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.  

Frozen

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...

It's HIPAA, not HIPPA

Just for the record, it's HIPAA, not HIPPA. The actual legislation is called the Health Insurance Portability and Accountability Act of 1996 (HIPAA), not the Health Information Patient Privacy Act (HIPPA). I can't tell you how many times I've seen the latter referred to. As a matter of fact, a colleague of mine once emailed a company after seeing HIPPA repeatedly displayed on their website. Once she educated them, they offered her a job!

Privacy and Security
It's true - when most of us think HIPAA, we think privacy of health information. And that's a huge part of it. We may even think, as coders, that we are only impacted by HIPAA when it comes to keeping the medical record information we read during the coding process confidential. But HIPAA is much bigger than keeping health information from falling into the wrong hands. The true intent of the law was the make sure people retained insurance coverage as they changed jobs. It includes several provisions for sharing data electronically and in order to enact this sharing of information, it was prudent that privacy and security provisions be built into the infrastructure of HIPAA.

As coders, we will likely be required to sign confidentiality agreements with employers. We will be subjected to criminal background checks and possibly credit checks. We will be forbidden from discussing that interesting ER case in the elevator. We won't be able to look up medical record information for friends and family. Well, I suppose you could, but make no mistake - there is very little to no tolerance for HIPAA violations. I've seen people dismissed immediately for violating patient confidentiality. I saw this most at a celebrity-frequented hospital where people tweeted or posted on Facebook when someone famous was admitted or they released specific protected health information (PHI). In this day and age, it's not uncommon for employers to have a social networking policy that addresses Facebook and Twitter.

And while privacy of PHI is a coder's concern, there are other provisions within HIPAA that impact us. I meet a lot of people who want to code so they can work from home. But setting up a home office as a coder means more than getting a computer and internet connection. Along with ensuring patient privacy comes security of PHI as well. The home workstation must be secure from breaches including hacking of computer systems and stolen computers. It's a natural concern when setting up a home office - who will have access to the work computer and if there are multiple people living in the household, what provisions are being taken to ensure that the workstation is secure? Some home coders may be subjected to a home evaluation by an employer to ensure the workspace is secure.

HIPAA-Defined Code Sets
Still not convinced that HIPAA impacts you greatly as a coder? How about the codes you use? Those are also intertwined into HIPAA legislation. Electronic exchange of information between two different parties requires specific transactions. For example, the submission of an insurance claim by a provider to a payer is one such HIPAA transaction. There is another for communication from the payer back to the provider about what was paid on each account. These HIPAA transactions require a common language between the parties. And that language is often codes. As such, HIPAA defines which code sets are approved for reporting diagnoses and procedures in order to ensure uniformity.

There are six code sets approved for various uses and time periods as defined by HIPAA:

• HCPCS (Healthcare Common Procedural Coding System, Level II)for ancillary services and procedures
• CPT-4 (Current Procedural Terminology) for hospital outpatient and physician services
• CDT (Current Dental Terminology) for dental services
• NDC (National Drug Codes) for over-the-counter and prescription medications
• ICD-9 (International Classification of Diseases, 9th Revision) for diagnoses and hospital inpatient procedures - currently used
• ICD-10 (International Classification of Diseases, 10th Revision) for diagnoses and hospital inpatient procedures - effective October 1, 2013

The HIPAA Version 5010 Standard
Most coders and coding students are aware of the massive effort currently under way to migrate from ICD-9 to ICD-10 in 2013. Many are not aware, though, of the updates to the HIPAA transactions that must occur in order to make ICD-10 data electronically exchangeable. We currently operate under the HIPAA version 4010 and as of January 1, 2012, we will use HIPAA version 5010. This upgrade includes many other updates besides those to get us ready for ICD-10. The impact of 5010 implementation is currently being felt by payers and providers as they gear up for testing these new transactions beginning in July. As of January 1 of next year, CMS will not accept any electronic data in the old format. And that means failure to comply will hold up claims submission and payment.

The 5010 upgrade is probably invisible to most coders in an organization. It's very much an information technology (IT) initiative and involves inventorying systems and working with vendors and payers to ensure everyone has updated to the 5010 standard. In addition to updating the number of bytes available to report ICD codes and allowing for alpha-numeric entry (instead of mostly numeric with ICD-9), it also includes updates to allow for reporting the present on admission indicator, eliminates the release of superfluous PHI for insurance certification and verification, and eliminates numerous other inefficiencies in reporting data electronically.

So keep an eye out for the acronym HIPAA - it will come into play a lot in your career as a coder. As for HIPPA, I still can't figure out what that is. There is no Health Information Patient Privacy Act, so as best as I can tell, a hippa is a baby hippo!