tag:blogger.com,1999:blog-8026892256957474742024-02-19T02:56:52.470-07:00Coder CoachThis blog is dedicated to the mentoring of future medical coding professionals. Ever wonder what you need to know once your initial training is done? There's a lot - probably years' worth of blog material, so let's get started...Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comBlogger129125tag:blogger.com,1999:blog-802689225695747474.post-74446388229034427732020-03-03T13:40:00.001-07:002020-03-03T13:40:57.724-07:00ICD-10 Remix: What the Heck is a DRG and Why Should I Care About Case Mix?I originally penned this blog post in 2011 and while the essence of DRGs hasn't changed much, the coding system has. So here is the ICD-10 update to one of my most popular blog posts of all time. Enjoy!<br />
<br />
So you want to be a coder. And not just that, you want to be a hospital coder because, on average, they make more money than physician coders. And you don't just want to be a hospital coder, you want to be an <span style="font-style: italic;">inpatient</span> hospital coder because then you get to look at the whole chart and piece together the patient's clinical picture. If this is your goal, then everything you need to know you will not learn in school. And that's mainly because there is so much to learn and practical experience is key.<br />
<br />
Most of all, if you want to be an inpatient coder, you need to know diagnosis-related groups (DRGs) because in hospitals, it's all about DRGs and case mix - and compliance. If you have no idea what I'm talking about, fear not - here's a primer on DRGs! I wish I could say I cover it all here, but this is just a beginning!<br />
<br />
<span style="font-weight: bold;">What is a DRG?</span><br />
The ICD-10-CM coding systems contains over 72,000 codes. Imagine trying to determine a payment amount for each individual condition. And that doesn't include accounting for procedures (over 78,000 ICD-10-PCS codes). The most logical solution is to create a system that allows for broader classification of conditions and services for easier comparison and assignment into payment categories. DRGs were created for this purpose. I look at DRGs as a way to "organize the junk drawer" where patients are grouped into different categories based on similar conditions and cost to treat the patient.<br />
<br />
<span style="font-weight: bold;">History</span><br />
DRGs were first developed at Yale University in 1975 for the purpose of grouping together patients with similar treatments and conditions for comparative studies. On October 1, 1983, DRGs were adopted by Medicare as a basis of payment for inpatient hospital services in order to attempt to control hospital costs. Since then, the original DRG system has been changed and advanced by various companies and agencies and represents a rather generic term. These days, we have various DRG systems in use - some proprietary and some a matter of public record - all of which group patients in different ways. Two of the main DRG systems currently in use are the Medicare Severity DRG (MS-DRGs) and 3M's All Patient Refined DRGs (APR-DRGs). Different DRG systems are used by different payers.<br />
<br />
<span style="font-weight: bold;">How to Get a DRG</span><br />
All DRG systems are a little different, but the basic premise is the same. DRGs are based on codes. In effect, DRGs are codes made up of codes. The following elements are taken into consideration when grouping a DRG:<br />
<ul>
<li>ICD-10-CM diagnosis codes</li>
<li>ICD-10-PCS procedure codes</li>
<li>Discharge disposition</li>
<li>Patient gender</li>
<li>Patient age</li>
<li>Coding definitions as defined by the Uniform Hospital Discharge Data Set (UHDDS) - in other words, the sequence of codes on the claim</li>
</ul>
Back in the 80s, DRGs were grouped manually using decision trees. These days, DRGs are grouped with the touch of a button and DRG groupers are a big part of encoding software. But I would be doing you a disservice if I didn't at least give you an idea of the grouper logic. As I mentioned, there are different DRG systems and probably the most popular is the MS-DRG system, so I will explain how MS-DRG grouper logic works.<br />
<br />
<span style="font-weight: bold;">MS-DRG Grouper Logic</span><br />
The first step in assigning an MS-DRG is to classify the case into one of the 25 major diagnostic categories (MDC). These MDCs are based on the principal (first) diagnosis and, with a few exceptions, are based on body systems, such as the female reproductive system. Five MDCs are not based on body systems (injuries, poison and toxic effect of drugs; burns; factors influencing health status (V codes); multiple significant trauma; and human immunodeficiency virus infection). Organ transplant cases are not assigned to MDCs, but are immediately classified based on procedure, rather than diagnosis. These are called pre-MDC DRGs.<br />
<br />
Once a case has been assigned into an MDC (with the exception of the transplant pre-MDCs), it is determined to be either medical or surgical. Surgical cases require more resource consumption (that's industry speak for "costs more!"), so they must be separated from the medical cases. If there are no procedure codes on the case (e.g., a patient with pneumonia may have no procedure codes), then it's simple - it's a medical case. But if the patient had a procedure, that procedure may or may not be considered surgical. For example, an appendectomy is quite clearly a surgical procedure. But something like suturing a laceration is not. It's all based on resource consumption - the cost of performing the procedure. For the most part, anything requiring an operating room is surgical.<br />
<br />
Okay, so now that we have our MDC and a designation as medical or surgical, we need to look at the other diagnoses on the claim. Right now, Medicare is able to process the first 18 diagnoses on the claim. These other diagnoses, depending on their severity, may be designated as complications and comorbidities (CCs) or major complications and comorbidities (MCCs). Medicare maintains lists of CCs and MCCs and updates them annually. CCs and MCCs are conditions that have been identified as significantly impacting hospital costs for treating patient with those conditions. For example, it's been determined that congestive heart failure without further specification does not significantly impact costs and it is not a CC/MCC. However, patients with <span style="font-style: italic;">chronic </span>systolic or diastolic heart failure do have slightly higher costs, so those conditions are CCs. More so, patients with <span style="font-style: italic;">acute</span> systolic or diastolic heart failure have even higher costs, so they are designated as MCCs. Are you beginning to see how slight changes in a physician's diagnostic statement impact coding and thus payment?<br />
<br />
<span style="font-weight: bold;">DRG Weights</span><br />
Now that we know the MDC, whether the case is medical or surgical, and whether or not there are any CCs or MCCs, how does that translate into reimbursement? Well, if you're using an encoder (and if you code for a hospital, you will), you hit a button and presto! You have a DRG with a relative weight. Now if only you knew what that relative weight meant. The DRG relative weight is the average amount of resources it takes to treat a patient in that DRG. Huh?<br />
<br />
Let me demonstrate. The baseline relative weight is 1 and represents average resource consumption for all patients. Anything less than 1 uses less than average resources. Anything above 1 uses more than average resources. So let's compare some respiratory MS-DRGs:<br />
<ul>
<li>MS-DRG for lung transplant has a relative weight of 10.7863</li>
<li>MS-DRG for simple pneumonia (no CC/MCC) has a relative weight of 0.6821</li>
<li>MS-DRG for chronic obstructive pulmonary disease with an MCC has a weight of 1.144</li>
</ul>
You can see how different combinations of codes lead to different MS-DRGs with different relative weights. In order to convert that into monetary terms, we multiply the relative weight by the hospital base rate. Now I'm sure you want to know how to get that hospital base rate. Me too. Well, up to a point. The base rate is exclusive to each hospital and takes <span style="font-style: italic;">a lot </span>of historical, facility-specific data into account, like what they've been paid in the past, whether they are an urban or rural hospital, and how much the hospital pays out in wages. That's just more math than my poor little head can comprehend! So for the purposes of this exercise, let's pretend like this hospital - we'll call it Happyville Hospital - has a base rate of $5000. So if we multiply the relative weights above by $5000, our reimbursement for those cases, respectively, is $53,932, $3,411, and $5,720.<br />
<br />
<span style="font-weight: bold;">Case Mix</span><br />
You just might be asked in an interview if you understand case mix. It's a good indication of whether someone really understands DRGs. And I have to admit, in my sometimes sadistic manner, I like seeing that look of glazed-over confusion on someone's face when I bring up case mix. But case mix is simple. It's the average relative weight for a hospital. So get out a big piece of paper for your hospital and start writing down the relative weights for every single case and then divide to get your average. Okay, so it's computerized now. But that's all case mix is - an average.<br />
<br />
In the industry, we officially refer to case mix as the type of patients a hospital treats. Let's say at Happyville, we have a high volume of transplant cases plus a trauma center and a well-renowned cardiac program. These are all highly weighted types of cases and our overall case mix will be higher than say, Anytown Hospital down the street that has no trauma center, no transplant program, and basic cardiac services (they transfer all their serious cardiac cases to Happyville!). Happyville's case mix will be higher than Anytown's.<br />
<br />
As a coder, you don't need to know what your specific hospital's case mix is at any given time. But knowing what impacts case mix is an indication that you know your stuff. First and foremost, case mix fluctuates. Most hospitals monitor case mix on a monthly basis because changes in case mix are a precursor to changes in reimbursement. Of course your CFO wants case mix to continue to rise, but that could be a red flag. And he certainly doesn't want case mix to fall. If case mix begins to decrease, the first place hospital administration usually looks is coding - after all, case mix is based on DRGs, which are based on codes. But there are lots of things that can impact case mix and many of them have nothing to do with coding, such as:<br />
<ul>
<li>The addition or removal of a heavy admitting physician - especially specialty surgeons</li>
<li>Opening or closing a specialty unit</li>
<li>Changes in a facility's trauma level designation</li>
<li>Movement of cases from the inpatient setting to outpatient, and</li>
<li>Anything else that impacts the type of services the hospital provides</li>
</ul>
<span style="font-weight: bold;">Your Life as an Inpatient Coder</span><br />
As an inpatient coder your job is to make sure you get all the codes on the claim in the correct order so that the accurate DRG is assigned and the hospital gets paid appropriately. When I put it that way, it sounds so easy! The reality is, with more and more patients being treated as outpatients, those who are admitted as inpatients are sicker than they've ever been. And sicker means harder to code. For instance, the patient comes in with shortness of breath and the final diagnosis is acute exacerbation of COPD, staphylococcal pneumonia, and respiratory failure. How you code and sequence the case will determine the appropriate DRG and reimbursement. The good news is, you'll have an encoder to help you model the DRGs and see what pays what. The bad news is, you have to paw through the medical record to determine the true underlying cause of that shortness of breath.<br />
<br />
So are you ready for the challenge? Are you ready to apply DRGs?Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-49789346750674605232018-10-31T15:55:00.000-06:002018-10-31T15:55:05.176-06:00How to Get Started in a Medical Coding Career<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dw4ufiuVFlregvB50m4RgwaYdazBD9d5ZaohmFKWCRCbLW3i32v3h-3G2gTUwLiP2ulUeDYR6m5prUf-S6DNQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<br />
I'm trying something new and launching a video blog. You may have noticed that I haven't written much lately and that's mostly because I can't write anything quickly without a million edits. And with a full time job and small child, ain't no one got time for that! Not that the videos aren't without outtakes and redos, but they do seem to be quicker (when I put all vanity aside and ignore the bad hair days). The frequency of videos is yet to be determined, but you can bet it will be related to how often I decide to do hair and makeup while working from home! It only took me just over a month to get the nerve to post this first video.<br />
<br />
This episode was inspired by <b>countless</b> social medial posts where people are asking how to get started as a medical coder, so that is answered here. Where do you find a program? AHIMA or AAPC? CCS or CPC? Don't enroll in a medical coding program without watching this video first! And share this video with anyone you know who wants to be a medical coder.<br />
<br />
In the video, I mention two websites and here are direct links to the pages that will help you locate coding schools:<br />
<br />
<ul>
<li><a href="http://www.ahima.org/careers/plan?tabid=program">AHIMA</a></li>
<li><a href="https://www.aapc.com/training/medical-coding-training.aspxv">AAPC</a> </li>
</ul>
<div>
Both websites have information about coding schools with face to face instruction as well as web-based instruction. Best of luck to you!</div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-28715212629698311252018-06-18T11:26:00.000-06:002018-06-18T11:26:24.274-06:00Slim Year for ICD-10 Coding Updates<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheDjPu2uszuLNjPG6oyxAf_UVZs7VC3pfpI0P_fSYApE9DxQX7B7vTiW_W-iv-ZlmWqBGcV7ZA9yPg9_odfE62GCEGkxqX0L9l5b49xnWRfKbFXz8AZxEfjnOqdCrQl-0VMJneRxkWLfWI/s1600/Coder+Coach+Code+Updates.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheDjPu2uszuLNjPG6oyxAf_UVZs7VC3pfpI0P_fSYApE9DxQX7B7vTiW_W-iv-ZlmWqBGcV7ZA9yPg9_odfE62GCEGkxqX0L9l5b49xnWRfKbFXz8AZxEfjnOqdCrQl-0VMJneRxkWLfWI/s320/Coder+Coach+Code+Updates.jpg" width="320" /></a></div>
Just like the past couple of years, we've been waiting rather impatiently over the last couple of months for the release of the fiscal year (FY) 2019 ICD-10-CM and ICD-10-PCS code updates. While the PCS code sets have been out for a month or two, the CM updates were released just last week, sans coding guidelines, which we are still eagerly awaiting. FY 2019 codes will be implemented on October 1, 2018 (the federal fiscal year runs from October 1 through September 30). In case you're wondering how the code changes stack up to previous years, what the process is for updating the code sets, or why they aren't released at the same time, this post is for you!<br />
