Author Topic: ICD-10 - Will it really affect you?  (Read 3262 times)

HeidiK

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ICD-10 - Will it really affect you?
« on: March 22, 2014, 02:27:13 PM »
Hi everybody!

This will be a long post - fair warning to anyone who is interested in this topic!  :)

I've been studying and reviewing so much information about ICD-10 and Merry (who I'm sure many of you are familiar with!) sent me a link to a website which offers to "swiftly and accurately" code patient's diagnosis and procedures.  I liked it, as much as I like many of the ones which are available out there and that's why I wanted to share my opinion with you - the sites and products being offered for this new coding system are great tools - as long as you know how to use them. 

Think about hanging a picture on a wall - all you need is a hammer and a nail, right?  What if you don't have the hammer? What if you have both but the wall is concrete - will that nail work?  What if you have both the hammer and the nail, but the picture is HUGE and weighs 142.5 lbs.  Will you still accomplish what you have set out to do?

That should give you an idea of what ICD-10 coding will be like on October 1 of this year.  Doctors will need to document details they never had to before - but in reality, they should have been.  Coders will need to know specifics in order to factor in the many guideline changes so they choose the right 3 - 7 digit code compared to what they use today.  As a biller, many of you might be saying "Well, I don't have to worry - I don't code."  I agree with you - as long as you realize what happens when the correct code is not provided to you - REJECTED CLAIMS!   :-\   

This will definitely become a situation you will be responsible for and my advice is to work on learning what you can so you have the answers needed when the inevitable questions are asked to you - as the biller - Why didn't I get paid?  or Well, what am I supposed to do?

With all the websites and youtube videos available about ICD-10, my advice would be to check the resources of the presenter and be sure they are respected and well-known.  Personally, I go straight to cms.gov and take full advantage of the Medicare Learning Network, articles, rules and regulations - they offer so much valid information and many insurance carriers follow Medicare guidelines as well.  Oh, I should also mention that it is all FREE!

Following here is my reply to Merry if you want a specific example of an ICD-10 code I looked up on the website she sent me.  No need to read further if you are confident and prepared, you will already know a similar example to what I chose to describe.

"I checked out the site you sent and I like it but it's a bit more complicated than they make it out to be...
 
As an example, I typed in hypertension and a lonnnng list populated.  I scrolled thru and chose O10.92 - Unspecified pre-existing hypertension complicating childbirth.  The description and the details which came up are correct - but only for that specific code in and of itself.

New ICD-10 guidelines state whenever a code is used from  Chapter 15: Pregnancy, Childbirth and the Puerperium O00-O9A you must also "use additional" code from category Z3A to specify the Weeks of Gestation as well as a code from Z32-Z39 to identify the Factors influencing health status and contact with health services.
 
In addition, the coder must be careful of the specificity of this new coding system.  In this OB example, the coder must be aware how Pre-existing hypertension has different codes for first trimester, second trimester, third trimester as well as during childbirth.  Because I chose the code for "complicating childbirth" you must also include a code from the Outcome of delivery codes - Z37.0-Z37.9.
 
With ICD-9 you may have only have needed 1-2 codes to include for the claim.  With ICD-10 this example would require a minimum of 4 codes.  If the mother was carrying twins, triplets or other multiple fetuses the coder would have to factor in the required 7th character (and know the guidelines for the X placeholder) for the outcome of delivery to identify each fetus.
 
0- not applicable or unspecified
1 - fetus 1
2 - fetus 2
3 - fetus 3
4 - fetus 4
5  - fetus 4
9 - other fetus
 
Imagine how many instances a mother carrying twins (or more nowadays) arrives with hypertension and DM and requires a C-section - and then one of the fetus's is stillborn?  OR - if the mother also has AIDS/HIV?  Those are all separate guidelines which all affect how each individual one must be chosen in order to be accurate.  Then factor in the difference between how the hospital will bill for their charges compared to the OB who has separate guidelines to follow for his/her billing!!!!
 
Any website or person who offers a "quick-fix" or crosswalk to choosing a correct ICD-10 code is putting their product out without mentioning that the person who uses it is assumed to be knowledgeable about the guidelines.  The guidelines are the most complicated part of this whole system - they ultimately determine if the code chosen is correct.
 
