Is ICD-10 Giving You F41.0 (Panic Attacks?)

Is it just me or is the amount of ICD-10 hype particularly increased over the last couple of months?   Now, at just 17 months until implementation, it seems the industry has taken it up a notch lately.  And that has me wondering if ICD-10 is giving anyone panic attacks yet.  And yes, there is a code for that:

• F41.0, Panic disorder [episodic paroxysmal anxiety] without agoraphobia

At least I hope no one has been moved to the point of panic where they are afraid to leave their homes.

As for me, I have been eating, sleeping, and breathing ICD-10.  In my day job, I've been writing training materials and even delivering training to clients.  On Colorado's ICD-10 Task Force, we've just planned a year's worth of statewide education.  I've given up a Saturday or two to attend or facilitate ICD-10 Coffee Chats locally for roundtable discussions on coding in ICD-10.  And I've hit two regional associations here in Colorado and given an hour long presentation to each on what's happening with ICD-10 on the state level.  On a daily basis, I receive at least 10-15 newsletters or marketing emails on ICD-10.

No wonder I find I have CPT amnesia.

At any rate, is it just me or are you feeling it too?  I've been looking for a new hook for my blog for 2013 and I think I may have found it, so look for upcoming blogs on some creative ways to navigate the onslaught of ICD-10 information.  Who has the most precise and condensed information out there?  Where can you get affordable (or free) ICD-10 education?  Where can you download and begin learning ICD-10 on your own?  All this and more as I eat, sleep, breathe... and blog about ICD-10.

Code for the Day: It's All About Heart (I21.-& I22.-)

I am not a fan of Valentines Day.  And please don't mistake this for bitterness, I just find it ridiculous that we have a holiday dedicated to telling the ones we love that we love them when there are 364 other perfectly good days in the year to confirm the sentiment.  So I really just see Valentines Day as an excuse for my grocery store to mark up the cost of roses for 2 weeks in February.  And let's be real here: I hate the combination of pink and red hearts.  I don't know what it is, but it makes me queasy.  Pink hearts alone are fine.  Red hearts alone are dandy.  But together, ick.  And it get even worse when they throw in those purple hearts for good measure.

As I sit here with my pink heart necklace - after all, I am a festive person and there are no red hearts in sight - I do like Valentines Day as a reminder of something more important: February is American Heart month.  Maybe you "go red" on Fridays or wear a red ribbon.  Maybe you take the month to become more educated on heart disease and the warning signs of a heart attack.  Today, I think we should definitely focus on ICD-10 coding for myocardial infarction!  So consider this my valentine to you: a short tutorial on what to expect in ICD-10 for coding myocardial infarction.

The first thing you need to know is that the definition of an acute myocardial infarction (AMI) has changed.  It is no longer one that has occurred within the past 8 weeks, the period is now reduced to 4.  You also no longer need to know if the AMI episode is the initial or a subsequent encounter for treatment.  In fact, forget everything you know about coding AMI in ICD-9-CM because it will just confuse you in ICD-10-CM.  Here are the highlights:

• The new period for an AMI is 4 weeks
• The terms ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) are now part of the code titles, not just inclusion terms for the codes
• AMI codes to two categories: 
• I21, ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
• I22, Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
• Additional characters report the specific site of the AMI (heart wall or vessel)
• Sequencing depends on the circumstances of admission

The key to knowing when to use a code from category I21 versus one from category I22 is not when the patient receives treatment, but for which AMI he is receiving treatment for.  

Let's take an example.  Bob comes in February 14 with a heart attack.  This is so tragic for Bob's wife, who did not get her roses.  For this Valentines Day visit, we assign a code from category I21 for an initial AMI.  This is the first heart attack Bob has had in the last 4 weeks.  

Let's say Bob comes back on his anniversary, February 28 with a second heart attack. I'm really starting to feel sorry for Bob's wife.  Oh, and Bob too. For this second visit, we would assign a code from category I22 to show that this is a subsequent heart attack that occurred within the 4 week period of his initial heart attack.  You would assign a code from category I21 as a secondary diagnosis to report that first heart attack on Valentines Day.

As for sequencing, notice in Bob's case, I22 was put first on the second visit since it was the reason for his admission (after study, yada yada).  But what if Bob had been admitted for that first heart attack on the 14th and experienced his second while he was an inpatient?  In this case, the I21 would be sequenced first with I22 as a secondary.  Again, sequencing depends on the circumstances of admission.

I'll just let that sink in a bit.

