ICD-10 Training Update from the 'Educator'

Yes - I survived AHIMA 'train the trainer' ICD-10 CM & PCS training. It was an incredibly tough class, but I did make it through, and LEARNED SO VERY MUCH!!! I am very grateful to the IdHIMA who sponsored me with a scholarship to the AHIMA training session in Coeur d'Alene.

All that is left to do is for me is to pass the AHIMA certification test. It was an amazing class. The trainers were very knowledgeable and helpful. So - if you or your office is interested, let me know, as I'll be available to get your office staff and providers I-10 AHIMA based training. It know it really seems like a long way off, but we are only 26 months away...

eeeeeks... now the pressure mounts!

"Go-live" is officially Oct 1, 2013 and CMS has stated that this date is FIRM! Those of you that know me, know that I am very committed to bringing you the BEST training possible, at the BEST price around. (Plus you know how much fun I am!!!) You can always e-mail me @ webbservices.lori@gmail.com to set up some training, or even do a quick 'overview' to help get things rolling for you, your providers and your practice.

To get a 'free' sneak-peek at what is happening on the ICD-10 processes, take advantage of what CMS has provided on their websites. http://www.cms.gov/ICD10 This information is what AHIMA has used to train me on both the ICD-10 CM (diagnosing) and ICD-10 PCS (procedural codes - formerly the ICD-9 book 3)

My feeling is that for our outpatient coders, the system and format look radically different, but the process of looking up the code in the alpha index, then going to the numeric/tabular index is the same. The guidelines and the feel of the set up are very similar. I have not yet had the opportunity to investigate the GEMS mapping. I understand that there are some inaccuracies in the maps, but they can help you see the cross over between ICD-9 and ICD-10.

For our hospital based coders,the ICD-10-PCS system is radically different from the Volume 3 ICD-9 we now use. ICD-10-PCS has a somewhat "CPT" feel, however it is much more in-depth. The ICD-10-PCS system combines the theory of ICD-10 diagnosing in a procedure based 'building' of the coding system. You actually get to 'build' the code from the ground up. While I was in class, building the codes by hand using the code-books rather than an encoder was very enlightening. We need to ensure that we all know how to use our books. However, I am hopeful that the software for our encoders will make surgical/procedure coding & diagnosing as quick for us when we go live with I-10, as it is now. Education and understanding of the new system is crucial for accurate coding and abstraction.

Basic Guidelines/Functions:

•All codes are seven characters long.

•The definition of each character is a function of its physical position in the code.

•The Tables are organized beginning with the numeric values in order first followed by the alphabetic values in order. For the second through the seventh character value, this same convention is followed within each Table.

•Root operation Tables contain values for characters 1–3 and four columns providing the valid combinations of values for characters 4–7 required for code creation.

•Each column in the Table may have a varying number of rows.

•Main terms are based on the second and third-character value.

•The root operation values, character 3, are included as main terms for the Medical and Surgical and related sections. For other sections, the general type of procedure performed is listed as a main term.

•Common procedure terms such as appendectomy are also listed as main terms in the Index.

The list below shows the 7 sections.....

Character 1 Section
Character 2 Body System
Character 3 Root Operation
Character 4 Body Part
Character 5 Approach
Character 6 Device
Character 7 Qualifier

... and as in ICD-9, ICD-10 still utilizes an Alpha index, to cross reference back to the tables, or 'numeric tables'.

ICD-10-PCS Code: 0/V/5/0/8/Z/Z Transurethral endoscopic laser ablation of prostate

ICD-9- Volume 3: 60.21 Transurethral guided laser induced prostatectomy


Anyway... I hope this helps 'pique' your interest in moving forward toward the new ICD-10 systems. Of course, the only thing that stays the same in the medical field is "change"...... Happy Coding, and I hope to hear from you all soon!

E&M - Minor Procedures & CCI verbiage

Welcome to May.... I am still chin-deep in I-10 CM and I-10 PCS training, (and trying not to drown) but I thought I would share with you some information passed along to me from my associate, Gail Eldridge. She was able to attend a class at the AAPC conference in Long Beach, CA on modifiers. This is the information she shared with me, and in turn, sharing with all of you.... I feel this is really important infornation - especially with the audits from CMS and ancillary payers targeting the mod 25 and 'separately identifiable' and 'medically necessary' criteria. Enjoy !! and many heartfelt thanks to Gail for sharing the knowledge...

Billing E&M service same day as minor procedure

The instructor in the AAPC presentation indicated that payers are using the language from the CCI edits to deny claims for E&M and minor procedures on the same day.

Below outlines the language from the CCI edits. Please let your providers know that if they are billing for a minor procedures and E&M on the same day, there must be enough documentation to support that enough medical decision making is supported other than the simple decision to perform the procedure. The decision to do the minor procedure same day is no longer enough to support both billings. Some examples would be simple lacerations and wart removals.

"If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service.

However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.

The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure."

It was an incredible end to a very busy busy month! I was fortunate to be chosen to speak at the AAPC National Convention in Long Beach, CA. We spent 4 days learning about the new changes on the horizon for ICD-10 and the challenges it will present for those of us coding for physician based services, and also for those who will be coding for hospital and facility based services. Some of the great presentations were for EHR electronic health records and the implementation of the record into the office and facility. I was able to take advantage of the presentations on OB global packages, and MIS (minimally invasive surgery) that some OB/GYN practices are currently doing in the office setting. Another really great presentation was the Anatomy Expo, and hospitalist services being utilized in the nation.

The AAPC also shared with us some fabulous speakers, on how to make your voice heard in Washington DC, how to keep motivated in times of personal and professional struggle, and also how we as members can contribute and volunteer for local, regional and national office with the AAPC.

I was fortunate to get to present my favorite educational session on the application of the daVinci and Zeus robotics currently being used in the world today. I was also fortunate to have this presentation noticed by ADVANCE Web… http://community.advanceweb.com/blogs/hi_1/archive/2011/04/19/aapc-wraps-up-successful-conference.aspx.

This just reinforced the feeling, that even though we may not think we have made a difference, having my presentation noted in a national publication was AMAZING. I feel so blessed and grateful.

On Friday of this week, I also got to present this same session (but a shorter version) for the IdHIMA state convention. Again, it was a BLAST!!! This is one of my favorite presentations to do, and there is so much in it… I am just so grateful and blessed for these opportunities.

Next on the Lori-Lynne agenda is to test for my ICD-10 trainer’s certificate in Couer d’ Alene, Idaho in 3 weeks. It will be 3 days of intense learning & training sponsored by my IdHIMA chapter scholarship, and AHIMA national organization. So if any of you are interested in getting the training for yourselves and/or your office or organization, please contact us through the IdHIMA or AAPC Idaho chapters, and we’ll be happy to get this going for you. Drop Dead date for implementation of ICD-10 is October 1^st 2013. (closer than we like to admit).

To wrap this all up… attending a national convention is always fun and informative. If you want any detailed information regarding the classes that were presented in Long Beach, the web link is included below. You can get access to the entire event for a small fee, or you can order specific presentations only.

http://www.dcprovidersonline.com/aapc/?event_id=AAPC102&search_filter=&pageno=7

Thanks again & keep up the great coding and billing that you all do on a day-to-day basis. We are so lucky to be able to do what we love, and help so many, who have helped us be our best!