So, I like the site (as well as many others) but it must be understood that it should only be used as a guide to point the coder in the right direction - ONLY.  Verification of the guidelines and all the rules must then be accomplished before you can be confident your code is accurate."


Whew!  Thank goodness for copy and paste!   ;)

Heidi Kollmorgen, CCS-P
hdmedicalcoding.com
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

Merry

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Re: ICD-10 - Will it really affect you?
« Reply #1 on: March 22, 2014, 04:40:08 PM »
I love your picture hanging analogy.  This is so much more than a software
solution.

RichardP

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Re: ICD-10 - Will it really affect you?
« Reply #2 on: March 24, 2014, 03:36:22 PM »
New ICD-10 guidelines state whenever a code is used from ...

Can you provide a link, and maybe a Page # for that?

Did you get that info from here?

http://www.cdc.gov/nchs/data/icd/icd10cm_guidelines_2014.pdf

HeidiK

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Re: ICD-10 - Will it really affect you?
« Reply #3 on: March 24, 2014, 04:34:47 PM »
Hi Richard!

The website you mentioned is one source however, I recently attended the AHIMA ICD-10-CM Trainers Academy and a similar example to what I posted above was discussed at length during training.  I'm currently studying and preparing to take the assessment so I can hold the actual title of AHIMA Approved ICD-10-CM Trainer

Right now I only have the Certificate of Completion and the Certificate of Attendance.  I encourage you to review the materials listed and speak with others if you believe my information is inaccurate.  I am learning along with everyone else and if I'm wrong I obviously need to correct my understanding!  :)

I chose AHIMA for my certifications as they are one of the four cooperating parties who approved the ICD-10-CM-PCS Guidelines along with AHA, CMS and NCHS. During training we were given the 2014 Draft ICD-10CM Code book along with a number of other resources to refer to as well:

http://www.ahima.org/ICD10/
http://www.cms.gov/icd10/
http://www.cdc.gov/nchs/icd/icd10cm.htm

The actual codes, guidelines and other specific ICD-10 materials can be located here:

https://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and-GEMs.html

There are a number of pages I referred to for the example I gave, most of which are included in Chapter 15 Guidelines as well as Chapter 9 Guidelines.

One common misinterpretation of the GEMS is that they can be used as a "crosswalk" to ICD-9.  The GEMS are to be used for converting multiple databases from ICD-9 to ICD-10 as well as research applications involving trend data.  GEMS cannot be used as a "crosswalk" because there is not a one-to-one match, there are many new concepts in ICD-10 and one ICD-9 code can map to multiple ICD-10 codes.

The website Merry forwarded to me is similar to many others out there which claim to give you the ICD-10 code simply by putting in the ICD-9 currently being used.  My intent was to show how this will not work and hopefully draw attention to the many "apps" and websites which claim to do so.

In my opinion, it is necessary for medical billers to become familiar with the new guidelines, even if they don't provide coding services for their clients.  Doing so will only help to solidify your service as one that goes above and beyond what others may offer.  In today's economy, everyone must have an edge over the competition.  :)
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

PMRNC

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Re: ICD-10 - Will it really affect you?
« Reply #4 on: March 24, 2014, 07:37:11 PM »
Quote
In my opinion, it is necessary for medical billers to become familiar with the new guidelines, even if they don't provide coding services for their clients.  Doing so will only help to solidify your service as one that goes above and beyond what others may offer.  In today's economy, everyone must have an edge over the competition.  :
)

I completely agree, I think however it needs to be really crystal clear that if you are a billing company and you are providing coding services (BEYOND ERROR CHECKING) You are LEGALLY protected to do so.  I think still too many billing companies are unaware of the differences in the two (coding and billing).

On another note, I did take a few of the "free" webinar's and the WHO's free online course. I am a medical billing and practice management company and consultant. Although the courses/webinars were HELPFUL, I was still in a quandary as I'm not a coder. I think what's out there is great for coders but not for billers. I think it's really important for those learning ICD-10 to understand what it is to LEARN to code ICD-10 compared to "understanding" ICD-10.  I don't like telling billing companies that if they take these free webinars and courses they will be "ICD-10 proficient" that's simply NOT true!! The medical biller needs to get the concepts in the same way they learned ICD-9, it is that simple. Many of the courses out there are being OVER taught to medical billers and that's going to create a problem, one wouldn't think it would, but it does. I do indeed believe there is a big difference in the way medical billers should learn ICD-10 compared to coding.   
Linda Walker
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HeidiK

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Re: ICD-10 - Will it really affect you?
« Reply #5 on: March 24, 2014, 09:26:55 PM »
I'm happy to see interest in this subject - it's only 6 months away so anything you can do is a step in the right direction!