Have a healthy and happy Valentines Day and enjoy the ones you love.  And if you must indulge, might I recommend some antioxidant chocolates and heart-healthy red wine?  Stay away from those overpriced roses!

Code for the Day: Let's Hope Steamboat Springs' Lighted Man Never Sees This on a Claim Form

I just spent a very fun weekend in Steamboat Springs with my boyfriend visiting his family.  For the second year in a row, we decided that the prime weekend for a visit was during Winter Carnival, which is pretty spectacular if you ever have the chance to witness it.  During the day, they load up Main Street with snow for events such as the donkey jump, where local cowboys saddle up their horses so they can drag kids on skis over ski jumps (something my boyfriend has experienced and survived) or the shovel race, where the cowboys drag "grown" men sitting on snow shovels down the street to see who can get the best time.

There are lots of other things going on as well.  Last year, we went to Howelsen Hill - home of the Steamboat Springs Winter Sports Club and training ground of many Olympians - to watch some ski jumps.  But perhaps the biggest draw is Saturday night's fireworks display and the Lighted Man.  This show begins after dark at Howelsen Hill as skiers carrying flares make their way down the mountain.  Cut your eyes to the right, and you will see ski jumpers with flares jumping through a ring of fire.  But the grand finale is always the Lighted Man - a skier outfitted in a suit of LED lights making his way down the hill while fireworks shooting from his body.

As for me, since I don't downhill ski, I spent the weekend running barefoot through snow-lined walkways from pool to pool at the hot springs, traipsing through a man-made ice castle, and giving cross country skiing a try. There were so many options for a code for the day, but I kept coming back to the Lighted Man.  Because codes on a claim tell a story, I just wonder what the insurance company would say should the Lighted Man have to report these codes:

• W39.xxxA, Discharge of firework, Initial encounter
• Y93.23, Activity, snow (alpine) (downhill) skiing, snow boarding, sledding, tobogganing and snow tubing

It's such a fun tradition, I hope he never has to find out. I didn't get close enough to the mountain this year to get a good pic of the Lighted Man, but if you'd like to see some great pictures of the Winter Carnival is like, there is a good synopsis if you click here.

Article Review: The Coder Coach Responds to "Industry Disconnect"

I'm afraid today's topic won't be quite the entertainment fodder that many of my readers have come to enjoy because this is a serious topic and one that I am very passionate about. And it deserves a serious blog posting!  Someone recently asked me on my Facebook page what I thought about a recent cover story published in For the Record Magazine.  "Industry Disconnect" by Selena Chavis is a great read for anyone who has been pounding the pavement looking for a coding job.  It is also a must read for any coding professional with hiring power.  In short, this article highlights the biggest threat to the future of the coding industry: the ability to hire, mentor, and train recent grads.

It's no secret how I feel about mentoring our future workforce.  My thoughts are well documented throughout the Coder Coach and my colleagues in the state of Colorado know how outspoken I am about the topic of mentoring coders.

So when I was asked, I thought, wow, what a great topic for my blog.  Here are my thoughts on the article: it illustrates an accurate, although bleak, outlook on the future.  But all is not hopeless.  This article has some great points, but it also brought to mind some myths about coding mentoring and training that I would like to address.

Myth 1: There is a disconnect between coding schools and employers and no one cares or is doing anything about it
Partially true.  In general there is a disconnect between schools and employers, as documented in the article.  It is not true that no one cares.  Hello!  Are you reading my blog?  I currently sit on Colorado Health Information Management's Student Alliance Task Force - a mouthful, I know!  This is an alliance made up of CHIMA members and directors from the local HIM schools and we spend our time trying to figure out how to get better and more meaningful internship experiences for students.  There are a ton of road blocks and we are trying to decide how to break them down.  More on that in a sec.

Myth 2: Hospitals will only hire people who can hit the ground running
I hate this myth.  Because, in my experience, there is no such thing as a coder who can hit the ground running.  Okay, that was deep.  Let me repeat with more emphasis,  there is no such thing as a coder who can hit the ground running.  It's true that new grads take more time and as the article mentioned, there is only so much you can teach in a 2-year program that will prepare people for a future in electronic medical records, privacy and security, coding, cancer registry, and the list goes on.  It is unrealistic to expect new coders to be able to hit the ground running and it's ridiculous to exclude new grads thinking they won't have anything to offer.  I have never hired a coder - novice or experienced - who didn't need on the job training.  It's true that you can teach an old dog new tricks, but it's equally true that old habits die hard.  A new coder may not have experience, but as Linda Donahue, RHIT, CCS, CCS-P, CPC mentioned in the article, it is easier to teach new habits than correct old ones.  If you can absorb information like a sponge, you may have a serious future in coding.

