The Centers for Medicare & Medicaid Services (CMS) issued a reminder Aug. 24 to health care providers, health plans, clearinghouses, and vendors about the approaching compliance dates for the transition to the Accredited Standards Committee X12 Technical Reports Type 3, Version 005010 (Version 5010) electronic health care transaction standards. Beginning January 2011, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) should be ready to test with their trading partners the functionality of the entities’ practice management and/or other related software featuring Version 5010 standards.

That date is right around the corner. Are you ready?

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Deborah Grider CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, COBGC, CPCD, CCS-P, AAPC president and CEO discusses the new and upcoming challenges coders face in today’s health care environment.

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One of the largest hurdles in practices has always been clinical documentation and what is needed to justify medical necessity. Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, vice president of business and member development for AAPC, shares six steps to improve documentation to improve reimbursement and make a smooth transition to ICD-10.

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Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, COBGC, CPCD, CCS-P, AAPC president and CEO, discusses the move to ICD-10-CM codes and the need for physicians to start preparing for it now.

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By: Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC

Successfully embracing ICD-10 in your practice boils down to one thing –  meticulous documentation. The specificity of accurate ICD-10 coding demands  recording all the details of what the provider sees and does, and it is time to start.

Medical necessity from today on depends on being fastidious and complete.  Even physicians utilizing electronic medical records (EMRs) must have a full understanding of the code set and the requirements found within ICD-10 to select the codes in the program. 

Not sure why?  Take a look at this example for acute otitis media:

• In ICD-9-CM we would have used 381.00
• In ICD-10-CM we now need to know which side and if it is recurrent such as:
  • Patient has an acute onset of otitis media of the right ear, which is recurrent. 
    • In ICD-10-CM this is report with H65.114 (Acute and subacute otitis media recurrent, right ear).

Here’s another example from a physician’s note:

IMPRESSION: Cellulitis and superficial abscess index finger.

PLAN: I am recommending debridement and irrigation of the digit today. I think the skin is dead and that she will tolerate it without anesthesia; I would like her to stay on the clindamycin and I will check her back in 3 days to see how she is doing.

Note that left or right is not documented. In ICD-10 it should not be coded without further documentation. In ICD-9-CM this was coded as 681.00 but in ICD-10-CM it will take two codes, but look at the choices when 681.00 is compared to the ICD-10-CM GEM file:

ICD-10-CM takes code assignment to new levels of specificity requiring us to take a long look at our current documentation habits to determine how we need to make improvements. A documentation audit is a good place to start. The following simple steps can help get you started:

1. Run a practice management report that pulls your most frequently used diagnosis codes
2. Run a separate report that can pull patients with those diagnosis codes
3. Use this list to randomly pull charts to begin your documentation audit
4. Utilize the GEMS files to begin mapping your current ICD-9-CM code to an ICD-10-CM code selection. The AAPC has a Code Translator tool available for free.
5. Compare your documentation with the code to see if you have documented enough to assign a potential code; if not, begin to work on the documentation aspects moving forward
6. Over the next couple of years, revisit this process to make sure you continue to document with the specificity required.

Following these simple steps early on will help you reduce the overall burden of ICD-10 implementation as the compliance date of October 1, 2013 draws closer. It is only with careful planning now that you will be able to implement ICD-10 successfully.

AAPC member Jacqueline Thelian, CPC, CPC-I, shares tips on how practices can prepare for ICD-10 and get the implementation ball rolling now.

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Disease classification has been around for centuries. In today’s modern world, disease classification is important to everything from research funding, to reporting, to health care claim submission.  AAPC member Angela “Annie” Boynton, RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I, discusses diagnostic and procedure codes and the need for advanced planning for ICD-10 to ensure a healthy transition. This article is not available online but can be found in the June issue of Health Cost Management.

Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, vice president of business and member development for AAPC, discusses the need for physicians and practice managers to understand the basics of ICD-10 implementation in order to be prepared for the Oct. 1, 2013 deadline. The article is published by the San Diego County Medical Society.

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Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, vice president of business and member development for AAPC, is quoted in this article stating that “[A code freeze] allows coders, physicians, and facilities to learn the new code set without having multiple changes along the way.” The article shares insights from experts including Buckholtz on the pros and cons of freezing the codes prior to the October 1, 2013 deadline.

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ICD-10 implementation involves extensive preparation, but physicians are not the only ones preparing for the transition. RACs are getting prepared and implementing the latest in technology to identify those who not in compliance with ICD-10 codes. A Q&A article with John Dugan, PricewaterhouseCooper’s partner in charge of RAC, emphasizes the fact that RACs will be prepared on Oct. 1, 2013—will you?

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