Monday, February 16, 2015

So Many Books, So Little Time- Part 2

ICD-9-CM Has Procedure Codes?
In part two of my blog series about coding systems, I'd like to present ICD-9-CM, Volume 3. If you've taken classes that are preparing you to take the CPC exam, it might be news to you that ICD-9-CM has three volumes. Or procedure codes. So that's it: volume 3 of ICD-9-CM is procedure codes. 

Hospitals Use It
In part one of this series, I mentioned that HIPAA defines which code sets are used for each health care setting. Volume 3 ICD-9-CM codes are only mandated for hospital inpatient claims. They are a major factor in the determining DRG assignments, which drive hospital inpatient payments. 

Some hospitals also assign ICD-9-CM volume 3 codes for hospital outpatients as well. This is solely for data collection purposes but the codes get "scrubbed" off the outpatient bill and don't go to the insurance company. ICD-9-CM codes may be used to analyze volume of a particular type of procedure performed either as inpatient or outpatient. For example, most appendectomies are performed as outpatients, but if there are complications, a patient may need to be admitted as an inpatient. Hospitals often pull procedure volume for physician credentialing or planning purposes (e.g., to determine if a new specialty unit or more operating rooms are needed).  As a coding manager, which was a long time ago, I wrote reports that pulled data based solely on ICD-9 codes. We didn't use CPT codes to pull data at all at that time. 

Why You May Have Never Heard of It
If you've never heard of volume 3 codes in school, then it's likely that you are taking a coding course for physician coding and billing. Physicians don't use volume 3 of ICD-9. But as mentioned above, hospital coders are using it and if a hospital requires its coders to assign ICD-9 codes on outpatients, they are coding procedures using both ICD-9 and CPT procedure codes. That isn't as complex as it sounds because most hospitals use encoder software that has a crosswalk between the two code sets. Unfortunately, any time you try to map from one code set to another, there can be errors. If they were easily translatable, we wouldn't need two code sets!

Here's another critical tip: if you are buying ICD-9-CM code books, it can be super confusing because there are various publishers and lots of code books with different-yet-similar titles.  If you purchase an ICD-9-CM code book for physicians, it will have only volumes 1 and 2.  If you buy ICD-9-CM for hospitals, you get all three volumes, or the complete ICD-9-CM code set.

What the Codes Look Like
The code format of volume 3 ICD-9-CM codes is different from other code sets with two numeric digits followed by a decimal point and then one or two more numeric digits. The code category ranges are 00-99. It's the most straightforward of all of the HIPAA code sets. 

Some examples of volume 3 codes are:

  • 47.0, Appendectomy
  • 36.97, Insertion of drug-eluting coronary artery stent(s)

Commentary on ICD-9 Volume 3 and Argument for ICD-10
If you weren't trained on ICD-9-CM procedure codes, let me tell you, you aren't missing much. It is the least robust of all of the coding systems. There just simply aren't enough three to four-digit codes to keep up with rapidly evolving healthcare technology. We have run out of available codes. This is my biggest argument for ICD-10 implementation. I hate to say that we can live without a diagnosis code update, but in comparison to procedures, the need isn't as great. We absolutely need a new procedural coding system for ICD in order to keep up with emerging technologies. Plus - and this drives the OCD coder in me crazy - there are hernia repair codes in the eye procedure chapter because it's the only chapter with available codes!  

If you were trained in CPT first and have to learn ICD-9 volume 3 codes, you may find it very difficult, but only because you are trying to find codes as specific as CPT. You will be disappointed because ICD-9 codes aren't that specific. While there are appendectomy codes in CPT for open and laparoscopic approaches, ICD-9 appendectomy codes don't differentiate between open and scope procedures. 

Who Needs to Learn it?
If you're planning to take a certification exam, here are the certifications that have traditionally tested on volume 3 ICD-9-CM codes, but keep an eye on test details for the testing switch over to ICD-10:

  • CCA (Certified Coding Associate) from AHIMA
  • CCS (Certified Coding Specialist) from AHIMA
  • CIC (Certified Inpatient Coder) from AAPC (new)

The COC (Certified Outpatient Coder), formerly called the CPC-H (Certified Professional Coder Hospital-based) does not focus at all on ICD-9 volume 3 codes. It does focus on hospital-related CPT codes and, of course ICD-9 diagnosis codes because we all use that. 

The bottom line on volume 3 codes, in my opinion, is that it is a coding system with a limited shelf life that isn't worth learning at this point in the game if we really move forward with ICD-10-CM/PCS in October (or unless you are planning to take one of the above-mentioned certification exams before ICD-10 is implemented).  There are enough existing coders to focus on the ICD-9 back work that will be involved after ICD-10 implementation and since this code set is only required for hospitals, it affects a pretty small population of coders overall.  But hey, at least you now know what it is and can have an intelligent conversation about it. 

Next up: Level I of HCPCS (AKA CPT)...

Wednesday, February 11, 2015

So Many Books, So Little Time - Part 1

What's Your Idea of a Best Seller?
Every once in a while I page through a magazine taking keen interest in the best seller and "must read" book lists that everyone is talking about.  I usually tear out the pages for books that are interesting so I can download them later.  And then I rarely read them.  Or it takes me literally months to finish a book.  I love to read, but frankly, after a day of reading code books, and spending a lot of time writing, I just don't have the eye or mental energy to crack a book for fun.