<br />
In comparison to past years, it's a slim year for code updates. When the code sets were unfrozen for FY 2017 after ICD-10 implementation, we saw a whopping 2,710 CM and 4,330 PCS code changes. Last year, for the FY 2018 release, there were 731 CM and 6,029 PCS code changes. FY 2019 has a pretty sharp drop for both code sets with 473 CM and 616 PCS code changes. <br />
<br />
If you've been playing along at home and waiting for the code releases, perhaps you've been wondering why the CM and PCS updates are not released at the same time. Even though both code sets are presented to the Coordination and Maintenance Committee for review and discussion before the Cooperating Parties and general public, each code set is maintained by a separate government agency. <br />
<br />
ICD-10-CM is maintained by the National Center of Health Statistics (NCHS), a component of the Centers for Disease Control and Prevention (CDC). ICD-10-PCS is maintained by the Centers for Medicare and Medicaid Services (CMS). Twice a year (every March and April), both agencies present proposed code changes at the Coordination and Maintenance meetings in Baltimore and then each agency works to finalize the code sets. <br />
<br />
Over the past couple of years, we've noticed that PCS changes happen more quickly and are released earlier than their CM counterparts. CMS presented code proposals for FY 2019 as late as the March 2018 meeting. On the other hand, most of the code proposals that NCHS presented for CM in March were for consideration for FY 2020.<br />
<br />
The other trend we've been noticing since converting to ICD-10 is the last thing to be released is generally the ICD-10-CM Official Guidelines for Coding and Reporting. We are still waiting for the FY 2019 coding guidelines to be released. It's been common for NCHS to release the code sets first and the guidelines at a different time, whereas CMS has been pretty consistent with releasing the PCS code sets along with the ICD-10-PCS Official Guidelines for Coding and Reporting.<br />
<br />
If you read this post hoping I would give some spoiler alerts, you'll have to wait for the webinars I'm presenting in August for Haugen Consulting Group. I hope you'll click the links to the marketplace and register for one or both (CM and PCS) updates webinars where I will outline the changes with some background information and a healthy dose of Haugen fun. Well, fun is relative - we're still talking about coding, but who said that has to be boring!<br />
<br />
Here are the links to help keep you updated for FY 2019!<br />
<br />
<ul>
<li><a href="https://www.thehaugengroup.com/event/2019-icd-10-cm-updates-diagnosing-what-you-need-to-know/?instance_id=56">2019 ICD-10-CM Updates: Diagnosing What You Need to Know</a></li>
<li><a href="https://www.thehaugengroup.com/event/2019-icd-10-pcs-updates-firsttoknow/?instance_id=57">2019 ICD-10-PCS Updates #FirstToKnow</a></li>
</ul>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-71504296639190293722017-09-06T07:52:00.003-06:002017-09-06T07:52:45.275-06:00Spotlight on Certification: Certified Interventional Radiology Cardiovascular Coder (CIRCC®)<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiFi3uh0FtjxduvBpKy415KKerNrxP0iEtQOTAErZNPiWwVjqD-fpXmta_X7sCqce8xl2m7venQrOFbgtv90Pa27N3nCBLhEFLq2I0aOTRUkR-XP5Y_v3DeMtnwZlw5zwZ22IlIo4yYqha/s1600/CIRCC.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="266" data-original-width="640" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiFi3uh0FtjxduvBpKy415KKerNrxP0iEtQOTAErZNPiWwVjqD-fpXmta_X7sCqce8xl2m7venQrOFbgtv90Pa27N3nCBLhEFLq2I0aOTRUkR-XP5Y_v3DeMtnwZlw5zwZ22IlIo4yYqha/s320/CIRCC.jpg" width="320" /></a>Lately I've heard a lot of buzz about the AAPC's credential, Certified Interventional Radiology Cardiovascular Coder (CIRCC). Interventional radiology (IR) coders are in demand because of the complexity of the field and the notoriously high error rates seen on audits. It may sound like a great credential to get, but before you make any sudden movements, here's what you need to know about the CIRCC exam. <br />
<br />
<b><u>Why this credential exists</u></b><br />
I've been coding now for 22 years and I've seen quite a bit. I helped train the workforce in ICD-10-CM and ICD-10-PCS. I've audited ICD-9, ICD-10, CPT and HCPCS codes. I've read the Federal Register on DRGs and APCs. But the hardest thing I've ever had to learn to code is IR and cardiology. The coding rules are complicated, ever changing, and often inconsistent for different parts of the body. Learning how to code IR and cardiology procedures by just looking at the CPT book is tough enough, but not all the rules are written there. There are other societies that develop suggested guidelines and then there are the payer's rules and interpretations. In a hospital setting, an understanding of IR and cardiology coding also usually requires an understanding of hospital charging and how departments are credited revenue. This credential exists to show that you've mastered these areas of coding. In my mind, this is the most difficult area of coding there is.<br />
<div>
<br /></div>
<b><u>This is not an entry-level credential</u></b><br />
I took the CIRCC exam four years ago with about 10 years of experience under my belt. It was a tough exam. As a matter of fact, it was the hardest multiple choice exam I've ever taken and I would put it up there with the Certified Coding Specialist (CCS) test as one of the toughest. If you are thinking you will get the CIRCC and then land a job as an IR coder without any experience, think again. This is the test you take after you've been coding those types of cases for a long time and feel confident in your abilities. AAPC recommends, but does not require, at least two years of coding experience before taking the CIRCC exam. <br />
<br />
<b><u>What's on the test</u></b><br />
The CIRCC exam is spotlighted for its focus on IR coding, but it also includes cardiology procedures. The procedures we're talking about are surgical-type procedures done in a radiology suite or cardiac cath lab using radiological (fluoroscopic) guidance. For IR, this can be vascular studies (angiograms) and interventions (e.g., angioplasty, stenting, thrombectomy) or nonvascular procedures (e.g., placement of biliary stents, nephrostomies, and fluoroscopically-guided biopsies). For cardiology, this can be diagnostic cardiac catheterization, angioplasty and stenting, and cardiac electrophysiology studies and arrhythmia ablations. If you don't know what any of that means, I don't recommend taking the test until you learn more!<br />
<br />
<b><u>What it costs</u></b><br />
At the time of this writing, the cost to sit for the CIRCC exam is $400. But the cost of taking the CIRCC doesn't end when you register and pass the exam. Like other credentials, you need continuing education units (CEUs) to maintain the certification. But unlike most other AAPC credentials, there are limited vendors from which you can get those CEUs. Before you decide to take the test, look at the CEU requirements and visit the vendor websites (the AAPC has links) to see how much your CEUs will cost you and be very realistic about what you can afford. If your primary job is coding these types of cases, check with your employer to see if they will reimburse you for any of the costs. This is an expensive credential to maintain, but if it's valued by your employer, they may cover the costs.<br />
<br />
<b><u>Read all about it</u></b><br />
I could regurgitate the contents of the AAPC's website about the CIRCC exam, but instead of doing that, I will direct you to their website with this simple instruction: Do your homework! There is a plethora of information on the <a href="https://www.aapc.com/certification/circc/">AAPC's website</a> for this exam and it will tell you everything you need to know from the breakdown of the exam questions, approved manuals and materials (yes, you can bring <a href="https://www.thehaugengroup.com/marketplace/ha-marketplace/icd-10-pcs-vir-flip-bits/">anatomy cards</a> showing selective vascular ordering), certification requirements, history of the exam, and FAQs. If you were going to spend $400 on a new smartphone, you would probably read up on the different models before making a final decision. Why wouldn't you also do this for a credential? Don't take this exam until you've read all the fine print.<br />
<br />
<b><u>Preparing for the exam</u></b><br />
Once you decide that you're ready to pull the plug and take the test, it's time to prepare. Even if you've coded these cases for a long time, there is still preparation to be done. Here is my list of recommendations:<br />
<br />
<ul>
<li><i style="font-weight: bold;">Get the right CPT book</i>. The AAPC's website is very clear that they will only allow you to use the American Medical Association's (AMA) version of CPT. If you have a CPT book from any other publisher, you cannot use it. I recommend the AMA's Professional Edition of CPT for its color coding and pictures. It's more expensive than the standard edition, but I think it's worth the money.</li>
<li><i style="font-weight: bold;">Mark your CPT book</i>. Don't waste time writing in the things you already know, but I do recommend making cross-reference notes for any codes that have a one-to-one relationship. For example, I wrote all of the C codes for drug-eluting stent placements next to their CPT counterparts so I didn't have to open another book during the test. Sometimes CPT includes instructional notes in the Surgical section directing you to the Radiology component code. And sometimes it doesn't, so I wrote those in too. Especially if you are used to using an encoder, make sure you have your book set up so you can flip to different code sections fast.</li>
<li><b><i>Get the exam prep book</i></b>. Yes, it costs more money and no, I am not being paid by the AAPC to push their products! The exam prep book will go over what's on the test. It will give you practice questions and show you the type of questions that will be on the exam. The one thing I remember from the exam prep book is it said in several places that none of the questions are meant to be trick questions. That might sound like a no-brainer, but when you really get into IR coding, you'll see why that's an important thing to remember.</li>
<li><b><i>Spend your study time on your weak areas</i></b>. Don't waste your time studying things you already know. If there is an area that is not your strongest, make notes on those CPT sections and find tricks to help you remember. When I took the test, I was strong in vascular IR and cardiology, but not so much on nonvascular IR, so those sections of my book had the most notes. Remember: you can write notes in your CPT book, you just can't put any loose pieces of paper in them. </li>
<li><i style="font-weight: bold;">Take a prep class</i>. If you can find a class that will cover part or all of the exam content, enroll now. I am teaching a <a href="https://www.thehaugengroup.com/marketplace/ha-marketplace/cpt-coding-for-vascular-interventional-radiology-vir-procedures/">vascular interventional radiology </a>class in October 2017 in Denver, which covers some of the trickiest IR coding. I would love to see you there and chat about your CIRCC aspirations!</li>
</ul>
<div>
If you've ever considered taking the CIRCC exam, I hope you found this post useful. Want to learn more about IR coding? Stay tuned - more posts to come!</div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-13554699399543956572017-05-11T11:11:00.000-06:002017-05-11T11:11:41.870-06:00What You Need to Know About Coding Using EMRs and Encoding SoftwareI haven't been perusing as many coding sites and Facebook pages recently as I was a couple of years ago, but I did recently come across a post that captured my attention. Someone was asking if there was a way to get trained in a popular electronic medical record (EMR) to help them meet the requirements of a job. It seems many employers are looking for work experience with a certain EMR before considering a person for a position. Is this fair? Well, it may not seem fair if you've never worked as a coder, but if you have, chances are pretty good you've had exposure to some of the major EMR software vendors. For those of you who don't have any practical EMR experience, here's what you need to know.<br />
<br />
<b>Is it reasonable to require EMR experience?</b><br />
First of all, if you've never coded before and your coding school didn't have a relationship with an EMR vendor allowing you to learn the system, any reasonable hiring manager is not going to expect you to have experience. And if they aren't reasonable, then you don't want to work for them anyway (problem solved!). If I pick up your resume and see you have taken some coding classes and have never worked in the healthcare field but are "proficient" in EMR software, I am going to have more than a few questions for you. How did you get your EMR experience? Which systems did you use? What did you like or not like about it? In other words, I won't believe you have experience with it and I will try to weed that out of you. Or even worse, I may be inundated with resumes and feel like you're lying about something on the resume and I may not have the time or energy to do any investigating. Your resume may be relegated to the "no" pile. <br />
<br />
<b>Fact: your employer will train you</b><br />
Here's a fun fact. Even if you've worked as a coder for 2 years using a certain EMR software, you will have to have training at your new facility. You may think you know everything there is to know about a certain EMR software, but they are all customizable. As a consultant, I've used the same EMR software at several clients and they are all a little different. You may find documents stored in different places. Your favorite EMR feature at Hospital A may not have been "turned on" at Hospital B. So expect to be trained on the same software you've already been using every time you change employers.<br />
<br />
<b>EMRs are from Mars, encoders are from Venus</b><br />
EMRs aren't the same as encoders. Of course the EMR is where you will find the medical record documentation, but it is also where you will find financial information and abstracted data. Encoders and computer assisted coding (CAC) software are usually separate from the EMR. As a matter of fact, there aren't a lot of EMR vendors who are also in the business of encoder software. That makes two different kinds of systems you need to be aware of. But have no fear: while it's a plus if you have been trained on an encoder, you can expect your employer to train you there too. <br />
<br />
<b>You need to understand interfaces</b><br />
