresses below, with some suggestions for medical
device companies. For the purpose of this eblast, focus will be on PCS only.
This is not just a “coders only” issue, but it belongs to all entities that
have a hand in coding and reimbursement guidance.
Let’s begin with a basic overview of ICD-10-PCS (PSC). PCS
is replacing volume 3 of the ICD-9 book, the section that describes hospital
inpatient procedures. The World Health
Organization (WHO) is responsible for maintaining the CM portion of ICD-9 and
ICD-10. The WHO has nothing to do with inpatient
procedures, or volume 3 of ICD-9. The United States is the only country
that will be using PCS and we use PCS for reimbursement purposes, as well as
for statistical reporting. ICD-9, Volume
3, is currently maintained by CMS via the Coordination and Maintenance Meetings
that are held twice yearly. CMS funded a
project, and with the 3M Company, created the ICD-10-PCS system. This new system has four major attributes[1].
1. Completeness
– There should be a unique code for all substantially different
procedures. In Volume 3 of ICD-9-CM,
procedures on different body parts, with different approaches, or of different
types are sometimes assigned to the same code.
2. Expandability
– As new procedures are developed, the structure of ICD-10-PCS should allow
them to be easily incorporated as unique codes.
3. Multiaxial
– ICD-10-PCS codes should consist of independent characters, with each
individual axis retaining its meaning across the broad ranges of codes to the
extent possible.
4. Standard
Terminology – ICD-10-PCS should include definitions of the terminology
used. While the meaning of specific
words varies in common usage, ICD-10-PCS should not include multiple meanings
for the same term, and each term must be assigned a specific meaning.
General differences include limited use of “Not Elsewhere
Classified” (NEC), “Not Otherwise Specified” (NOS), and Diagnoses are not
included with the procedures codes using PCS.
As there are very specific “Value” choices for each code section, there
should be very minimal need for NEC or NOS in the future.
PCS Code Structure consists of seven “Sections” and each
Section has specific “Values” to make up each seven alphanumeric code. Each Section contains up to 34 possible
values, and uses the numbers 0-9 and the letters A-H, J-N and P-Z. The letters “I” and “O” are not used in PCS
so as not to confuse them with the numbers “1” and “0”. The seven characters for Medical and Surgical
looks like this:
Section
|
Body System
|
Root Operation
|
Body Part
|
Approach
|
Device
|
Qualifier
|
A typical code would look like 0BB20ZZ, meaning
Medical/Surgical (0), Respiratory System (B), Excision (B) Carina (2), Open
(0), No Device (Z) and No Qualifier (Z).
So even though there is no device or qualifier, you would use “Z” to
indicate such, so that you have a complete 7 alphanumeric code. The seven characters are set up in “Tables”
and a table has the first three characters, one under the other, at the top of
the table, with “Rows” of “values” underneath.
You find the purpose of your procedure in the Medical and Surgical
Section, for example – “Insertion” and you know your procedure is on the lumbar
spine – which is “Lower Bones,” so you would go to Table “0QH” and then across
the Row for “004Z” to complete your code (0QH004Z) for insertion of internal
fixation device of the lumbar spine.
It is important to note, devices are only coded when they
are left in the body. Bio-absorbable
screws (while they are left in the body) are not coded as a device since they
do absorb and are replaced by bone.
There are 31 official Root Operations in the Medical and
Surgical Section, with some of these being using in other sections, and some
sections have their own section-specific root operations. Obstetrics uses 10 of the original root
operations, as well as two specific only to Obstetrics. Values for the Body Systems are the same
throughout the Medical and Surgical Section.
Approach has seven values and these also are consistent throughout the
book. For more information on the PCS
structures, go to www.cms.gov.
How can Medical Device and/or Biologics Companies help with
ICD-10-PCS coding? While in no way
trying to influence sales of company products, sales staff and other
professionals can use such tools as reimbursement guides, coding call centers,
and general education to assist physicians with documentations needs.
As part of your coding guidance hand-outs, you may want to
include a list of Root Operations and Approaches, or better yet, have a small
laminated card to give the providers, that allows them to keep it in their
pocket. It is important for physicians
to provide accurate, as well as the correct details, for coding professionals
to be able to assign the most complete code.
Physicians being aware of the Root Operation definition can greatly
assist the coder in what the purpose of the procedure is. For example, Excision and Resection are two
root operations that have clear definitions.
Excision is basically when you take out a portion of a body part, while Resection is when you take out the entire body part. Physicians, and other medical professionals,
often use these words interchangeably.
Coders will need to see a clear picture of what the procedure
encompassed. If the provider states
“excision” of the entire kidney, the coder will see that this is actually
“resection.” Unlike in the past, coders
are actually able to assume some interpretation, but it still needs to be clearly
stated what service or procedure is done.
Another way companies can assist the physicians, is to know
what their particular device is called in the PCS guidelines and/or definitions
list. An example may be to state
“Coflex, interspinous process device” when documenting. This tells the name of
the product, as well as the type of product being use. While this may not seem like a big deal,
coders often may be confused with new technologies when they are first used. CMS is creating a reference guide with these
types of definitions, but it is not currently a very extensive list, and may
take quite a while until every device is cross referenced.