On a side note, I decided to test this no-such-thing-as-hit-the-ground-running theory, so I called up my friend and newest coworker, Sandy Giangreco, RHIT, CCS, RCC, CPC-I, PCS, COBGC, CPC, CPC-H and AHIMA-Approved ICD-10-CM/PCS Trainer (are you getting the impression that Sandy has a little experience?!).  I asked her if she felt like she'd hit the ground running and she said sort of.  Now keep in mind that Sandy has many years of excellent coding experience (and a couple certifications!) and was hired by Haugen Consulting Group as a Senior Consultant.  We don't have to teach her how to code.  But she is trying to get used to our way of doing things and our training materials so that she can further develop more materials and peer review other content.  She is not up to speed yet.  But it's only like her second week, so I'll cut her some slack!

Myth 3: If hospitals take the time to train people, they will just leave and take those skills elsewhere
Oh waaaa.  Oops, did I type that out loud?   This is something that industry leaders need to get over.  We no longer live in an era where people pledge allegiance to a certain company and stay there for 30 years and retire to a blissful lifestyle at the age of 62.  When I got my first coding job, my manager and mentor, Lila, told me she knew she wouldn't be able to keep me but she wanted to give me an opportunity.  And I am so thankful she did.  There are other Lila's out there who are willing to train you so they can have a hand in training the future workforce as a whole - not just at their own institution.  I think if more people adopted this mentality, the future of the coding field would be bright indeed.

Myth 4: No one is willing to train on the job
So it turns out Lila was right.  I worked for her for three years before taking a job as her peer coding supervisor at a sister hospital.  And then she moved on for another career opportunity outside our hospital system.  That was 15 years ago.  Recently our paths crossed again when Lila took a management position with one of my clients.  Last fall I got to travel with her during a training trip and it was so much fun to be back in the company of that person who first gave me a start.  And I was dying to ask her: if you could do it all over again, in today's climate of EMRs and code-based reimbursement, would you hire a green coder like I was back in the day?  And she said yes.  Here it is almost 20 years since she gave me a chance and so much has changed with coding and HIM and she still feels the same way about training and mentoring.  God bless Lila and every coding manager like her.  We also have a hospital system in Colorado that recently opened their own coding school in preparation for ICD-10 and they are accepting people with baseline coding class experience and placing them into coding positions at the end.  People are willing to train, you just have to find them.

Myth 5: Experienced coders know more
Okay, so this may be where I lose some loyal blog readers and for that I apologize.  I will start by saying that I know some really smart, terrific coders who can code like nobody's business.  And as a coding trainer, I also know a lot of "experienced" coders who don't know as much as they think they do.  At Haugen Consulting Group, we actually have a training program for experienced coders about coding basics or fundamentals where we get them back to the coding guidelines.  Because they forget.  They get so caught up in the details that they can't see the forest between the trees.  And it's not really their fault.  My point is, new coders may have an advantage here - we are trying to get coders back to the guidelines and most students know nothing but those guidelines.  They are also "closer to the books" when it comes to things like anatomy and physiology.  And I cannot stress enough How.  Very.  Important. This. Will.  Be. For. ICD-10.  No coder knows everything - it's impossible.  I learn more about coding every day and I teach the darn stuff.  That's actually what I love about it.

Myth 6: Coding students can't get hands-on experience because of EMRs
There is some truth to this.  I hate that word "can't," though.  When I did my internship I reported to the hospital every day for 3 weeks like it was my job.  There was a coding unit and all the coders sat together.  I understand that that hospital no longer has a coding unit.  The coders all work from home by accessing the electronic medical record (EMR).  And that's how most hospitals are these days.  It's not impossible for students to get hands on experience, but it is challenging.  The main road block here is HIPAA.  The Health Insurance Portability and Accountability Act of 1996 allows for electronic submission of health information and as HIM professionals, we understand the confidentiality and security issues surrounding protected health information (PHI).  As HIM professionals, we have a duty to keep this data confidential but we also have the duty to train new professionals.  We are trying to find ways to bust this excuse, but our first commitment is to the patient and protecting their data.  That's just something to think about when you complain about the background check you need to go through to get access to a system as a student.  How would you feel if it was your medical record?