Rather than obsessing over how to get trained on a particular EMR or encoder, here's something more important for you to focus on: you need to understand software interfaces. Because your EMR and encoder are coming from two different vendors and they have to talk to each other, they rely on interfaces. How that's set up is not important to you (although it's very important to the information technology department), but how and why you enter data the way you do is based on interfaces. I've coded for lots of hospitals with lots of different computer systems, but in general, here's how it works:<br />
<br />
<ol>
<li>You pull up the patient in the EMR.</li>
<li>If you work with a CAC product, you launch the CAC by clicking a button in the EMR. This opens the CAC using an interface, so that it automatically pulls up the patient you are working on in the EMR and displays medical record documentation for coding.</li>
<li>If you don't have a CAC, you review the medical record documentation in the EMR and then launch the encoder using a button in the EMR.</li>
<li>Once you are in the CAC/encoder, you code the record. This software allows you to look up codes and save them to a list. When you're done, you click a complete button, and then you find yourself back in the EMR in the abstracting screens.</li>
<li>If the interface is working properly, everything you entered in the CAC/encoder is shown on your abstracting screens. This is also where you can assign surgeons and dates to procedures as well as any other abstracted data your facility chooses to collect.</li>
<li>You send the account to billing in the EMR by indicating the account is complete.</li>
</ol>
<div>
<b>(Most) EMRs don't have grouper software</b></div>
<div>
Groupers are the magic software that calculate DRGs and APCs based on assigned codes. Grouper logic is something that is built into CAC/encoder software, but not into EMR software. If you ever need to make a change to codes to rebill an account, you can't just change the code in most EMRs. It's pretty standard practice to reopen the account, relaunch the CAC/encoder, make corrections, send them back to the EMR through the interface, and then send for rebill. This concept is something that many coders don't understand and, I would argue, this concept is more important than knowing the ins and outs of any particular EMR product as a new hire.</div>
<div>
<br /></div>
<div>
<b>Knowing how to code is more important than anything</b></div>
<div>
After all this, the most important thing you need to know to get a coding job is how to code. Your employer can teach you everything I've mentioned above specific to your facility. And they can also work with you on enhancing your coding skills. But it's more important for you to focus on coding, coding guidelines, and a cursory background in coding reimbursement than it is for you to know an EMR inside-out. </div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-77628737975310069562016-06-01T17:43:00.001-06:002016-06-02T16:08:31.630-06:00The Reality of Coding from Home with ChildrenThese days I have more going on than audits, updates, and continuing education for CPT and ICD-10 as I eagerly await the arrival of my first child. The beauty of the internet means I can order all kinds of things for my pregnancy and the baby from the comfort of my recliner and have them delivered directly to my doorstep. One recent package included a packet of "stuff" - everything from a baby bottle, to gift cards for obscure things I'm pretty sure I'll never order, to coupons, to a flyer telling me I can work from home as a medical coder while I take care of my baby.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTIMttkFtTAqU3lUI1kYhQHLVlueaXLtj6nqomZEvsck1CKNj4kLiFCc_fSQjket2v9W3BMJZesXDouLzc9C3Y9hw7l_FhGnIblInLVddA8kEps5DbQK3XtzvGpm743Nv01TRjaqrrqEs6/s1600/Coding+From+Home.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="165" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTIMttkFtTAqU3lUI1kYhQHLVlueaXLtj6nqomZEvsck1CKNj4kLiFCc_fSQjket2v9W3BMJZesXDouLzc9C3Y9hw7l_FhGnIblInLVddA8kEps5DbQK3XtzvGpm743Nv01TRjaqrrqEs6/s400/Coding+From+Home.jpg" width="400" /></a></div>
<div>
<br /></div>
<div>
It was the last item that really jumped out at me and gave me pause. I wasn't really surprised by the claims about making lots of money while working from home. It wasn't the statement about the "prestige" of working for physicians. What caught my eye were the pictures on the flyer of women sitting in front of computers with infants on their laps. Because while I don't know what it's like to be in charge of a baby all day (yet), I do know what it's like to be a coder working from home and the job doesn't lend itself to simultaneous babysitting.</div>
<div>
<br /></div>
<div>
Most days I love working from home. It's awesome on those days when you know you have to get work done but you don't really feel like taking a shower or being in public first thing in the morning. So yeah, it's great if you are not a morning person! On those days, there's nothing better than shuffling down to my office, coffee cup in hand (okay, so it's half-decaf these days), flipping the switch on my computer, and easing into my day. Some days I am joined by my eternal lap cat, who could sit on my lap all day if I were a statue. On some days she wants to sit on my lap while I work, which is generally only okay if I am on a conference call where I don't need to take notes. Which is pretty much never.</div>
<div>
<br /></div>
<div>
Here's the big secret the flyer doesn't advertise: coding requires an immense amount of concentration and some days I can concentrate pretty well and block out the world. Other days, I have to shut off all email, the ringer on my phone, and the radio just so I can focus on work. On those days, I shoo the cat off my desk/lap and try to direct her to her bed in the corner. If necessary, I can put her in the hallway and close the door. You can't really shove your kid aside when you need to concentrate. And you can't code effectively and efficiently with a kid on your lap. And if you can, then your child isn't getting the attention he/she needs.</div>
<div>
<br /></div>
<div>
The point: coding from home is a nice perk, but it is not a substitute for child care. Like most other new parents, I'm discovering the joys of budgeting for child care after maternity leave. And I get it - it's expensive. </div>
<div>
<br /></div>
<div>
Just in case this post hasn't quite convinced you, maybe this will. Many remote coding contracts include a clause on child care. You may be required to promise in writing that you will not engage in child care when you are on the clock. So if your reason for wanting to code from home is so you can save on child care, coding isn't the job for you.</div>
<div>
<br /></div>
<div>
<br /></div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-74793403964985301202015-12-17T17:11:00.000-07:002015-12-17T18:58:03.850-07:00Top 10 Cringe-Worthy Things Wannabe Coders SayMy blog is over six years old! Seriously, I just checked. In the last six years as I've put myself out there as the Coder Coach, I've spoken either personally, over the phone, or via email to hundreds - okay, it's really probably dozens - of coders and tried to answer their questions about what it takes to be a coder. I've been amazed at how those answers have changed since then, from the evolution of technology, which allows most coders to work remotely to finally seeing ICD-10 come to fruition. So I figure it's about time I published my top 10 list: the most cringe-worthy things people say when they tell me they want to be a coder.<br>
<br>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ4CfIUZ4FWw5_0whLwzZxY9wX_A9DUpU9ma_QoepF_jvi38fkJozybY09kCnRohqZqjUXN-SWlqRfrRfbEXFbONxxuzi4yiqYiiKHOV0HZQxX8av55hNWLq50x74IVljh3NWUmQR9nrom/s1600/I%2527m+not+arguing_blog.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ4CfIUZ4FWw5_0whLwzZxY9wX_A9DUpU9ma_QoepF_jvi38fkJozybY09kCnRohqZqjUXN-SWlqRfrRfbEXFbONxxuzi4yiqYiiKHOV0HZQxX8av55hNWLq50x74IVljh3NWUmQR9nrom/s400/I%2527m+not+arguing_blog.jpg" width="400"></a>Don't get me wrong. My intent is not to put anyone off, but over the last six years, this coding thing has really caught on and I wouldn't want to steer anyone into a career that isn't right for them. So take a moment to read through the list and decide if you're guilty of any of these. Since David Letterman's Late Show is no longer a thing, consider this my replacement Top Ten List.<br>
<br>
And before you get upset, please read the sign: I'm not arguing, I'm just explaining why I'm right. In other words, I'm being a coder (occupational hazard).<br>
<br>
<h3>
<b><i>Number 10:Which type of coder pays the most?</i></b></h3>
Answer: A really good one. Focus your efforts on landing a job and then mastering it. If you choose your work setting solely for making money, you may find yourself miserable and (maybe) sort of well off. If you choose to follow your passion, the possibilities - and pay check - are pretty much endless. Employers are willing to pay good money for really good coders who don't complain about how much they hate their jobs. I don't actually do any hiring, but if I did, I would hire the hungry novice coder with a good attitude and a willingness to learn over the experienced grouchy coder who seems to hate her job.<br>
<div>
<h3>
<b><i>Number 9: Should I be a hospital or physician coder?</i></b></h3>
Have you ever seen the movie <i>City Slickers</i>? The answer is in that movie when Jack Palance says the meaning to life is "one thing." Billy Crystal asks him, with great interest, what that one thing is. The answer: that's what you've gotta figure out. You and only you can decide which setting is right for you and there is no right or wrong answer. I love getting an inpatient hospital chart and trying to figure out the latest surgical procedures and how to code them. I would rather poke my eyes out with a dull pencil than assign an E/M level to a physician's chart. I know other coders who love E/M coding. It's like being a cat person or a dog person. You will probably find that you like one more than the other and there is no wrong answer (unless you are <b><i>not </i></b>a cat person, and then we can't be friends anymore).</div>
<h3>
<b><i>Number 8: No one will hire me with the coding credential I have; they all want something else</i></b></h3>
<div>
This is probably going to sting a bit, so brace yourself. Why did you pay to get credential without first looking at local job postings and doing some research? If you are reading this before going to school or getting certified, then <b>do your homework before you pay any money to any educational institution</b>. All kinds of people will tell you anything to get your money. Only local employers will be honest about what credentials they want.</div>
<h3>
<b><i>Number 7: Where can I get free continuing education credits?</i></b></h3>
<div>
Free CEUs are out there, you just have to look for them. Most AAPC local chapters offer free monthly educational sessions. There are opportunities to summarize articles and get credit. Coding Clinic offers a quarterly webinar that is free. Other organizations offer free CEU credits. Do an internet search and you may be surprised what you will find. Did you do something, like attend grand rounds at a hospital, that you thought was very educational but you don't have a certificate? Contact the certifying body and see if they will grant you CEUs for it.</div>
<h3>
<b><i>Number 6: I can't afford to join AHIMA or AAPC</i></b></h3>
<div>
This one might sting too. Find a way to make it happen. As far as I'm concerned, when I hear this, it tells me you don't want it bad enough. Granted, I started very young and was still living at home when I first joined AHIMA, but make no mistake, I worked hard to get where I am today. Find a way to afford that membership and show people you are serious about a coding career. And if you have a credential through and let your membership lapse, you likely lose the credential. You worked hard for that credential - don't let it go.</div>
<h3>
<b><i>Number 5: This is my second (or third) career; I can't afford to start at the bottom</i></b></h3>
<div>
This is a great second or third career for people who discover they missed their passion until later in life. But here's the reality: you still likely have to start at the bottom. I've seen people find their way into coding by some very unusual means, but the ones who make it are the tenacious ones who won't take no for an answer. Pretty much no one starts out in their dream coding job. You will have to pay your dues. And please don't think that means I can't appreciate your experience in your previous profession. There are definitely things you can bring to the table, but remember that in coding, you are a novice. I'm a great coder, but I'm pretty sure if I decided to change careers tomorrow and become an aerospace engineer, there would be a bit of a learning curve. </div>
<h3>
<b><i>Number 4: Will you mentor me?</i></b></h3>
<div>
It's an innocent question and I'm flattered. Really. But I decided a long time ago that I would mentor from afar by penning this blog. I don't have a consistent schedule to be able to spend a lot of quality one-on-one time mentoring. But if you email me a specific question, I will do my best to answer it. My advice is to find someone local to mentor you. Ask them if they can meet you once a month for lunch and come prepared. What are the questions you want answers to? What challenges have they had in their career that they wish someone would have told them when they were getting started? This is a great entry into your local coding network.</div>
<h3>
<b><i>Number 3: I went to school for (fill in the blank) months/years and I'm certified; I'm qualified to be a coder anywhere</i></b></h3>
<div>
No. You're really not. I went to school too for two years and let me just tell you that even though I learned some good fundamentals, the real coding world is nothing like I thought it would be. I learned everything I really needed to know about being a coder on the job, not in school. I've now been coding for more than 20 years and I hold four different certifications and I have a news flash for you: I am not qualified to code <b>any</b>where. I lack the practical experience of a physician office coder. I find coding radiation oncology charts waaaaaayyyy outside my comfort zone. And please don't ask me to fill out an IRF-PAI for inpatient rehabilitation. In other words, after 20 years, I am not all that and a bag of chips, so please don't insult the world of experienced coders by thinking you have this all figured out. I learn something new each. and. every. day. Keep an open mind and be willing to learn - and admit when you're in over your head. Natural curiosity and a willingness to learn is a good thing. Acting too big for your britches is not.</div>
<h3>
<b><i>Number 2: How can I get experience if no one will hire an inexperienced coder?</i></b></h3>
<div>