In regards to the ICD-10 training tool on the World Health Organization (WHO) website, it should be understood that this is information pertaining to ICD-10, which is different.  ICD-10 was adopted by the World Health Assembly in 1990 and has been used by many countries, including the U.S., for mortality reporting (coding of death certificates).

ICD-10-CM-PCS is the Clinical Modification set which will be used on October 1, 2014 and the guidelines and use are quite different.  It may seem confusing, although the history and development of the coding set are available online for anyone interested.
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

Michele

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Re: ICD-10 - Will it really affect you?
« Reply #6 on: March 25, 2014, 11:26:17 AM »
Thanks for pointing out that the crosswalks are NOT 1 to 1 matches.  There are just a few ICD9's that can be directly matched to ICD10's.  Most must be manually matched based on additional info.  The crosswalks are a great tool to point us in the right direction but they cannot be used exclusively to replace old codes.
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HeidiK

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Re: ICD-10 - Will it really affect you?
« Reply #7 on: March 25, 2014, 12:04:12 PM »
Here is another article with additional reasons ICD-10 translation tools should be questioned...

http://icd10watch.com/blog/why-you-should-resist-temptation-icd-10-translation-tools
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

RichardP

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Re: ICD-10 - Will it really affect you?
« Reply #8 on: March 25, 2014, 12:28:27 PM »
Heidi - I was not questioning the correctness of the information in your post.  You mentioned guidelines, and links to those guidelines will be helpful for future readers who maybe don't know where to start.

I think the specialist is going to have a more complicated transition to ICD-10 than the generalist.  I extracted all of the codes our clients have actually used over the last 15 years (a good mixture of generalists and specialists).  After deleting duplicates, I am left with about 1600 unique codes that our clients have actually used in the last 15 years.  About 500 of the codes are used regularly.  The rest, sporadically.  Of the 500 used regularly, about half translate "directly" to a single, specific ICD-10 code.  Examination shows there is no other ICD-10 code that is more appropriate.  Another quarter of the 500 codes translate "approximately" to a single, specific ICD-10 code.  Examination shows that, for most of them, there is no other ICD-10 code that is more appropriate for how the doctors are using the ICD-9 code, even though the translator said only "approximately".  The last quarter of the 500 translate "approximately" to two or more (sometimes six or seven) ICD-10 codes.  A cursory examination shows that only one or two of the multiple codes offered are anywhere near relevant to how the doctors use the ICD-9 code.  And so - for most of our generalists, the translation to ICD-10 is going to be relatively straight-forward for the most-used codes.  I am assuming that the infrequently-used codes will require a closer examination, which I haven't done yet.  And, as Heidi demonstrated, the codes for the specialists require much more specificity, and therefore much more care in their selection.

Of course, the proof of all of this will be in whether the codes get paid or not after October 1, 2014.  I expect there will be some period of adjustment based on what codes don't get paid (if any).  I'm working to minimize the adjustment needed.

I am not a coder, and my selections will be provided to our clients for their final examination and approval.  I'm just simplifying the process for them.  I am using this translator:

http://www.icd10data.com/Convert
http://www.icd9data.com/2014/Volume1/default.htm

HeidiK

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Re: ICD-10 - Will it really affect you?
« Reply #9 on: March 25, 2014, 02:44:08 PM »
Hi Richard!

Your obvious dedication to performing a valuable service for your clients is amazing!  The process you are taking is what it takes to be prepared for the October 1 deadline.  I'm sure you will agree, it was a bit time consuming, am I right?  :)

Once you are familiar with the guidelines, codes and process it will be a much better system to work with than ICD-9 for everyone.  And yes, specialists will have more challenges during the initial phase although preparing now will avoid any cash flow issues later this year.

Thank you for sharing your ideas on the process you are taking - I think it's amazing!
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

RichardP

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Re: ICD-10 - Will it really affect you?
« Reply #10 on: March 25, 2014, 06:22:34 PM »
Yup.

But it is a good way to learn the ICD-10 layout.