Myth 7: There are not enough coding jobs for students
Bologna.  I've said it before and I'll say it again.  There may not be a bunch of jobs for "coder," but there are tons of jobs that are coding related.  Stop searching for coding positions in HIM departments and ending your search there.  Start looking for jobs that have ICD-9-CM and CPT embedded in their job descriptions.  You will learn more than you think just by being around codes.  Plus, if you can get a job in billing, this is a great place to see coding reimbursement in action.

Wow, this is already way longer than I intended, so I will leave you with this.  I love that Ms. Chavis's article was the cover story.  I think this is the most critical issue facing our industry today (even more so that ICD-10!). But I don't want you to walk away from this article thinking that a future in coding is futile.  Get out there and network!  People give jobs to people they know, so go out there and get known!

If you haven't found a job in coding, ask yourself if you've exhausted every option.  I meet all kinds of people who want to be coders for all kinds of different reasons.  If you want to be a coder only because you want to work from home, stop now.  You won't be successful.  But if you want to be a coder because you love the detective work you have to do to pull documentation together to get those codes, then there should be nothing on this earth that will stop you.  I see a lot of people making excuses about why they aren't getting coding jobs, but I firmly believe that if you want it badly enough, you will get there.  I'm no stranger to excuses myself - mostly when it comes to living a healthy lifestyle.  So lately, I've been carrying around this quote as a reminder any time I catch myself making an excuse and falling into the role of victim:

"Ninety-nine percent of the failures come from people who have the habit of making excuses."
-George Washington Carver

I am willing to work with my colleagues to remove the excuses about why we can't train and mentor.  Are you willing remove excuses for any of your own roadblocks that you've put up?

Code for the Day: There's Even a Code for One of My New Year's Resolutions! (Y93.E9)

How do people start New Year's resolutions on January 1?  Am I the only person in the world who bakes, entertains, gift wraps, and parties myself into oblivion until the point where I don't want to do a darn thing come New Year's Day?  Here we are on January 14 and I am finally getting things organized enough to focus on how to better myself in 2013. 

Oh sure, I had lofty goals.  Last year, we took an awesome New Year's day hike at Red Rocks Park near Denver.  And we were going to do it again.  But this year 2013 hit us in a sleep deprived state so we decided to forgo the hike and head to a late breakfast instead.  We did end up at Ikea, though, so I suppose a few hours there could technically be classified as a hike.

In general, I hate New Year's resolutions.  I think they are incredibly cliche and what's even more cliche is the fact that they never last.  I think the number 1 New Year's resolution should be to make your New Year's resolution last longer than a few weeks - maybe even the whole year. 

I try to start out every year with a general plan to get organized and unload myself of unnecessary clutter. I am, after all a super organized coder and that carries over into my home and daily life. So I've spent the last couple of weeks organizing my kitchen, planning menus, organizing closets, cutting back on what I eat (duh, who doesn't have that resolution!), and decluttering my physical space.  And I was so delighted to find that there is, in fact, a code for that:

• Y93.E9, Activity, other interior property and clothing maintenance

If only there was a companion code specific to shoe shopping - then I could code the before and the after!

What's in Store for 2013?

Happy New Year to all of you!  I am not sure what is in store for my blog in 2013, but I continue to look around for inspiration. For now I am still inspired by the Code for the Day, even though it doesn't seem to come every day. Look for an FAQs page coming some time in the next couple of months for people interested in a coding career.  And best wishes for keeping your New Year's resolution past first quarter!

Twelve Codes of Christmas: On the Twelfth Day of the Coder's Christmas (F42)

Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells!!!

• F42, Obsessive-compulsive disorder

Happy Holidays!!!

Twelve Codes of Christmas:On the Eleventh Day of the Coder's Christmas (F60.2)

Yep. You guessed it.  Another animal picture.  This is the last one, though.  I think.

Pets are better than TV and in since the news is so depressing lately, I highly suggest turning the tube off and tuning in to the closest animal.  It's even better when you have a camera.

This little picture was captured one Christmas when I was snapping pictures of my Christmas decorations - something I often do to either remember how I decorated or to keep a record of Christmases past since I have a tendency to change decor colors every couple of years.  Yes, I'm one of those.  But I think I've already mentioned my affinity for Christmas decorations.

This is a picture of my sweet kitty, Mandy, pondering pouncing on Ginger, the dog.  Ginger was raised by cats and actually liked cats better than dogs.  So the cats pretty much had the rule of the roost and there wasn't a lot Ginger ever did about it.  But this picture looks a little sinister, so here's our carol and code for this eleventh day of the coder's Christmas:

• Thoughts of Roasting You on an Open Fire (F60.2, Antisocial personality disorder)