My idea of a best seller is a string of code books that I use every day.  Don't worry though, I find other ways to have fun that have nothing to do with coding!

The last time I moved, I had lots of friends helping me lug boxes and it didn't take long for them to zone in on the heaviest ones: they were labeled "code books."  I have code books for various coding systems going back several years and yes, they are heavy.  And it's hard to explain to the layman why I need so many books in such an electronic age.  I've found it can also be challenging to explain the different code sets to novice coders.  But alas, I am going to give it a try in a series of blog posts because you may not be exposed to all coding systems in coding school, but depending on the setting you work in, you may find you have to become familiar with something new.

I Don't Hate Encoders
Let's get one thing out of the way first, though.  I have no issues with computers or encoders.  In fact, I use a computer for almost everything and, like so many people, I am pretty addicted to my iPhone and iPad.  But as a coding trainer, I learned by the book and I teach by the book and will always default to the book when I have a question.  Encoders are only useful when the user understands the logic behind the program and that logic is based on the book.

ICD is from Mars, HCPCS is from Venus
In healthcare, we deal with two major planets of coding systems: the International Classification of Diseases (ICD) and the Health Care Common Procedure Coding System (HCPCS).  And as if that wasn't enough, those coding systems are divided into further classifications with different uses. Coding for a physician practice?  Then you'd better brush up on different parts of the coding spectrum than what you'd see in a hospital. Coding outpatient services for a hospital? Then you need to know something different than what you would need to know if you were coding hospital inpatient services.  Want to know how to code everything?  Then it's time to become familiar with your new best seller list.  This post will start with the basic coding system that everyone uses.

ICD-9-CM Volumes 1 and 2: Everyone Does it 
You probably aren't surprised to hear that the government determines which codes we use in the U.S.  But you may be surprised to hear that the law that defines those coding systems is a little law called HIPAA. Yes, the same law that addresses privacy and security of medical information also tells us which codes we must use to report healthcare services.  This is why some code books boldly state on the cover that they support HIPAA compliance.  In order to make health information portable and comparable,the Healthcare Portability and Accountability Act of 1996 (HIPAA) makes sure we're all speaking a common language, expressed in codes, before we exchange data electronically. The privacy and security provisions are simply byproducts of making sure health care data can be shared electronically. 

Every health care case, regardless of provider and setting, has one code set in common: ICD diagnosis codes. This coding system was developed by who?  That's right - it was developed by WHO: the World Health Organization. Here in the U.S. we currently use an adaptation of WHO's ICD, which is currently the ninth version. We call the U.S. version a clinical modification. And thus, we have ICD-9-CM: the International Classification of Diseases, 9th Revision, Clinical Modification.

ICD-9-CM has three volumes. The first two volumes include the diagnosis codes.  This includes the tabular (Volume 1) and index (Volume 2). I'll address volume 3 in part 2 of this series. Bottom line here: every HIPAA-covered entity, which includes hospitals and physicians (and excludes workers' compensation and car insurers) utilizes ICD-9-CM codes to report diagnoses on a claim.

ICD-9-CM codes have 3-5 digits with a decimal point after the first three digits. All codes are numeric except for V codes, which start with a V and then have two numeric digits and may have up to two more digits after the decimal point; and E codes, which start with an E and have three numeric digits and may have an additional digit after a decimal point. E and V codes are actually "supplementary" codes that are not included in the main part of the ICD-9-CM volumes 1 and 2 code set.

Here are some examples of ICD-9-CM codes:

  • 486, Pneumonia, organism unspecified
  • 401.9, Essential hypertension, unspecified
  • 250.00, Diabetes mellitus without mention of complication, Type II or unspecified type, not stated as uncontrolled
Examples of supplementary codes:
  • V08, Asymptomatic HIV infection status
  • V27.0, Outcome of delivery, single liveborn
  • V76.51, Screening for malignant neoplasm of colon
  • E961, Assault by corrosive or caustic substance, except poisoning
  • E885.3, Fall from skis
Regardless of who you plan to code for, you will be using ICD-9-CM diagnosis codes for billing.  As such, this is likely the first coding system you learn.  

You may notice in my picture that my most recent ICD-9-CM code book is from 2012.  That's because that was the last year that we had updates to the coding system.  ICD-9-CM is under a permanent code freeze as we optimistically await ICD-10 implementation.  Don't worry, I will address ICD-10 in future posts.  For now, you are safe using an ICD-9-CM code book from 2012 or newer, but I wouldn't waste money on a new book if (heaven forbid), ICD-10-CM is not implemented this year.  ICD-9-CM remains forever frozen and is no longer being maintained.  If you want to bone up on ICD-9-CM coding guidelines, they are printed in the front of your code book.  Or you can do what I do and download the PDF document so you can easily search the document for something specific.  Here is a link to the last version of the ICD-9-CM Official Guidelines for Coding and Reporting.  

Next up: ICD-9-CM Volume 3...