I would give anything if people would stop asking me this question. Because honestly, I don't know the answer. I don't know what your background is. I don't know what your aptitude for coding is - and it is a skill that many people don't possess. I don't know where you've applied or how hard you've tried to sell yourself. And probably most importantly, I don't have a clue what it's like to try to get a job today because the atmosphere is so different from 20 years ago. But this is what I do know. Don't limit yourself to coding jobs. Find a job - any job - that will require you to have coding knowledge. When you do an online job search, search on the code sets (ICD-10 or CPT) and not the word coder. There are so many jobs out there that revolve around coding that aren't traditional coding jobs. Getting your foot in the door is one step closer to getting that traditional coding job - or something even better than you ever imagined. And don't forget to network. If you want to work with coders, surround yourself with coders. Who you know may be your golden ticket.</div>
<h3>
<b><i>And the Number 1 Cringe-Worthy Thing Wannabe Coders Say is: I want to be a coder because I want to work from home</i></b></h3>
<div>
AACK!!!! Not a good lead in! And if this is the first statement out of your mouth when you go into an interview, you probably won't get hired because here's a huge industry secret: hiring managers hate hearing that's why you're there. It's like going on a first date with someone you just met and gushing about how badly you want to get married and have 6 kids. It's just not done. If this is the real reason you want to be a coder, please re-evaluate. Coding is a great career if you love it. If you don't love it, you will be miserable for 8 hours every day. And if you are miserable at home for 8 hours a day, that can be really depressing. Also think about the child care aspect. I often hear people say they want to work from home because they can't afford child care. Many coding contracts require you to have child care in place. Coding takes intense concentration and you can't babysit a kid at the same time. Working from home is a great perk, I will admit, but it is not the reason I have the job I have. I refer you back to Number 10 above: follow your passion. If you're lucky, you can make some good money while you do what you love... from home... in your bathrobe.</div>
<div>
<br></div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-28954695644426494342015-09-17T13:49:00.001-06:002015-09-17T13:49:45.070-06:00Reflections of a Coder Coach: Ready to Get Back to NormalA few weeks ago, it occurred to me that my job hasn't been "normal" for the last six years. Right around this time six years ago is when I first went to AHIMA's ICD-10 Academy and earned my status as a trainer. Creating and presenting ICD-10 training materials came soon after that and it wasn't until recently I realized that my job hasn't been normal for the last six years. And since I've only known my husband for four years, one could argue that he's never known me when I'm normal... er.. at least when my job is normal!<br />
<br />
As I look around the articles and social media related to coding, a lot has changed in this industry in the six or seven years that I've put myself out there as the Coder Coach. When I first started blogging and meeting once a month with coding students and wanna-be's, there weren't a lot of people out there looking to mentor coders. Now, my voice is one of many as people who never heard of coding before ICD-10 jump on the bandwagon to get a piece of the action. There have been questions about certifications - which ones to get and how to make sure ICD-10 certification requirements are met. There have been questions about how to code things we never had to think about before - initial vs. subsequent encounters for injuries and poisonings and root operations based on procedure intent.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzebYPv4tPEzYQQckc8NEX2ODZuw0MkRo0cMA8T6omOEMyb38-gj0XpgI39GmQ44nUsZs6x8-LqzHoW6BbSiy_gwlSgdKgcXsrKvS1Jvpl0xgM81cbLjNkjwE2OhrXPrXd56rnsbwjEvtL/s1600/Final+Rule.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzebYPv4tPEzYQQckc8NEX2ODZuw0MkRo0cMA8T6omOEMyb38-gj0XpgI39GmQ44nUsZs6x8-LqzHoW6BbSiy_gwlSgdKgcXsrKvS1Jvpl0xgM81cbLjNkjwE2OhrXPrXd56rnsbwjEvtL/s640/Final+Rule.jpg" width="640" /></a></div>
I have to be honest and say that in my abnormal day-to-day life as a coder over the last few years, I've had trouble finding my voice and giving advice as a coding mentor. I no longer feel qualified to tell a coder how to break into the industry because things are so different than they were 20 years ago when I got my start and coding is something that many people are now aware of - not something that people kind of fall into anymore. Since I fill my days adding to my own intellectual bank by researching procedures and learning how to explain them - and how to code them - I wonder what it is that new coders need right now. And for everyone who is trying to learn coding, I just want to reach out and give them all a virtual hug because this is, in my humble opinion, about the hardest time to learn this industry. <br />
<br />
This week I am working on something I haven't done in years. I'm reading the Final Rule for the 2016 MS-DRG changes. That is something I used to read and summarize every year for my clients. And even though the codes are different and there are some new sections to read in this super long file, I had a moment of realization, a sigh of relief if you will, that this... this is normal! After we flip the switch on October 1 and everyone starts using ICD-10 (because I have pretty much zero faith in our congressmen to accomplish any earth shattering legislation in two weeks when they're so focused on Donald Trump's run for president), I'm sure there will be a few things that don't go as planned. But for coders, it's a time for us to return to "normal." I miss having a general confidence in assigning codes (although this has gotten better as I train more coders!). I miss code updates! Oh, how I miss those code updates! We've had frozen ICD code sets for four years! I've been following the recommendations made to the Coordination and Maintenance Committee and I can't wait to see which changes they decide to adopt on October 1, 2016. <br />
<br />
And maybe when the dust settles a bit and we see how many people really want to stick with coding in ICD-10, I will find my voice again as the Coder Coach. I sincerely hope so, because I miss meeting people with a passion to learn about my passion and giving them little nuggets of wisdom to help them make a difference in this industry.<br />
<br />Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-82392555365506377122015-03-09T08:30:00.001-06:002015-03-09T08:30:16.437-06:00So Many Books, So Little Time - Part 3<span style="font-family: Georgia, Times New Roman, serif;">Yes, it's true. There are so many books and so little time, I haven't even had time to blog for the last two weeks because I had my nose in two of them. Thank God for smartphones and long waits at the car wash, or who knows how much longer it would been before I posted again!</span><br />
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">In my <a href="http://codercoach.blogspot.com/2015/02/so-many-books-so-little-time-part-1.html">first post of this series</a>, I gave one of my favorite quotes: "ICD is from Mars, HCPCS is from Venus." So let's move on to Venus for a bit. Don't worry, we'll be back to Mars, but I like to talk about the present before I talk about the future (ICD-10), so let's get on with it. I apologize for the length of this post, but I have a lot to say today!</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTi1VfcoZKd9kiBqscKf23_dYfUU2BJqLfSCJNurDMMVhF1ZMtsHT852nL55E2GurSu7eIxYSAd4EW4dxMu4Zde1rfCla8aROFimZoUDvlwh6vpPuoxmLFJYGLFPpKBzO0gyLLZOCGCk3s/s1600/Code+Books_CPT.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif;"></span></a></div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<b><span style="font-family: Georgia, Times New Roman, serif;">Three Levels of HCPCS</span></b><br />
<span style="font-family: Georgia, Times New Roman, serif;">The Healthcare Common Procedure Coding System (HCPCS) has three different levels and just to make things more interesting, Level I is not usually called HCPCS, it's called CPT. The Current Procedural Terminology (CPT) was developed and is maintained by the American Medical Association (AMA). </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<b><span style="font-family: Georgia, Times New Roman, serif;">By Physicians for Physicians</span></b><br />
<span style="font-family: Georgia, Times New Roman, serif;">What makes CPT so unique is that it is the only coding system in the HIPAA-approved code sets that is developed by physicians for physicians. The codes you see in the CPT code book are the result of various medical and surgical societies coming together with the AMA to decide which procedures deserve their very own CPT codes. Every year at the AMA's CPT Symposium, coders from around the country gather in Chicago to listen to these physicians present the coding updates for the coming year. It's an expensive but valuable conference that I think every coder should experience at least once. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTi1VfcoZKd9kiBqscKf23_dYfUU2BJqLfSCJNurDMMVhF1ZMtsHT852nL55E2GurSu7eIxYSAd4EW4dxMu4Zde1rfCla8aROFimZoUDvlwh6vpPuoxmLFJYGLFPpKBzO0gyLLZOCGCk3s/s1600/Code+Books_CPT.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTi1VfcoZKd9kiBqscKf23_dYfUU2BJqLfSCJNurDMMVhF1ZMtsHT852nL55E2GurSu7eIxYSAd4EW4dxMu4Zde1rfCla8aROFimZoUDvlwh6vpPuoxmLFJYGLFPpKBzO0gyLLZOCGCk3s/s1600/Code+Books_CPT.jpg" height="233" width="320" /></a><span style="font-family: Georgia, Times New Roman, serif;">CPT codes are primarily used by physicians to report procedures and services performed in every possible setting where a physician - or qualified health practitioner - may see a patient: his office, the hospital, a clinic, a nursing home, etc. But it doesn't stop there. CPT is also used to report hospital <i>outpatient</i> procedures. Of course, since there are still a lot of procedures that are performed solely as inpatient, hospital coders use a small number of CPT codes in comparison to pro-fee (physician) coders. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<b><span style="font-family: Georgia, Times New Roman, serif;">Three within Three</span></b></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">So now that we know that CPT is one of three levels of HCPCS, let's delve a little deeper into this major code set. CPT has three categories of codes and this is still a pretty new concept for me because when I was learning, there were no categories, just CPT codes. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<b><span style="font-family: Georgia, Times New Roman, serif;">Category I Codes</span></b></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Category I codes are the original CPT codes they're what I like to call "grown-up" CPT codes. In order to get a grown-up CPT code, a procedure has to meet some pretty stringent criteria: </span></div>
<div>
<br />
<ul>
<li><span style="font-family: Georgia, Times New Roman, serif;">The procedure must have FDA approval</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">The procedure must be commonly performed by practitioners nationwide</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">The procedure must have proven efficacy</span></li>
</ul>
</div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Once these criteria are met, a five-digit numeric code is assigned to the procedure and unlike ICD (different planet, remember?), these codes do not have decimal points. The codes are arranged in sections by type of procedure or service:</span></div>
<div>
<br />
<ul>
<li><span style="font-family: Georgia, Times New Roman, serif;">Evaluation and Management (E/M) (codes beginning with 9)</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">Anesthesia (codes beginning with 0)</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">Surgery (codes beginning with 1-6)</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">Radiology (codes beginning with 7)</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">Pathology and Laboratory</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">Medicine (the rest of the codes beginning with 9)</span></li>
</ul>
</div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">The Surgery codes are divided by specialty, for example, the cardiovascular codes begin with 3 and neuro codes begin with 6. After coding for a while, you should be able to look at a CPT code and have a general idea of what it is. A common newbie mistake is to look for the E/M codes in the back of the book. After all, they begin with 9! But remember that CPT is a coding system that was developed by physicians for physicians and since physicians use E/M codes more than any others, they are in the front of the book for quick reference. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Here are a few examples of Category I CPT codes:</span></div>
<div>
<br />
<ul>
<li><span style="font-family: Georgia, Times New Roman, serif;">99283, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">12002, Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.6cm to 7.5cm</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">75625, Aortography, abdominal, by serialography, radiological supervision and interpretation </span></li>
</ul>
</div>
<div>
<b><span style="font-family: Georgia, Times New Roman, serif;">Category II CPT Codes</span></b></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Category II CPT codes are located behind the Category I CPT codes in the book. These are the only CPT codes that are optional. They are used by physicians for tracking performance measures. The purpose of these codes is to decrease administrative burden on providers while collecting information on the quality of patient care. Category II codes are five-digit alphanumeric codes that end in "F." Here are some examples:</span></div>
<div>
<br />
<ul>
<li><span style="font-family: Georgia, Times New Roman, serif;">1040F, DSM-5 criteria for major depressive disorder documented at the initial evaluation (MDD, MDD ADOL)1</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">3775F, Adenoma(s) or other neoplasm detected during screening colonoscopy (SCADR)12</span></li>
</ul>
</div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Category II CPT codes are implemented throughout the year and may be implemented before they actually appear in the CPT book. Code updates can be accessed on the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-ii-codes.page?">AMA's website</a>. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<b><span style="font-family: Georgia, Times New Roman, serif;">Category III CPT Codes</span></b></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Category III CPT codes, or "baby codes," as I like to call them, are for emerging technologies that do not meet the criteria of a grown-up Category I CPT code. The Category III codes are found behind the Category II codes in the CPT book. For procedures that are not commonly performed, lack FDA-approval, or don't yet have proven efficacy, Category III codes are assigned. These are temporary codes for a period of 5 years. It has become common practice to see Category III codes reach Category I status with each annual update. For 2015, one of those procedures that was moved was transcatheter mitral valve repair with a prosthesis. The MitraClip uses this relatively new technology to treat mitral regurgitation and it received FDA approval in 2013. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">These are five-digit alphanumeric codes that end in "T." The codes are added throughout the year and may be implemented before they are published in the CPT book. Here are some examples of some Category III codes:</span></div>
