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