In summary, Medical Device Companies can assist their
provider customers by encouraging documentation that meets the needs of the
physicians procedure, as well as makes is clear for coding. This will in the long run, assist both the
physicians and the facilities with their revenue cycle (which is a good thing)
and provide for more accurate data for tracking and statistical purposes. And last, physicians do not want to be
queried by coders for amended documentation when the record lacks information
needed, much less be queried many, many times at the onset of ICD-10. Knowing your products and procedures and how
it fits into the ICD-10-PCS world, can be of great benefit to your physician
and facility customers.
The Proposed Change in the Compliance Date for ICD-10
News Release
| FOR IMMEDIATE RELEASE April 9, 2012 |
Contact: HHS Press Office
(202) 690-6343 |
New health care law provisions cut red tape, save up to $4.6 billion
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act.
The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.
“The new health care law is cutting red tape, making our health care system more efficient and saving money,” Secretary Sebelius said. “These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients.”
Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility.
The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems. This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.
The proposed rule also delays required compliance by one year– from Oct. 1, 2013, to Oct. 1, 2014– for new codes used to classify diseases and health problems. These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.
Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.
The proposed rule announced today is the third in a series of administrative simplification rules in the new health care law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months.
More information on the proposed rule is available on fact sheets at http://www.cms.gov/apps/media/
The proposed rule may be viewed at www.ofr.gov/inspection.aspx. Comments are due 30 days after publication in the Federal Register.
Sunday, April 1, 2012
About Debra O’Halloran
My name is Debra O’Halloran and I am an RHIT. I come from a long line of nurses including
my Grandmothers, Mom, four of my five Aunts and my sister, but for some odd
reason I did not inherit the ‘Florence Nightingale’ gene. I wanted very much to be in the medical field
but had no care giver drive, so chose the paper part of the health care
delivery system. I went through the
AHIMA program at a community college – received my AS degree in June of 1985
(then called Medical Record Science) – and wrote the RHIT (then called ART) exam
that September.
I live in the great Pacific Northwest and enjoy the beach
and by dog Cleo keeps me busy fetching her toys from under the sofa. I have a small rose garden I like to fuss
over and grow beautiful tomatoes and peppers in the summer.
I worked in a 355 bed Acute Care Facility for 26 years where
I learned to code all patient types. The
facility provided all care types with the exception of burns, organ transplants
and major neonatal surgery, those cases were transferred out. I now work for a coding service remotely from
my home. I enjoy the freedom this gives
me with my daily schedule and the pay is much higher than what you might see in
a facility.
Thank you Debra for contributing!!!!
Veronica
The 21st Century Inpatient Coder - By Debra O’Halloran, RHIT
Hi all -
I’ve been asked to contribute some thoughts on Inpatient
coding. While the number of policy
changes and guideline re-writes over the last thirty years rivals that of
“burgers served”, there has always been one constant……QUALITY. With a nod to that constant I’d like to focus
on the single area I feel has had the most significant impact on the Inpatient
coding professional….knowledge.
Let’s take a ‘memory lane’ look at the Inpatient coder. In the early days coders functioned more in
the role of a translator. We were
skilled in medical terminology and had a basic understanding of that ‘thigh
bone connected to the knee bone’ thing.
Using those skills, the information in the patient record, diagnoses and
procedures, were quite literally ‘translated’ into corresponding ICD-8-CM and
later ICD-9-CM codes. The physician’s
word was final and the thought of asking for clarification; well let’s just say
those encounters were few and far between.
Things went alone in this manner for a number of years. Everyone got paid and life was good. Then someone invited our Uncle Sam to the
party. Hang on to your hats folks, we’re
about to find out what’s behind the green door!
Fast forward, it’s nineteen eighty-two, can you say DRG? Knew you could. I believe this single government issued
health care payment policy change caused the transformation of what was a coder
then, into the HIM coding professional we know today. This one single change moved the focus and
thus the skill set and knowledge base of the Inpatient coder from objective to
subjective.
Subjective! Lucy……you
got some splaining to do. Let’s think
about that word…..subjective. “A topic
or issue described or depicted in an artistic work…..to cause to undergo some
experience or action…..to make liable; expose.”
A pretty powerful word indeed!
The focus, skill set and knowledge base of today’s trained,
quality oriented Inpatient coding professional often equals that of a nurse
practitioner. We interpret lab data,
read EKG’s, screen and evaluate physician documentation and clinical
indicators. We understand drugs and
dosage therapies. We are fluent in
medical terminology and can interrupt and process signs and symptoms. We have a solid command of the anatomy and
physiology of the human body. We
converse with various medical staff members, provide education and
clarification to quality control committees.
We review and write appeals for various audits and payment rejections,
and provide support to facility contract services and informatics.
Inpatient coding professions are in high demand today, and the
wider and deeper your fund of knowledge the higher the
quality of your coding. AHIMA will set a
bar for you. Medicare will set a bar for
you and your employer will set a bar for you as well. These should all pale in comparison to the
bar YOU set for yourself my friends!!
Never stop learning and never lose sight of the prize.
Knowledge equals quality and quality assures a successful and
rewarding career you’ll look back on with a smile on your face and joy in your
heart. For me the last 27 years have
been a fabulous, exciting, hair pulling - crazy making experience and I
wouldn’t have missed it for the world!
Debra -
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