<div>
<br />
<ul>
<li><span style="font-family: Georgia, Times New Roman, serif;">0387T, Transcatheter insertion or replacement of permanent lead less pacemaker, ventricular</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">0274T, Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic</span></li>
</ul>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Updates to Category III codes can also be found on the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-iii-codes.page?">AMA's website</a> throughout the year. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
</div>
<div>
<b><span style="font-family: Georgia, Times New Roman, serif;">Staying Updated</span></b></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Back in the day, it was important just to make sure that you had the most recent year's CPT book to ensure you were using valid codes. However, with the Internet, now it's also important to monitor the CPT updates and errata on a regular basis since changes are made throughout the calendar year. I find it easiest to put a reminder on my calendar the first of each month to check the AMA's website for updates to the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/errata.page?">errata</a>, which is a list of corrected errors in the CPT code book, as well as changes in Category III codes. Since I don't use Category II codes, I forego that update, but if you are coding them, be sure to look for those updates too. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">By the way, the errata is on the list of approved materials for the AAPC exams. The year I took the CIRCC exam (Certified Interventional Radiology and Cardiology Coder), there were a lot of errors in the electrophysiology code notes and the errata was something I really needed. Be sure to check it out!</span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<b><span style="font-family: Georgia, Times New Roman, serif;">Modifiers</span></b></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">HCPCS codes have a concept specific to HCPCS codes only: modifiers. Think of modifiers like moons that are specific to a planet (and please forget for a moment that Venus doesn't have any moons!). Modifiers apply to HCPCS codes only, not ICD-9-CM codes. They are added to HCPCS codes to provide additional information, such as a bilateral procedure or an unusual service or to indicate that a procedure was discontinued. CPT modifiers are two numeric digits that are appended to a HCPCS code with a dash (e.g., <a href="tel:75710-59" x-apple-data-detectors-result="1" x-apple-data-detectors-type="telephone" x-apple-data-detectors="true">75710-59</a>). </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<b><span style="font-family: Georgia, Times New Roman, serif;">All CPT Coders are not Created Equal</span></b></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">The people who assign CPT codes are just as complex as the coding system. Since hospital coders code only a subset of CPT codes, they don't have the same skill set that a pro-fee coder has. Remember that hospital <i>inpatient</i> coders use volume 3 of ICD-9-CM to code procedures. Hospital <i>outpatient </i>coders assign CPT codes for procedures that are found in the outpatient setting. So while the pro-fee coder coding for the cardiologist will code everything from a clinic visit in the physician's office to an angioplasty in the hospital cardiac cath lab to a full blown coronary bypass in the hospital's OR (all using CPT, of course), the <i>outpatient</i> hospital coder would only use CPT to code the angioplasty. Hospitals don't follow conventional E/M rules and coronary bypass is an <i>inpatient</i> procedure that gets coded using ICD-9. In addition, many of the modifiers used by hospitals are different than those used by physicians. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">These differences are one of the reasons it's so difficult to make the crossover from hospital to pro-fee coding and vice versa. I personally hate E/M coding but I know people who love it. So if you find that one area of coding is not really your cup of tea, fear not! You may find another area very rewarding. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I also really can't talk about CPT without bringing up a little tiny thing from the hospital side called a <b>charge description master (CDM)</b>, or as it's more commonly called, the charge master. It's as masterful as it sounds: a line-item listing of everything a hospital department charges for. Each line item has a description of the charge, charge amount, and sometimes a CPT code. One of the most difficult transitions I see in pro-fee coders crossing over to the hospital side is not understanding that the coder doesn't code everything. There are many codes that are assigned automatically by the charge master when a charge is applied to the bill. This is the case when the CPT code doesn't require a lot of subjective reasoning (e.g., lab test or x-ray). For those procedures and services, such as operative procedures, that require subjective reasoning, a real-live coder will assign the code. It may sound counter intuitive, but this actually increases the amount of coding-related jobs in a hospital. The <b>charge master analyst</b> requires coding knowledge as he/she works with hospital departments to set up charges, research appropriate CPT codes for the procedure or service, and determine if it will be hard coded (by the charge master) or soft coded (by a person in coding). </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<b><span style="font-family: Georgia, Times New Roman, serif;">CPT Made (Too?) Simple</span></b><br />
<span style="font-family: Georgia, Times New Roman, serif;">This posting really oversimplifies the CPT code set</span><span style="font-family: Georgia, 'Times New Roman', serif;"> </span><span style="font-family: Georgia, 'Times New Roman', serif;">(that's right, it gets more complex!)</span><span style="font-family: Georgia, 'Times New Roman', serif;">, but it's a start if you're still finding your way in the coding field. I have a love-hate relationship with CPT because I find it both challenging (love!) but also frustrating when I hear conflicting coding advice between CMS, the AMA, and medical/surgical societies (hate!). If you find that you love all aspects of CPT, then you can have a very lucrative career in either the pro-fee or facility coding arenas.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">Stay tuned to this series... Next up is HCPCS Level II.</span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<br /></div>
<!-- Blogger automated replacement: "https://images-blogger-opensocial.googleusercontent.com/gadgets/proxy?url=http%3A%2F%2F4.bp.blogspot.com%2F-mdeHmO1XSeg%2FVP2mjP1FUtI%2FAAAAAAAAAcg%2FZ3OyXzo-6g8%2Fs1600%2FCode%252BBooks_CPT.jpg&container=blogger&gadget=a&rewriteMime=image%2F*" with "https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTi1VfcoZKd9kiBqscKf23_dYfUU2BJqLfSCJNurDMMVhF1ZMtsHT852nL55E2GurSu7eIxYSAd4EW4dxMu4Zde1rfCla8aROFimZoUDvlwh6vpPuoxmLFJYGLFPpKBzO0gyLLZOCGCk3s/s1600/Code+Books_CPT.jpg" -->Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-5400560173412228042015-02-16T18:00:00.002-07:002015-02-16T18:00:29.949-07:00So Many Books, So Little Time- Part 2<div>
<b>ICD-9-CM Has Procedure Codes?</b></div>
<div>
<span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;">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. </span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCoTzlaaCu4Xl4udiYHt7GRISALfanmsPwwkk1ZFw-sqTbHy6nYX22H-oKrM10EwFI11C3L2uGNkLIXzMX5avvmDzyrT-7ywK5rtDyXajfqOHGUsmEnQB2Bp80LTAdTltTnMM8jGmpxsYE/s1600/ICD-9-CM.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCoTzlaaCu4Xl4udiYHt7GRISALfanmsPwwkk1ZFw-sqTbHy6nYX22H-oKrM10EwFI11C3L2uGNkLIXzMX5avvmDzyrT-7ywK5rtDyXajfqOHGUsmEnQB2Bp80LTAdTltTnMM8jGmpxsYE/s1600/ICD-9-CM.jpg" height="238" width="320" /></a></span></div>
</div>
<div>
<br /></div>
<div>
<b>Hospitals Use It</b></div>
<div>
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. </div>
<div>
<br /></div>
<div>
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. </div>
<div>
<br /></div>
<div>
<b>Why You May Have Never Heard of It</b></div>
<div>
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!<br />
<br />
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.</div>
<div>
<br /></div>
<div>
<b>What the Codes Look Like</b></div>
<div>
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. </div>
<div>
<br /></div>
<div>
Some examples of volume 3 codes are:</div>
<div>
<br />
<ul>
<li>47.0, Appendectomy</li>
<li>36.97, Insertion of drug-eluting coronary artery stent(s)</li>
</ul>
</div>
<div>
<br /></div>
<div>
<b>Commentary on ICD-9 Volume 3 and Argument for ICD-10</b></div>
<div>
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! </div>
<div>
<br /></div>
<div>
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. </div>
<div>
<br /></div>
<div>
<b>Who Needs to Learn it?</b></div>
<div>
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:</div>
<div>
<br />
<ul>
<li>CCA (Certified Coding Associate) from AHIMA</li>
<li>CCS (Certified Coding Specialist) from AHIMA</li>
<li>CIC (Certified Inpatient Coder) from AAPC (new)</li>
</ul>
</div>
<div>
<br /></div>
<div>
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. </div>
<div>
<b><br /></b></div>
<div>
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 <b><i>if</i></b> 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. </div>
<div>
<br /></div>
<div>
Next up: Level I of HCPCS (AKA CPT)...</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
</div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-65971334632499809082015-02-11T13:46:00.001-07:002015-02-11T14:26:31.452-07:00So Many Books, So Little Time - Part 1<b>What's Your Idea of a Best Seller?</b><br />
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.<br />
<br />
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!<br />
<br />
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.<br />
<br />
<b>I Don't Hate Encoders</b><br />
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.<br />
<div>
<br /></div>
<div>
<b>ICD is from Mars, HCPCS is from Venus</b><br />
In healthcare, we deal with two major planets of coding systems: the <b><i>International Classification of Diseases (ICD)</i></b> and the <b><i>Health Care Common Procedure Coding System (HCPCS)</i></b>. 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.<br />
<br />
<b>ICD-9-CM Volumes 1 and 2: Everyone Does it</b> </div>
<div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQL0YyUrGBhBMQglPDfzEGh2egUvDv7e8cCLk-nJn0Hnghmvq6htEZlQK2VscTAChNp3u2JLTs9suGn124PaVXs9BbNpATFMYPpvb-_7qc2dxLDkLymE6I4BprsZ20SbkN6li9I_nDwZdE/s1600/ICD-9-CM.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQL0YyUrGBhBMQglPDfzEGh2egUvDv7e8cCLk-nJn0Hnghmvq6htEZlQK2VscTAChNp3u2JLTs9suGn124PaVXs9BbNpATFMYPpvb-_7qc2dxLDkLymE6I4BprsZ20SbkN6li9I_nDwZdE/s1600/ICD-9-CM.jpg" height="238" width="320" /></a></div>
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 <b><i>Healthcare Portability and Accountability Act of 1996 (HIPAA)</i></b> 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. </div>
<div>
<br /></div>
<div>
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 <i>clinical modification</i>. And thus, we have <b><i>ICD-9-CM: the International Classification of Diseases, 9th Revision, Clinical Modification</i></b>.<br />
<br />
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.<br />
<br />
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<span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;"> 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.</span><br />
<span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;">Here are some examples of ICD-9-CM codes:</span><br />
<br />
<ul>
<li>486, Pneumonia, organism unspecified</li>
<li>401.9, Essential hypertension, unspecified</li>
<li>250.00, Diabetes mellitus without mention of complication, Type II or unspecified type, not stated as uncontrolled</li>
</ul>
Examples of supplementary codes:<br />
<ul>
<li>V08, Asymptomatic HIV infection status</li>
<li>V27.0, Outcome of delivery, single liveborn</li>
<li>V76.51, Screening for malignant neoplasm of colon</li>
<li>E961, Assault by corrosive or caustic substance, except poisoning</li>
<li>E885.3, Fall from skis</li>
</ul>
<div>
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. </div>
<div>
<br /></div>
<div>
<b>Frozen</b></div>
<div>
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 <a href="http://www.cdc.gov/nchs/data/icd/icd9cm_guidelines_2011.pdf">ICD-9-CM Official Guidelines for Coding and Reporting</a>. </div>
<div>
<br /></div>
<div>
<b><i>Next up: ICD-9-CM Volume 3...</i></b></div>
</div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-18386242928432225422014-12-23T10:36:00.002-07:002014-12-23T10:36:55.336-07:00All I Want for Christmas is Fewer RAC DenialsThis December, coders across the country got the ultimate Christmas present: a bill passed the House and Senate without the addition of language that would further delay ICD-10 implementation. As we breathe a sigh of relief and get ready for a worry-free Christmas (at least as far as coding is concerned), we aren't fully exhaling until the end of March when the SGR bill comes up again for a vote.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjreh4cEA-6JliVuTWK6mtJGINcrO7BRX4t_XeeUaUBvJzaLpzP7w7AuAx4Ijiv5ilng5HFRK1-6GbGh37gXvGuBJT2V60eeVHgKxsjiwAmcmfymo1FU0_g3HVcRps7lX5Zr4_bQM4Pzvm9/s1600/HIP+Act+of+2014.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjreh4cEA-6JliVuTWK6mtJGINcrO7BRX4t_XeeUaUBvJzaLpzP7w7AuAx4Ijiv5ilng5HFRK1-6GbGh37gXvGuBJT2V60eeVHgKxsjiwAmcmfymo1FU0_g3HVcRps7lX5Zr4_bQM4Pzvm9/s1600/HIP+Act+of+2014.jpg" height="400" width="361" /></a></div>
<div>
<br /></div>
<div>
But how many people are aware that there is another type of legislation at work that could cut down on the number of RAC denials we get? Sounds almost too good to be true, doesn't it? While the legislation is real, it's in very draft form right now. Unfortunately, from where I sit, it also seems to be flying very low under the radar among my peers and I think it deserves some attention.</div>
<div>
<br /></div>
<div>
