We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC’s website.
It is imperative to a practice’s ICD-10 implementation to obtain provider engagement. Without the understanding of the providers as to their importance in the process, you may hit a lot of snags along the way to our live date. Hold some short meetings in which you engage your providers in the process, give a presentation on the basics of ICD-10, and let them know how important their documentation is to supporting medical necessity and the connection to the granularity of the new code system. Show them what their top used codes will look like in ICD-10-CM and have discussions on the documentation points that will need to be met. Discuss timelines and educational opportunities for ICD-10 so they feel part of the process. Engaged providers will make the transition to ICD-10 smoother and easier.
June 12th, 2014
HISTORY OF PRESENT ILLNESS: The patient is a 65-year-old female who underwent left upper lobectomy for stage IA non-small cell lung cancer. She returns for a routine surveillance visit.
She has undergone since her last visit an abdominopelvic CT, which was normal. She underwent barium swallow, which demonstrates a small sliding hiatal hernia with minimal reflux. She has a minimal delayed emptying secondary tertiary contractions. PA and lateral chest x-ray from the 11/23/09 was also reviewed, which demonstrates no lesions or infiltrates. Review of systems, the patient continues to have periodic odynophagia and mid thoracic dysphagia. She denies weight loss, anorexia, fevers, chills, headaches, new aches or pains, cough, hemoptysis, shortness of breath at rest, or dyspnea on exertion.
PHYSICAL EXAMINATION: BP: 117/78. RR: 18. P: 93.
WT: 186 lbs. RAS: 100%.
HEENT: Mucous membranes are moist. No cervical or supraclavicular lymphadenopathy.
LUNGS: Clear to auscultation bilaterally.
CARDIAC: Regular rate and rhythm without murmurs.
EXTREMITIES: No cyanosis, clubbing or edema.
NEURO: Alert and oriented x3. Cranial nerves II through XII intact.
ASSESSMENT: Patient here for surveillance with history of lung cancer with no evidence of disease now status post left upper lobectomy for stage IA non-small cell lung cancer 13 months ago.
PLAN: She is to return to clinic in six months with a chest CT. She will be called with the results. She was given a prescription for nifedipine 10 mg p.o. t.i.d. p.r.n. for esophageal spasm.
ICD-10-CM Code(s): - Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm
- Z90.2 Acquired absence of lung (part of)
- Z85.118 Personal history of other malignant neoplasm of bronchus and lung
Rationale: This example states the patient presented for a surveillance visit with a history of lung cancer. Under code Z08 there are two instructional notes that indicate other codes and their sequencing. The first one states to use an additional code to identify any acquired absence of organs. This patient had a left upper lobectomy, so the second listed code is the absence of the lung. The next instructional note states to use an additional code to identify the personal history of malignant neoplasm, in this case the lung. According to the ICD-10-CM guidelines (I.C.2d), when a primary malignancy has been previously excised or eradicated form its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy.
June 11th, 2014
In preparation for the transition to ICD-10, theCenters for Medicare & Medicaid Services (CMS) have launched the Road to 10 Program. The Program is designed to provide resources and tools to Small Physician Practices as they prepare for the ICD-10 transition. CMS has created free and actionable tools, resources, and training specifically designed to help small physician practices jump start their ICD-10 transition activities. The Road to 10 action plan contains a checklist of activities and processes that each practice should consider when planning the transition to ICD-10.
With the recent CMS delay of ICD-10 multiple questions have been asked. Many have expressed concerns about continuing with their current implementation plans while some organizations have made the decision to hold any further efforts towards implementing ICD-10. Here are answers to some of the most frequently asked questions –
Question: Why should we keep working at ICD-10 when we now have at least one more year until implementation?
Answer: Moving ahead allows time for fine tuning your training. It will allow time for Coders to use the code set either by utilizing dual coding or by performing documentation assessments. Using the codes will enhance your proficiency. Now is a good time to contact your vendors to see what progress they are making including the payer organizations.
Question: My physicians do not want to hear about ICD-10 and are resistant to providing education. How do I engage them?
Answer: One of the biggest challenges when implementing ICD-10 is the lack of appropriate documentation. Improving clinical documentation should be addressed as quality improvement. In addition, complete documentation is a means of supporting medical necessity for services such as Evaluation and Management, diagnostic testing, and surgical procedures. Good clinical documentation is essential, whether one is coding in ICD-9 or ICD-10.
Question: When looking at our current documentation for ICD-10 readiness, what should we be looking for?
Answer: The first step should be reviewing the physician’s most commonly utilized ICD-9 codes. Pull documentation for those ICD-9 codes and determine if a code can be assigned using ICD-10, without the use of unspecified codes.
Question: Is it true that payers will not reimburse for unspecified codes?
Answer: The jury is still out on that – however in some situations where a patient is still undergoing diagnostic testing, an unspecified code may be the only option available. But common sense tell us that if the code is specific to a time parameter, such as acute or chronic; or laterality with left or right, this information should be included in the documentation. To determine what specific area to address in clinical documentation improvement, start with the area that is most common and will require the least effort. When that concept is mastered then move to the next or more complex concept. If the concept can be templated within the EMR, or even on the paper template, it will serve as a reminder to the physician to document the concept each time.
The American Medical Association (AMA) released on June 6 a handful of new or revised CPT® Category II codes.
A change to an existing code under Patient History was implemented January 1, 2014:
VTM5* criteria for major depressive disorder documented at the initial evaluation (MDD, MDD ADOL)
Under Diagnostic/Screening Processes or Results, two Category II codes will be implemented July 1, 2014:
3125F Esophageal biopsy report with a statement about dysplasia (present, absent, or indefinite) (PATH)
3126F Esophageal biopsy report with a statement about dysplasia (present, absent, or indefinite, and if present, contains appropriate grading) (PATH)
And two Category II codes, also under Diagnostic/Screening Processes or Results, were implemented April 1, 2014:
3775F Adenoma(s) or other neoplasm detected during screening colonoscopy (SCADR)
3776F Adenoma(s) or other neoplasm not detected during screening colonoscopy (SCADR) [emphasis added]
The AMA also announced June 5 that the FDA approval pending indicator was removed from vaccine codes 90687 Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use and 90688 Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use for CPT® 2014.
These new codes and code changes will first appear in the CPT® 2015 codebook. Until then, for future reference, you can go to www.ama-assn.org website to download the CPT® Category II Codes and Category I Vaccine Codes documents.
Tip: Start dates for late release codes may vary from payer to payer and may differ from the AMA implementation dates. Verify specific payer information regarding use of these codes.
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