Saturday, January 7, 2017

Three things that can affect ICD-10 coding in 2017

Carl Natale
Three things that can affect ICD-10 coding in 2017
U.S. healthcare has been using ICD-10-CM/PCS coding for more than a year so there doesn't seem like anything new could happen. But there are three things that might make their marks on the code sets.

New coding updates

Obviously any ICD-10-CM/PCS updates are considered developments. But I'm interested in seeing how the updates are handled.
Healthcare providers are going to panic because the 2017 ICD-10 updates set them back (which we do not know yet) or they will yawn because they have coding systems that tackle the new codes without creating hassles.
If the latest updates don't throw healthcare providers out of sorts, it's possible physicians will appreciate the new granularity they wanted to be able to document on medical claims.


There are reports that diagnosis coding productivity is returning to ICD-9 levels. The procedural coding levels are another matter. But that is a challenge for hospitals that have resources to throw at the problem.
How productivity levels for clinicians and medical coders trend will greatly affect how ICD-10 coding is perceived.

Soon-to-be President Donald Trump

This isn't meant as an insult, but it is doubtful that President-elect Donald Trump knows what ICD-10 coding is. Very few successful and intelligent people outside of healthcare do. So he probably has no opinion on what should happen to it.
But he has nominated Rep. Tom Price to lead Department of Health and Human Services (DHHS). Price never has been a fan of ICD-10 coding. He has co-sponsored anti-ICD-10 bills.
But it's hard to imagine Price asking Congress to revert U.S. healthcare back to ICD-9 coding. That would create more havoc and cost than the original ICD-10 transition. Besides, he's going to be busy reimagining Obamacare and reforming Medicaid.
By the way, I predict in 2018 I will have to write posts explaining why we still have ICD-10 coding despite the repeal of Obamacare.
But whatever Trump and Price come up for healthcare, they're going to want to target waste and fraud. Politicians love to campaign against waste and fraud. So it would be a great idea to create a healthcare system that pays for benefits by eliminating waste and fraud.
Someone could persuade Trump that ICD-10 coding will be a great tool to identify the waste and fraud. That could be more persuasive than physician complaints about how onerous and burdensome this ICD-10 mandate is.
If Trump promises the best electronic health records (EHRs) and massive reductions in healthcare regulations and red tape, ICD-10 will work beautifully.
This could be the year that great change comes to healthcare, and ICD-10 coding stands a chance of being part of that.

Wednesday, December 28, 2016

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An old problem with DRG assignments

 has ICD-10 repercussions

Carl Natale
An old problem with DRG assignments has ICD-10 repercussions
The Office of Inspector General (OIG) is applying greater scrutiny to a couple DRG assignments.
One focuses on mechanical ventilation. An OIG audit found a 95 percent error rate in Medicare billing from 2009 to 2011. That isn't an ICD-10 problem. The problem has existed long before ICD-10 implementation. But if there is greater scrutiny of medical ventilation diagnoses, healthcare providers need to make sure they nail the right assignments of ICD-10 codes and DRGs.
It underscores the need for healthcare providers to continue training. Their medical coders need to know more than just new codes. They need to understand the rule and guidelines. The correct application is as tricky and important as it every was.

Monday, December 5, 2016

Why Black Friday was a Big Day for ICD10 Coding!

Carl Natale 

Why Black Friday was a big day for ICD-10 coding
After processing the Thanksgiving Day calamities, it would be nice to get a break. Except Black Friday isn't known as a day of recuperation.
The good news is that most of the possible diagnoses will come from one section of the ICD-10-CM code set. The bad news is this:
  • R46.1 - Bizarre personal appearance (just saying)
  • W03.xx - Other fall on same level due to collision with another person (Please, watch where you're going)
  • W10.0XXA - Fall on/from escalator, initial encounter (What happens on the escalator doesn't always stay on the escalator)
  • W21.01 - Lack of adequate sleep (After a day of giving thanks, who got enough rest to get the best Black Friday deals?)
  • W50.3XXA, Y92.512 and Y99.0 - Clerk accidentally bit by another human while at work (It's a jungle out there.)
  • W51.XXXA - Accidental striking against or bumped into by another person, initial encounter (Which can cause the W03.xx.)
  • W52.XXXA - Crushed, pushed or stepped on by crowd or human stampede, initial encounter (That mad rush when doors open at midnight.)
  • Y04.0xxA - Assault by unarmed brawl or fight (Deep discounted appliances bring out the worst in us.)
After all of that, it seems like the safest strategy is to avoid the crowds and do the shopping online. But there's always G56.00 (carpal tunnel syndrome).

Thursday, December 1, 2016

AHA pens letter to Trump calling for support of hospital policies

Written by Emily Rappleye   | November 30, 2016

The letter called on Mr. Trump not to make any abrupt changes or to repeal the ACA without a replacement plan, and it outlined the following five areas of healthcare policy for Mr. Trump to consider."To help advance health in America, we ask that your administration — in collaboration with Congress and the courts, and in partnership with healthcare providers — help modernize the public policy environment to enhance providers' ability to improve care and make it more affordable for patients," wrote Richard Pollack, president and CEO of AHA.
1. The AHA called for some regulatory trimming and pruning. They specifically called for the elimination of Stage 3 meaningful use for hospitals, implementation of a penalty for high rates of incorrect denials under the Recovery Auditor Contractor program, protection of clinical integration arrangements under the Anti-Kickback Statute, standardization of the Federal Trade Commission's merger review process and elimination of several post-acute care regulations.
2. The organization called for the President-elect's support on several financial policies. These include addressing drug prices, protecting the 340B Drug Pricing Program, challenging mergers among payers and considering Medicare reforms, such as raising the eligibility age.
3. It asked the Trump administration to consider redesigning many quality reporting requirements. The AHA wrote that requirements are excessive, redundant and not always meaningful. Notably, it called for suspension of the hospital star ratings on the Hospital Compare website.
4. The AHA urged Mr. Trump to ensure access to care in his healthcare policies. Particularly, the hospital association pointed to continued funding for CHIP, expanded mental health services, elimination of site-neutral payment cuts and establishment of a permanent Veterans Choice Program, which allows veterans to access care outside of the VA health system.
5. The association also called for the preservation of value-based care models adopted under the ACA. The AHA asked that several models be updated, including several ACO requirements and the advanced alternative payment models under the Medicare Access and CHIP Reauthorization Act.
"We look forward to working with you and your administration on public policy solutions to achieve our vision of a society of healthy communities where all individuals reach their highest potential for health," Mr. Pollack concluded.

Tuesday, November 29, 2016

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Monday, November 14, 2016

Compliance Question of the Week


For the Week of November 14, 2016

If the doctor places a drug-eluting stent (DES) in the left anterior descending (LAD) artery and also does an angioplasty only of a diagonal artery, would the appropriate coding for a Medicare patient be C9600 and 92920 or C9600 and 92921?

If a DES is placed in the LAD, and separate angioplasty of a diagonal is performed, you would report the codes listed below. The angioplasty is in an additional branch of the LAD.

C9600Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
92921Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)