First of all, if you are not yet familiar with RACs, those are the Recovery Audit Contractors hired by Medicare to recoup improper payments to hospitals and physicians and return that money - with penalties - to the Medicare program. The idea is great - run all the claims data through proprietary software and analyze it to see what looks weird. This can be anything from improperly coded claims to admitting a patient to the hospital for a short stay rather than treating them as an outpatient. Side note: contrary to what a lot of Medicare patients are told, hospitals do not get paid more for outpatient claims; they actually get paid less. Medicare patients pay more out of pocket for hospital outpatient services and in most cases, hospitals get paid less than if patients were inpatient. But if hospitals admit patients who could be treated as outpatients for short stays, they can have to pay the money back plus RAC penalties.</div>
<div>
<br /></div>
<div>
There are two types of RAC audits: automated and complex. Automated reviews can be identified just by looking at data without reviewing the medical record. Complex reviews require review of the medical record (e.g., for coding errors). But the RACs don't have the final say; there is a rather lengthy appeals process that providers can - and should - take advantage of because several RAC denials have been overturned. The problem is, there are about eight levels of appeals that end with the administrative law judge and currently there is a backlog of appeals at the administrative law judge level.</div>
<div>
<br /></div>
<div>
Enter the Hospital Improvements for Payment (HIP) act of 2014 (don't you just love that so many healthcare laws start with "hip?!"). This is a <b>draft</b> proposal aimed at reducing RAC audit backlogs by creating a new Hospital Prospective Payment System (HPPS) for Medicare short stays (less than 3 days length of stay), including observation services. In short, it calls for the following;</div>
<div>
<ul>
<li>Creation of the new HPPS by the year 2020</li>
<li>Creation of an alternate reimbursement system for short stays from fiscal year 2016 to fiscal year 2019 as data is gathered for the 2020 system</li>
<li>Elimination of RAC reviews for short hospital stays until HPPS is implemented</li>
</ul>
<div>
By now, there may be a lot of people jumping up and down with joy, but of course there is a catch. The proposal calls for dual submission of claims by hospitals in fiscal year 2016 in order to establish payments. This means that hospitals would have to submit both ICD-10-PCS and CPT codes for short hospital stays for 2016. Yes, the proposal assumes that we will be coding ICD-10-PCS in fiscal year 2016, which incidentally, begins on October 1, 2015. The proposal would also implement an ICD-10-PCS to CPT crosswalk. If the dual coding of claims didn't make you nervous, the crosswalk should. I've never met a crosswalk I trusted. Let's face it, if one coding system easily crosswalked to another, then we wouldn't need two different coding systems, would we? I can see lots of operational challenges starting with the productivity dive that would surely occur and ending with training challenges since it's getting harder to find inpatient coders who code CPT and many facilities have decided not to train their outpatient coders in ICD-10-PCS.</div>
</div>
<div>
<br /></div>
<div>
<b><u>Read All About It</u></b></div>
<div>
This is just a small snipit of what HIP is about, but I encourage you to read up on it yourself, starting with information from the House Committee on Ways and Means and checking out the industry commentary to see where you stand. Here are some links you should check out:</div>
<div>
<ul>
<li><a href="http://waysandmeans.house.gov/uploadedfiles/hip_sec-by-sec_.pdf">Document from the House Ways and Means Committee - section by section of proposed bill </a></li>
<li><a href="http://www.aha.org/letters">AHA Comments to Rep. Kevin Brady Re: Hospital Improvements for Payment Act of 2014 Discussion Draft dated December 18, 2014</a></li>
</ul>
<div>
<b><u>Let Your Voice be Heard</u></b></div>
For more information from the House Ways and Means Committee, including information on submitting comments, <a href="http://waysandmeans.house.gov/news/documentsingle.aspx?DocumentID=397845">click here</a>. This proposal has the potential to rock the world of hospital reimbursement (again) and has some definite pros and cons. While it's still only a draft and is not a done deal, it's time to take the opportunity to let our voices be heard and submit comments.<br />
<div>
<br /></div>
</div>
<div>
<br /></div>
<div>
<br /></div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-53996616421868201822014-12-19T16:05:00.000-07:002014-12-19T16:05:56.335-07:00I don't want to live in a world where Ebola is sold out at the Giant Microbe store - and there's no code for itThere is a super cute little toy shop in Coeur d'Alene, ID called <a href="http://cdacoffeeshop.com/">Shenanigan's Toy Emporium</a> that sells vintage toys and other unique items. When traveling there on business, we usually make a stop in to shop from their wall of amazing salt water taffy and check out their selection of toys that don't come with a power button. You know, the kind of toys we had prior to the Atari and Game Boy era! <br />
<br />
Shenanigan's also has a great display of giant microbes - small plush renderings of everything from the common cold to diarrhea. I am still marveling at how they could create a plush toy out of liquid stool! I'm sure it's just the geeky coder in me (and my colleagues), but we decided to buy a few and put them out during our training sessions along with our baskets of Play Dough, pipe cleaners, and candy (we like to have FUN in our training sessions!). Needless to say, they were a big hit with our clients and we noticed on one of the tags that there was a website where we could order more. By now your interest is surely piqued, so be sure to check out the online <a href="http://www.giantmicrobes.com/">Giant Microbes store</a>.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_q38YCRsxXSl2MH7oiICRiaAaeIkeFbx8Nwsa77pLUWmAMPpsmiwiuPq48iWqgpV7285x8b4k3QuwTRYgb-ENU3OV-T2_r5XtQYA6Mz1vXRmrXII4PhYk0dd5EdruDa1iog_sNq-kTkfF/s1600/Santa_edited.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_q38YCRsxXSl2MH7oiICRiaAaeIkeFbx8Nwsa77pLUWmAMPpsmiwiuPq48iWqgpV7285x8b4k3QuwTRYgb-ENU3OV-T2_r5XtQYA6Mz1vXRmrXII4PhYk0dd5EdruDa1iog_sNq-kTkfF/s1600/Santa_edited.jpg" height="320" width="233" /></a>You're probably thinking what I'm thinking right about now, which is, wouldn't these giant microbes make great white elephant gifts for Christmas? My thoughts immediately went to what would be appropriate for my family's white elephant gift exchange. Don't worry, my family has a great sense of humor - there's still a copy of Pamela Anderson's novel (yes, she wrote one) complete with the "naughty" pages clipped together courtesy of my grandmother who was sheltering her daughter from the filthy parts. And what better gift for someone in 2014 than the Ebola virus? There's just one problem.<br />
<br />
<b><i>Sold out.</i></b><br />
<br />
Apparently I am not the only person who thinks that Ebola would make a great Christmas gift. It's a sign of recent headlines that this virus, which is actually kind of cute in plush form, is unavailable. What's even more worrisome given that this was the year Ebola came to the US, is that we don't have an ICD-9-CM code to report it. Here's the best we can do in ICD-9:<br />
<br />
<ul>
<li>065.8, Other specified arthropod-borne hemorrhagic fever</li>
<li>078.89, Other specified diseases due to virus</li>
</ul>
<br />
What about ICD-10-CM? How about this?<br />
<br />
<ul>
<li>A98.4, Ebola virus disease</li>
</ul>
<br />
YESSSSSS! Way more specific!<br />
<br />
In previous years as we've prepped for ICD-10 implementation, the opponents have given a laundry list of extensive and admittedly ridiculous (yet fun!) ICD-10 codes that begged the question, why do we really need this? And this year, Ebola was delivered to our health system and we have nonspecific codes to report it. But in ICD-10, we have a very specific code. Hmm. Perhaps this ICD-10 thing really could help with reporting and impact patient care. Just a thought.<br />
<br />
So Santa, if I can't have Ebola for Christmas this year, could I please have ICD-10 so that I can code it for those people who did get it?<br />
<br />
<i>Author's Note: I am not affiliated with Shenanigan's Toy Emporium or giantmicrobes.com in any way. I am just a really big fan!</i>Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-43600057705392936932014-12-18T07:45:00.000-07:002014-12-18T07:45:49.528-07:00Diversity - and Flexibility - is KeyI've been pretty quiet lately around the blogosphere and some may even think I've disappeared. And for about a year, up until about October, I really had disappeared a bit to plan and live through my wedding. After a couple months of an identity crisis, I'll announce here that Coder Coach Kristi <i>Stanton </i>has disappeared and the new Coder Coach is now Kristi <i>Pollard</i>. The new last name will take a couple of decades to get used to, but I am hopeful that if I'm quoted in the future, it won't be as the first actress to play Buffy the Vampire Slayer. True story.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-LvFPuaOLyPTVUANAlYdcJi7uV97Vgt2hyM6AOTS2CCbpK1J2jYi58uv-1wNwbgDW8LK-k_jAWPYr70_KItbWEJJT07LynYanwlQy-rqc36Y3paK2fMeFCArBdmXJLaOavc_cpFYXdOTn/s1600/Diversify_edited.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-LvFPuaOLyPTVUANAlYdcJi7uV97Vgt2hyM6AOTS2CCbpK1J2jYi58uv-1wNwbgDW8LK-k_jAWPYr70_KItbWEJJT07LynYanwlQy-rqc36Y3paK2fMeFCArBdmXJLaOavc_cpFYXdOTn/s1600/Diversify_edited.jpg" height="229" width="320" /></a></div>
<br />
For the last couple of months I've been waiting for inspiration to strike so I could once again become passionate about the blog. I've been observing. Don't get me wrong, with all the legislation and talk about more ICD-10 delays, I've also been writing my congressmen, participating in Twitter rallies (follow me at @codercoach), and making posts on Facebook, but I've spent more time just watching. Watching the industry. Watching my colleagues. Watching hopeful coding professionals trying to break their way in. And this is what I've deduced: if you want to make it in the coding field, you've got to diversify.<br />
<br />
It didn't take long after the ICD-10 delay was announced in March to see the fallout. Some of our clients stayed the course while others postponed some training. There have been very few canceled trainings all together for ICD-10. A couple of months ago, I dusted off a couple of our CPT training manuals that hadn't been updated in awhile to get them ready to train in 2015. It was comforting to fall back into something that still required the skill of a senior consultant that was a sure thing. Of course, I hope for a future with ICD-10 and will continue to advocate for it, but there's always CPT as well.<br />
<br />
<b><i>Here is my message to the coding students and aspiring coders</i></b>. Coding is not steady and it's not comfortable. Even without ICD-10, annual updates to the coding industry can rock your world (case in point all the new lower GI endoscopy CPT codes for 2015). This field has a tendency to attract detail-oriented people who like to organize everything in pretty and neat little black and white buckets. As coders, we don't like gray areas. Well, as a coder, be ready for gray, purple, and yellow polka-dotted areas. You need to be flexible. You need to be ready when the House throws language into a bill at midnight the night before a vote that will impact your daily work. And you need a backup plan just in case.<br />
<br />
I feel a bit like a financial adviser as I tell you you need to diversify. DI. VER. SI. FY. Don't put all your coding eggs in one basket. As someone who has coded in ICD-9-CM, ICD-10-CM/PCS, CPT, and HCPCS, I understand what I'm asking you to do. It's not easy. They all have different rules and methodologies. I understand that I'm asking you for a lifetime of education. But the payoff for doing the work is immeasurable. And the more you have exposure to, the more marketable you are as a coder.<br />
<br />Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-14724106157616823962014-08-29T14:32:00.000-06:002014-08-29T14:32:37.047-06:00From the Trainer: ICD-10 FAQ #1 - If the US is the last to implement, why are there so many unknowns?For the last year, I've traveled across the country providing ICD-10-CM and ICD-10-PCS education to coders and clinical documentation specialists. Our company's model provides three separate training sessions for our clients: basic, intermediate, and advanced. This means lots of repeat visits to each client, lots of really hard questions, and tons of professional growth for me. I thought it was time to start a new series here on my Coder Coach blog: ICD-10 FAQs. This is a question I've been asked a lot lately as we get into advanced trainings and more controversial topics:<br />
<br />
<b>If the United States is the last country to implement ICD-10, why are there so many unanswered coding questions and why do we have to wait for <i>Coding Clinic</i> advice?</b><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDmGqJTLQPHmGyw9_FYooxu6WRQgsGEz8eiF274UrrHy_eZtqg2OdvEoBvFEVTNDYIMzsleenSsDDuKprMiyuSVRO95NOznluRv6na6drwKey_Z3K9RsGL3gx7mnB5VTsUS6poS06VDvKz/s1600/US_ICD-10.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDmGqJTLQPHmGyw9_FYooxu6WRQgsGEz8eiF274UrrHy_eZtqg2OdvEoBvFEVTNDYIMzsleenSsDDuKprMiyuSVRO95NOznluRv6na6drwKey_Z3K9RsGL3gx7mnB5VTsUS6poS06VDvKz/s1600/US_ICD-10.jpg" height="225" width="400" /></a></div>
<b><br /></b>
<br />
While it seems logical that someone would have figured out all of this ICD-10 stuff within the last 20 years as we've been "messing around" here in the US (please note the sarcasm, because I don't really think we've been messing around; we've actually been quite busy), the reality of the situation is that the US version of ICD-10 is different from everyone else's. The core ICD-10 code set was developed by the World Health Organization (WHO) and classifies causes of morbidity (i.e., diagnoses) and every country has the ability to adapt it further (e.g., ICD-10-CA in Canada, ICD-10-AM in Australia, ICD-10-CM in the US). Two things should have jumped out at you based on this statement:<br />
<ol>
<li>ICD-10 diagnosis codes may be different in Canada, Australia, and the US</li>
<li>The international code set does <i style="font-weight: bold;">not </i> include procedures</li>
</ol>
<br />
<div>
Let's tackle #1 first. The US version of the ICD-10 diagnosis codes, ICD-10-CM, is a clinical modification (BTW - that's what the "CM" stands for; it's not "coding manual" like some people seem to think). It is based on the WHO version, but has been adapted for use here in the good ole United States of America. I haven't had a ton of time to compare it to the original, but what I do know about the CM version is this:</div>
<div>
<ul>
<li>The Excludes1/Excludes2 convention, which solves a lot of problems from ICD-9 (and creates a few new ones) is not part of the WHO version</li>
<li>The use of 7th character extensions for injuries and poisonings is not part of the WHO version</li>
<li>The expansion of the external cause codes, which are <i style="font-weight: bold;">not </i>required for reporting, are not nearly as extensive in the WHO version</li>
