The ICD-10 changeover, regardless of implementation date, will not be a quick fix. We know that the process will take time and a great deal of effort. “Practices can’t simply buy a new code book and be ready the next day,” says Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC vice president of ICD-10 training and education in the May/June issue of Health Imagining magazine.

Highlighted in the piece is how the specifics of ICD-10 will aid physicians in their coding procedures. “Physicians can spell out to payors the exact clinical condition of a patient with ICD-10. When additional services or procedures are billed under ICD-9, the codes may not justify the additional procedure. Often, additional paperwork or audits are required. ICD-10 should clearly spell out the condition without the extra paperwork,” says Buckholtz.

Read the full article here.

Do coders and physicians speak the same language? With ICD-10 looming that potential language barrier could widen. Just Coding recently discussed this topic highlighting presentations from the AAPC National Conference in Las Vegas last April. VP of ICD-10 training and education Rhonda Buckholtz and Dr. Joseph Nichols, MD were the presenters during a conference session, Michelle Leppert, CPC-A authored the article.

“At the end of the day, good documentation is really about good patient care …ICD-10 also has the potential to change the way coders and physicians interact,” Buckhotlz says. The level of specificity will present challenges for both clinicians and coders, so teamwork is essential.”

Read the full article here.

With ICD-10 still looming on the horizon, many of us have begun the process of implementation, but there is still much to be done. Some have not begun either and AAPC ICD-10 trainer Jackie Stack, CPC, CPC-I, BSHA wrote that “taking a medical terminology or anatomy and pathophysiology course is a great way to prepare for ICD-10,” in the most recent HFMA Revenue Cycle Strategist.

“Many coding resources are available that will aid the transition to ICD-10,” she continued. “For the training to be successful, it should be completed in phases and at the appropriate time.”

Read the full version in hard copy version or by subscription in the May issue of the Revenue Cycle Strategist.

How much do each of us really know about the ICD-10 changeover? AAPC’s vice president of ICD-10 education and training, Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC will discuss ICD-10 and the issues surrounding it in an upcoming webinar hosted by Advance for Health Information Professionals.

The webinar is August 15 and is free to attend. Read the full details here.

*Update—Attendees to this free webinar can now earn 1.0 CEUs for attending.*

A patient presents herself today for a follow-up for her hypertension. At the last visit, she was complaining of swelling in her feet and ankles, back pain, trouble sleeping, and having to get up at night to urinate. She has a family history of CKD. She presents herself today for results of her GFR test.

ROS: As above, otherwise negative.

PFSH: As above. She does not drink or smoke.

Her GFR was 50. We discussed the fact that she is at stage 3 CKD. We discussed a referral to the nephrology department for recommendations and a treatment plan. She is positive about her diagnosis as she has had family members with CKD that take care of themselves and function very well. She wants to see the nephrologist as soon as possible. Calls were made to his office today and an appointment was made for her before she left our office. Dr. Jones will send me back his recommendations and we will move forward from there.

ASSESSMENT: Hypertension. CKD, stage 3.

The visit today was strictly counseling and coordinating care and a total face-to-face time of 40 minutes was spent with the patient discussing her condition, prognosis, outcomes, and referral to nephrology.

ICD-10-CM Codes:
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
N18.3 Chronic kidney disease, stage 3

Rationale: According to the 2012 ICD-10-CM Official Guidelines/Reporting (C.9.a.2) assign codes from category I12 when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD) are present. Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies CKD with hypertension as hypertensive chronic kidney disease. The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.

NOTE: The GFR test measures how well your kidneys are filtering a waste called creatinine, which is produced by the muscles. When the kidneys aren’t working as well as they should, creatinine builds up in the blood. Levels below 60 mL/min/1.73 m² for 3 or more months are a sign of chronic kidney disease.