<li>While we have adapted diabetes terminology in the US to Type 1 and Type 2 diabetes, the WHO version still uses the insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) terminology that we've worked so hard to banish from our medical record documentation here in the States</li>
</ul>
<div>
Most of the really hard diagnosis questions I get about coding ICD-10 diagnoses revolve around the changes that are unique to the CM version.</div>
</div>
<div>
<br /></div>
<div>
As for the procedural component, ICD-10-PCS (which stands for procedure coding system), that was developed in the US by CMS under contract with 3M. Although I've heard that other countries have plans to adopt PCS, right now the US is the only country using it. Although other countries have procedural coding systems, it's important to remember that we are the only ones using coding for reimbursement. For that reason, we will likely place more weight on those procedure codes than other countries and when it comes to PCS, it's uncharted territory.</div>
<div>
<br /></div>
<div>
Hopefully that answers a couple of questions about the ambiguity of ICD-10. And may I also just point out that this is nothing new. Coding has always undergone an evolutionary process. We have seen it with ICD-9-CM and CPT. It's the reason we have official publications like the <i>Coding Clinic</i> and <i>CPT Assistant</i>. If you are not familiar with these publications, you need to be. They are official resources that answer a lot of questions. And as of second quarter of this year, the American Hospital Association has stopped publishing <i>Coding Clinic for ICD-9-CM</i> and is only publishing <i>Coding Clinic for ICD-10-CM/PCS</i>. My colleagues and I have been monitoring the publication very carefully each quarter because their advice does change some previous assumptions many have made based on what we know about these new coding systems.</div>
<div>
<br /></div>
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-81891250263823323182014-03-27T15:21:00.001-06:002014-03-27T15:24:10.027-06:00Are Legislators Suffering from R41.9?In terms of the blogosphere, I've been severely slacking for the last several months. In terms of ICD-10 preparation, I would argue I've done my fair share. As an AHIMA-Approved ICD-10-CM/PCS trainer for nearly 5 years, AHIMA ICD-10 Ambassador, and a senior consultant specializing in ICD-10 education, I've spent much of the three years with my current employer writing ICD-10 web-based and instructor-led training, coding cases using the ICD-10 code sets, and spending countless hours face-to-face with coders across the country conducting basic, intermediate, and advanced ICD-10-CM and ICD-10-PCS training. For three years I chaired Colorado's ICD-10 Task Force, which has worked hard to raise awareness and push implementation efforts forward. <div><br></div><div>I've been in the coding industry for 19 years and we've been talking about ICD-10 for my entire career. I remember where I was when the proposed rule for ICD-10 was released and who told me. It was that big of a deal. I remember reading the final rule with elation. I remember ICD-10 being held just after Obama took office because the final rule was released in the last month of the Bush's administration. That delay was short-lived. And, of course, I can still feel the utter frustration I felt the day CMS announced that ICD-10 would be delayed until October 1, 2014. </div><div><br></div><div>And now the fate of ICD-10 hangs in the balance. Again. For crying out loud, US Government, can't we just move on?</div><div><br></div><div>If you haven't heard, some language was slipped into House bill 4302 late Tuesday night that would delay ICD-10 for another year. And this morning, the bill passed. Now it's on to the Senate. </div><div><br></div><div>I can only believe that the reason this passed is because our legislators are suffering from <b>R41.9, Unspecified symptoms and signs involving cognitive functions and awareness</b>. They just don't know what they don't know. </div><div><br></div><div>I'm just not buying the excuse that we can't be ready for ICD-10 in 6 months, even after we've been given a one-year delay already. I've been getting ready for several years, my company has been getting ready for several years, and providers and insurers have been padding their budgets for ICD-10 prep over the last 2 years. I've never seen hospitals buy into IT and training initiatives like they have for ICD-10. And I just don't think postponing ICD-10 again because some providers aren't ready because they didn't think it would really be implemented is a viable reason for a delay. </div><div><br></div><div>To be fair, this bill isn't really about ICD-10. It's about the sustainable growth rate for physicians that they are trying to address before a 24% pay cut for physicians goes into effect on April 1. The last payment fix for them expires at the end of the month. However, I am bewildered as to how 7 lines of text calling for a one-year delay on ICD-10 managed to make its way into this bill. I am also bewildered as to how a bill that was released 24 hours before it was sent to vote actually passed. Did our congressmen and congresswomen really read the whole bill? And by "read," I mean "read for comprehension." I can only hope that the bill gets killed in the senate. Seriously, the government can't keep leading us on like this! And more importantly, how will we, as an industry, get enough credibility to <i>ever</i> implement ICD-10 if we have another delay? If we delay now, we lose all momentum (and dollars) spent by the parties who actually thought the government was serious about ICD-10. </div><div><br></div><div><b>Here's what you can do</b>: become informed and get your senators informed. The bill claims it will save more than $1 billion over the next 10 years. But what no one is telling them is that those 7 lines that address the ICD-10 delay are projected to cost between $1 billion and $6.6 billion by delaying ICD-10 by <i>one year. </i>And that is only 10-30% of the money that has already been spent by the healthcare industry so far. Are we really willing to throw all that money away when our healthcare industry is already under too much scrutiny for spending?</div><div><br></div><div><b>Go to www.ahima.org</b> and see how you can contact your senators by phone or email. You don't need to be an AHIMA member to do this and you can even read more information about why the language to delay ICD-10 implementation should be removed. <b><i>Please act today and share this information with your fellow professionals so they can respond too. </i></b></div><div><br></div><div>Now if you'll excuse me, I have some emails to write and phone calls to make...</div>Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-45778933735385387102013-09-05T22:28:00.002-06:002013-09-05T22:28:47.298-06:00Newsflash: The AMA is Fighting ICD-10 - is my Blog to Blame?Okay, so it's not really news that the American Medical Association is showing R45.4 (Irritability and anger) and R45.5 (Hostility) when it comes to ICD-10. But are their R45.82 (worries) really worth all the R45.83 (Excessive crying of child, adolescent, or adult)? <br />
<br />
Okay, all kidding aside, I hate to admit that blogs like mine might be partly to blame for the backlash, but are they? In learning ICD-10-CM, it's just not fun to write blogs and articles about how the ICD-9-CM code for unspecified hypertension will be I10 in ICD-10. Okay, bad example. ICD-10 gives us I10 (hypertension). Oh wait, you've heard that one? <br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXO_AA6KGnKNrnPMIhMJDMN7SsrvcJeAd6Zp9i9eZD0AIynKqwFXtW6B2wngEoiAWMPzJXdzpEozJA4UuovLEscuywsA9EBXgj_6a032wmSEVB-dB0qVsZltjVCRYtHDRPDLc1dLy60xIT/s1600/Exciting+Boring-2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXO_AA6KGnKNrnPMIhMJDMN7SsrvcJeAd6Zp9i9eZD0AIynKqwFXtW6B2wngEoiAWMPzJXdzpEozJA4UuovLEscuywsA9EBXgj_6a032wmSEVB-dB0qVsZltjVCRYtHDRPDLc1dLy60xIT/s320/Exciting+Boring-2.jpg" width="320" /></a>I'll go out on a limb here and just say it. Coding is boring. But I love it anyway and find it fascinating and go out of my way to try to make learning coding fun and enjoyable. And since in my day job I don't get to spend a lot of time reflecting on the fun and entertaining external cause codes, I have decided to take to my blog to explore some of the more entertaining ICD-10 codes and inject some humor where I can. And it's hard. Because, as I mentioned, coding is boring.<br />
<br />
But with all of the hype on ICD-10 we've managed to fool a lot of people into thinking that it's not really boring no-nonsense work and that what we do is actually very trivial and unimportant. In an April interview on Fox News, Congressman Ted Poe (R-TX) gave several arguments against ICD-10-CM implementation in the United States and several examples of why the new coding system is ridiculous and unnecessary, including the various codes for injuries by turkeys and dog bites by specific breeds of dogs (BTW - dog bites by breed codes do not exist). <br />
<br />
Indeed, there are some very silly external cause codes, but in an <a href="http://library.ahima.org/xpedio/groups/public/documents/government/bok1_050189.hcsp?dDocName=bok1_050189">article by the American Health Information Management Association</a>, which wasn't as well publicized as Congressman Poe's interview, AHIMA states that there is no national mandate to report external cause codes in ICD-10-CM. In fact, if providers are not reporting E codes in ICD-9-CM, they won't be required to report external cause codes in ICD-10-CM. And since the 1500 billing form, which is used by physicians to report codes to Medicare, only has space for four diagnosis codes, the external cause codes are not likely to play a large role in pro-fee coding and billing. And then all that's left is those boring codes in the remaining ICD-10 chapters.<br />
<br />
But why isn't anyone pointing that out? Well, I suppose it's just more fun to talk about a code for being pecked by a chicken. Or struck by a chicken (is that a live chicken or, say, a frozen chicken from the supermarket?!). But in reality, we are training coders on the important enhancements that ICD-10 coding brings. Here are a couple of important "for instances" for you:<br />
<ul>
<li>Somewhat simplified sepsis coding (okay, so they couldn't do it all, but we'll take somewhat simplified over super confusing any day)</li>
<li>One diagnosis code for admission for vaccination (the procedure code indicates the specific vaccine given)</li>
<li>OB codes that actually make sense - most of them classify conditions by trimester rather than that "delivered with antepartum complication" nonsense</li>
<li>New and specific codes for subsequent acute myocardial infarction (AMI) that occurs within the timeframe of an initial AMI</li>
<li>Codes for blood alcohol level (here in Colorado we're waiting for the blood marijuana content codes - I'm pretty sure Washington is interested too)</li>
<li>Bye-bye to encounter for therapy codes (talk about administrative burden - insurance companies hate those V codes for admission for physical/occupational/speech therapy codes; the new code system has a way of denoting that an injury is in the healing phase)</li>
<li>Combination codes for diabetic complications (because half the time coders forget to code the second code anyway)</li>
</ul>
Now don't get me wrong. I am not saying that physicians won't be impacted at all because they will. We will be asking them to document more clearly but in general we want documentation that really should already be there. It's nice to know whether the left or right femur is broken. I'm pretty sure that it's not just the coders who are interested. And even though physicians won't have to code ICD-10-PCS procedure codes, we will be prompting them for more specific documentation within operative reports. <br />
<br />
And while we're at it, let's talk about the volume of codes. Yes, there are <strong><em>a lot</em></strong> more ICD-10-CM codes than ICD-9-CM codes. That's to be expected when they create codes for left, right, bilateral, and unspecified where applicable. And my favorite quote regarding this issue came from Don Asmonga of AHIMA at a conference last spring: "There are a lot of words in the dictionary, but that doesn't mean you use all of them." Indeed. There are many codes that we will never use. And coders aren't supposed to memorize codes anyway. In the training I've done thus far, coders have actually expressed that having more codes is better - they are able to better drill down to what's really going on with the patient instead of sticking a junky nonspecific code on the case.<br />
<br />
So if you come across a physician who is arguing against ICD-10 implementation, I would suggest that you put the kibosh on the fun code talk and get straight to the boring benefits. Will ICD-10 impact patient care? Probably not as directly as nurse finding a medication error before meds are administered. But the data that is collected on the back end will have implications for future quality initiatives; in fact many of the quality initiatives coming up depend on ICD-10 data. Besides, even the boring ICD-10-CM codes are more exciting than the same old boring ICD-9-CM codes that <strong><em>no other industrialized nation in the WORLD uses anymore</em></strong>. I mean, I hate to play the peer pressure card, but seriously, we should be leaders in in medicine - and in collecting medical data. Who else is on board?<br />
Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-52835096110272044272013-09-05T21:26:00.000-06:002013-09-05T21:26:29.141-06:00How I Spent My Summer, by the Coder Coach (Y93.E6)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAuG-4_tR_rBsMSVWe2t_eylKrHcaRqFjlC_oYJcAsRRtTN_YIUQs1neGbSnpi19Vcoy-K3vle6SeZy8yqCZQn9i6MiUbQ5zsqhDrhOwlM8ZPaIX2WKciZPocDtpzFzF19-uIsaHUuPpNe/s1600/boxes.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAuG-4_tR_rBsMSVWe2t_eylKrHcaRqFjlC_oYJcAsRRtTN_YIUQs1neGbSnpi19Vcoy-K3vle6SeZy8yqCZQn9i6MiUbQ5zsqhDrhOwlM8ZPaIX2WKciZPocDtpzFzF19-uIsaHUuPpNe/s320/boxes.JPG" width="240" /></a></div>
I really don't care if I ever see another cardboard box as long as I live. After a summer of botched real estate closings and not one, but - count them - two moves spaced two weeks apart (complete with my office and two cats), I think I've arrived in my new home with everything except for potentially my sanity. <br />
<br />
I'm not sure which was more foolish - deciding to move the summer before we enter the home stretch of the last year before ICD-10 implementation or deciding to plan a wedding that will occur just a couple of weeks before ICD-10 implementation. Just for good measure, I decided to do both. The comforting thing is, ICD-10 is still there waiting for me even after the dust has settled from all of those cardboard boxes and I never did lose sight of my ICD-10 codebooks during the move - er moves. In fact, my training calendar is booking up fast between now and September of next year!<br />
<br />
I was pretty excited to find that there was indeed an ICD-10 code to describe how I spent my summer:<br />
<br />
<ul>
<li>Y93.E6, Activity, residential relocation</li>
</ul>
This code includes packing up and unpacking involved in moving to a new residence. I wish there was a code for hernia acquired by moving boxes of code books. I swear those things multiply like rabbits. And for the record, I have informed my fiancé that we are never moving. Ever. Again.Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-43662489723685824332013-06-19T10:33:00.001-06:002015-02-11T14:57:09.822-07:00The Great Cat Extraction - 10D07Z8I've been spending the last couple of months training clients on ICD-10-CM and ICD-10-PCS and one of the things I love most about it is that I continue to learn more about ICD-10 and it's getting easier. As a matter of fact, I now feel more qualified to teach ICD-10 than ICD-9. But of course, I could pick ICD-9 back up again quickly if I had to. You can't erase nearly two decades of experience overnight!<br />
<br />
Many who know me well and have sat through my training sessions know that I like to teach by analogy (much the same way this blog is written). So when I unpack my laptop and training materials at a client, I also unpack a series of stories, jokes (well, I think they're funny), and tricks to remembering all the knowledge that I'm about to lay on them. Probably one of my favorites is the Great Cat Extraction, which I was reminded of yesterday when I took my sweet little Mandy to the vet.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFW6bjWdUS6_RkIfYIkV7AjC5Xkz0rlCcBLNr340wfkUpXUN5MNZMF2bO6uZFx8arol4YZtgM7YRhXniFFB5bHAe8dMQNh-07lnEEGqcyc-nBYCzx9cjtEP2cqdq4YgiIqnQk91RfYKxSQ/s1600/Mandy+Carrier+Collage.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFW6bjWdUS6_RkIfYIkV7AjC5Xkz0rlCcBLNr340wfkUpXUN5MNZMF2bO6uZFx8arol4YZtgM7YRhXniFFB5bHAe8dMQNh-07lnEEGqcyc-nBYCzx9cjtEP2cqdq4YgiIqnQk91RfYKxSQ/s320/Mandy+Carrier+Collage.png" height="161" width="320" /></a></div>
My cat Mandy is 6 petite pounds of pure purring pleasantness. Until you try to get her into her pink fluffy carrier to go somewhere. Then she develops the will and strength of an Olympic wrestler and I'm still not quite sure how it happens, but the neck arches back and in true cartoon form, her extremities extend in all directions so that she resembles a star. Try shoving that into a carrier. And yesterday when we got to the vet, I thought I would be clever getting her out and unzip the top of the carrier. No go. Somehow, she buried her head into a corner and it kept getting caught as I tried to pull her out. Poor kitty.<br />
<br />
You may be wondering what the heck the Great Cat Extraction has to do with coding. Well, it comes up in our discussion of the root operations Delivery and Extraction in the Obstetrical section of ICD-10-PCS. The root operation Delivery is defined as, "Assisting the passage of the products of conception from the genital canal," or more cleverly, simply defined as "catching the baby" without the use of instrumentation or manipulation. The way this was described to me is that the baby is going to come whether the doctor or midwife is there to catch it or not. There is only one code in the Delivery table: 10E0XZZ (I still think that looks like a license plate number). <br />
<br />
The root operation Extraction, on the other hand, is defined as. "Pulling or stripping out or off all or a portion of a body part by the use of force." Okay, first: ouch. Second, if you look at the options for this table, which I've pasted here below for you, you will see that Extraction includes everything from cesarean section (the row that includes Open as the approach) to vacuum extraction (the row that has Products of Conception as the body part and Via Natural or Artificial Opening as the approach) to dilation and curettage (the last row, which has Products of Conception, Retained and Products of Conception, Ectopic as the body parts). <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtpk1fQ0HSJQSg03F0yPEKmCs6WGMgEnmKoXfDJM-QQPnpm2YPuR-0xJkAutVlcgy9pd8VE9YgNp59ndPnwhMgwBIUNjXaz-jb7ahI8J11vGM1IVLMBltP9JN1Sm_7rLToihAEvlAUVZYk/s1600/Extraction+Table.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtpk1fQ0HSJQSg03F0yPEKmCs6WGMgEnmKoXfDJM-QQPnpm2YPuR-0xJkAutVlcgy9pd8VE9YgNp59ndPnwhMgwBIUNjXaz-jb7ahI8J11vGM1IVLMBltP9JN1Sm_7rLToihAEvlAUVZYk/s640/Extraction+Table.JPG" height="136" width="400" /></a></div>
<br />
Normal position for a fetus at the time of delivery is head down, but some babies are breech. Version is usually attempted on breech babies to turn them into correct position, but they can be delivered in breech position with some finesse. But a breech extraction is by no means a normal or simple delivery. Trying to get the baby's limbs to deliver without injuring it or getting caught is very much like the Great Cat Extraction. The code for a breech extraction is 10D07Z8 - this is assuming that no internal version was performed. So when you think breech extraction, think Mandy the itty bitty kitty with the strength and limb extension of a gymnast.<br />
<br />
By the way, everything came out okay at the vet. Including the cat. Eventually.Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-19616523389926891862013-05-01T12:47:00.001-06:002013-05-01T12:47:40.714-06:00Is 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: <br />
<ul>
<li>F41.0, Panic disorder [episodic paroxysmal anxiety] without agoraphobia</li>
</ul>
<span class="codeDesc">At least I hope no one has been moved to the point of panic where they are afraid to leave their homes.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikh4028lmzrKjTPEzP6ekMv0BSoivx29LRYVFV-Vbwez-R7PU57Z2Em0hZUhLgC5RmvOcLxT5PPPjDEIiSHk-JJeYs8CDPPYQWP3YkMkOBEbZDWO2uS5F0yr2nkRF8V1NuK7Cm9mCzbttp/s1600/Panic.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikh4028lmzrKjTPEzP6ekMv0BSoivx29LRYVFV-Vbwez-R7PU57Z2Em0hZUhLgC5RmvOcLxT5PPPjDEIiSHk-JJeYs8CDPPYQWP3YkMkOBEbZDWO2uS5F0yr2nkRF8V1NuK7Cm9mCzbttp/s320/Panic.png" width="320" /></a></div>
</span><span class="codeDesc">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.</span><br />
<span class="codeDesc"></span><br />
<span class="codeDesc">No wonder I find I have CPT amnesia.</span><br />
<span class="codeDesc"></span><br />
<span class="codeDesc">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.</span>Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-53661874366044611312013-02-14T11:58:00.002-07:002013-02-14T12:00:41.887-07:00Code 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.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4epYqUhLs4OG7WclVUC63kAY3z_PYRoPrqrR3am8lldhS02OyIIwxgVNZKTRDDDdeOYVAnTd5OzZMid_TzjCkd1SSPB3nA2SFcCNuc8GoVUy4_CgQOFYqe8djh0UXinbV0kylerCMaNP8/s1600/Heart+Month.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4epYqUhLs4OG7WclVUC63kAY3z_PYRoPrqrR3am8lldhS02OyIIwxgVNZKTRDDDdeOYVAnTd5OzZMid_TzjCkd1SSPB3nA2SFcCNuc8GoVUy4_CgQOFYqe8djh0UXinbV0kylerCMaNP8/s320/Heart+Month.jpg" width="302" /></a>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.<br />
<br />
The first thing you need to know is that the definition of an <i>acute</i> 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:<br />
<ul>
<li>The new period for an AMI is 4 weeks</li>
<li>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 </li>
<li>AMI codes to two categories: </li>
<ul>
<li>I21, ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction</li>
<li>I22, <span class="codeDesc">Subsequent ST elevation (STEMI) and non-ST elevation
(NSTEMI) myocardial infarction</span></li>
</ul>
<li><span class="codeDesc">Additional characters report the specific site of the AMI (heart wall or vessel) </span></li>
<li><span class="codeDesc">Sequencing depends on the circumstances of admission </span></li>
</ul>
<span class="codeDesc">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. </span><br />
<br />
<span class="codeDesc">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. </span><br />
<br />
<span class="codeDesc">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.</span><br />
<span class="codeDesc"><br /></span>
<span class="codeDesc">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.</span><br />
<span class="codeDesc"><br /></span>
<span class="codeDesc">I'll just let that sink in a bit.</span><br />
<span class="codeDesc"><br /></span>
<span class="codeDesc">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!</span><br />
<br />
<br />
<br />
<br />Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-64554976296788761952013-02-11T11:44:00.001-07:002013-02-11T11:44:40.205-07:00Code for the Day: Let's Hope Steamboat Springs' Lighted Man Never Sees This on a Claim FormI 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.<br />
<br />
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.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnfneKgv436_If47mzwmE9geqD_zNjP-6VX1-GJeg2mAwwnAtIX9thnvtuRuwzjI2WBHw5CTVMFiQM7zPufh-mXd5QvD8af4IK0eqHrcUYrLsrTzNh4M7SCCB40Qz6q9DAiiH7nqN8ZRTV/s1600/Steamboat+Collage.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnfneKgv436_If47mzwmE9geqD_zNjP-6VX1-GJeg2mAwwnAtIX9thnvtuRuwzjI2WBHw5CTVMFiQM7zPufh-mXd5QvD8af4IK0eqHrcUYrLsrTzNh4M7SCCB40Qz6q9DAiiH7nqN8ZRTV/s320/Steamboat+Collage.jpg" width="320" /></a>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:<br />
<ul>
<li>W39.xxxA, Discharge of firework, Initial encounter</li>
<li><span class="code">Y93.23, </span><span class="blankImage"></span><span class="codeDesc">Activity, snow (alpine) (downhill) skiing, snow boarding,
sledding, tobogganing and snow tubing</span></li>
</ul>
<span class="codeDesc">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 <a href="http://nwcoloradoheritagetravel.org/100th-steamboat-springs-winter-carnival-highlights/?doing_wp_cron=1360605807.4114639759063720703125">click here</a>.</span>Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-88584955328543469662013-01-31T11:56:00.000-07:002013-02-01T15:02:47.090-07:00Article 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. <a href="http://www.fortherecordmag.com/archives/011413p10.shtml">"Industry Disconnect"</a> 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.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwR1iq8PpHnBr4I1WlouNwWas7wQ96DWVOfpm7wJYEiWUxqCGsBbsAwzb1KFzjE1mUV-4mKO0H7u_VhkSTTs_Fk3w3CFsjyFIBhgTY9r6iwOYMiuKEXZcliHt1fnJMDdFIEOzMKsDPjIU0/s1600/Help+Wanted.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwR1iq8PpHnBr4I1WlouNwWas7wQ96DWVOfpm7wJYEiWUxqCGsBbsAwzb1KFzjE1mUV-4mKO0H7u_VhkSTTs_Fk3w3CFsjyFIBhgTY9r6iwOYMiuKEXZcliHt1fnJMDdFIEOzMKsDPjIU0/s320/Help+Wanted.jpg" width="213" /></a>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.<br />
<br />
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. <br />
<br />
<i><b>Myth 1: There is a disconnect between coding schools and employers and no one cares or is doing anything about it</b></i><br />
Partially true. In general there is a disconnect between schools and employers, as documented in the article. It is <i>not true</i> 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.<br />
<br />
<i><b>Myth 2: Hospitals will only hire people who can hit the ground running</b></i><br />
I hate this myth. Because, in my experience, there is no such thing as a coder who can hit the ground running<i>.</i><b> </b>Okay, that was deep. Let me repeat with more emphasis, <i><b> </b></i><i>there is no such thing as a coder who can hit the ground running. </i>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.<br />
<br />
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!<br />
<br />
<i><b>Myth 3: If hospitals take the time to train people, they will just leave and take those skills elsewhere</b></i><br />
Oh waaaa. Oops, did I type that out loud? <i><b> </b></i>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.<br />
<br />
<i><b>Myth 4: No one is willing to train on the job</b></i><br />
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.<br />
<br />
<i><b>Myth 5: Experienced coders know more</b></i><br />
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.<br />
<br />
<i><b>Myth 6: Coding students can't get hands-on experience because of EMRs</b></i><br />
There is some truth to this. I hate that word "can't,"<i><b> </b></i>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?<br />
<br />
<i><b>Myth 7: There are not enough coding jobs for students</b></i><br />
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.<br />
<i><b> </b></i><br />
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!<br />
<br />
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:<br />
<blockquote class="tr_bq">
"Ninety-nine percent of the failures come from people who have the habit of making excuses."<br />
-George Washington Carver</blockquote>
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? Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-18747855208552954502013-01-14T20:02:00.001-07:002013-01-14T20:02:14.306-07:00Code for the Day: There's Even a Code for One of My New Year's Resolutions! (Y93.E9)<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMR4IUbq3tTDJjY1EsYfY_4C3bOfPAxp83Q8EKuKFVARhDMljSfHwI5QooodFsQItWFVTA9FninY-pTWmVTIuxxtw4Rj0uzXEFBCg5jwKggXeFRXoeGg57-0YmEFRN4D6Wmoaw1gRQg7Ss/s1600/Happy+New+Year+edited.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMR4IUbq3tTDJjY1EsYfY_4C3bOfPAxp83Q8EKuKFVARhDMljSfHwI5QooodFsQItWFVTA9FninY-pTWmVTIuxxtw4Rj0uzXEFBCg5jwKggXeFRXoeGg57-0YmEFRN4D6Wmoaw1gRQg7Ss/s320/Happy+New+Year+edited.png" width="273" /></a>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 <i><b>finally</b></i> getting things organized enough to focus on how to better myself in 2013. <br />
<br />
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.<br />
<br />
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. <br />
<br />
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:<br />
<br />
<ul>
<li>Y93.E9, Activity, other interior property and clothing maintenance</li>
</ul>
If only there was a companion code specific to shoe shopping - then I could code the before <i>and</i> the after!<br />
<br />
<b>What's in Store for 2013?</b><br />
<br />
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!Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.comtag:blogger.com,1999:blog-802689225695747474.post-25378621534150114822012-12-24T09:00:00.000-07:002012-12-24T09:00:08.126-07:00Twelve Codes of Christmas: On the Twelfth Day of the Coder's Christmas (F42)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnyJKCox6HOCYMGA0SkIsBLA5HDrgpbBizu0cNoKDrthwbQUjI10VaT1Q5T96-RqnQBX5hp2YivbUtknPZtUFYX6kB6dOcKEqPM6i10wQg0hLWbvk7h4Qa-NPiQ_l6iuFwZYZUthrzeNRA/s1600/Jingle+Bells-edited.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnyJKCox6HOCYMGA0SkIsBLA5HDrgpbBizu0cNoKDrthwbQUjI10VaT1Q5T96-RqnQBX5hp2YivbUtknPZtUFYX6kB6dOcKEqPM6i10wQg0hLWbvk7h4Qa-NPiQ_l6iuFwZYZUthrzeNRA/s320/Jingle+Bells-edited.jpg" width="320" /></a></div>
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!!!<br />
<br />
<ul>
<li>F42, Obsessive-compulsive disorder</li>
</ul>
<br />
Happy Holidays!!! Kristihttp://www.blogger.com/profile/13542466342482196577noreply@blogger.com