ICD-10 Code for the Day

I received an email from a former coworker today, who was looking everywhere she could think of to find a posting I made about a code for the day.  She was checking Linkedin.  What she found was a snarky comment I made on my personal Facebook page earlier this week.  Actually, I also made another posting last week with a code for the day. So no wonder she thought it was "out there," so to speak.  And since I've been feeling rather uninspired to blog lately, I decided to go public with the code for the day and post it here.

Before I get to the first official Coder Coach Code for the Day, let me tell you this: these codes will be ICD-10 codes because I've been living and breathing ICD-10 lately and it's given me the opportunity to find some very interesting codes.  It's also led me to some very inspiring philosophical questions - you know, something along the line of why do we have an ICD-9-CM code for vomiting alone (787.03) and not one for vomiting in a group?  Couldn't a code for vomiting in a group come in very handy for St. Patrick's Day, New Years Eve, and countless 21st birthday parties?!  I know, I know, the code is really differentiating between vomiting with and without nausea.  But this gives you an idea of what goes through my mind as I read some code descriptions.  Besides, coding can be so boring, so why not make it fun and amusing?

So now that we've established my unique brand of coder humor, you need to know that there is no method to my madness regarding the selection of the code for the day.  I am not going to start at the beginning of ICD-10.  I am not going to randomly open an ICD-10-CM or ICD-10-PCS code book and pick a code.  The code (or codes) I choose will most likely be something inspired by a daily event or something I come across in my work and find incredibly interesting.  For example, last Tuesday, I worked a 16 hour day.  I started to come up with one code on the following day, but upon further reflection, I decided two would more accurately and completely report my condition (and we coders are about accuracy and completeness!):

• Z72.820, Sleep deprivation 
• F15.20, Other stimulant dependence [caffeine)] uncomplicated

I suppose coders who know ICD-10 will tell me I sequenced it wrong since the substance abuse code should go first followed by the Z code (which is ICD-10's equivalent of an ICD-9 V code), but I decided since one led to the other - that is, the sleep deprivation led to an excessive need for coffee on Wednesday, the sequencing was appropriate in my case.  And these codes will not be reported on a claim to CMS on behalf because 1) I didn't see a health care professional and 2) I don't have Medicare (how old do you think I am anyway?!). 

What I find interesting here is the new subcategory of Z codes for sleep problems - the one that jumped out at me was poor sleep hygiene.  I first found the set of codes while doing a documentation review for a sleep lab clinic in preparation for ICD-10.  I admit.  I had to google it.  What is sleep hygiene?  If I drool in my sleep, does that mean I have poor sleep hygiene?  Turns out it means a host of other things like irregular sleeping habits or leaving the lights on when you're trying to sleep.  Come to think of it, I think my head hit the pillow around 3am Wednesday morning and I was up again around 7am, so perhaps I should have added Z72.821, Inadequate sleep hygiene to the list above as well.

And really, I am not addicted to caffeine.  Anymore.  But I sure felt like I needed it on Wednesday.  The uncomplicated part could probably be argued by my boyfriend since I was pretty much exhausted for the rest of the week.  But really, the ICD-10 code is more referring to medical complications of drug dependence.  Think I'm kidding about the classification of caffeine as a drug you can be addicted to?  That part is no joke.  When you look up addiction, it takes you to dependence and caffeine is listed right there in the index!

This the kind of thing you'll have to look forward to in my Code for the Day posts.  Consider it my way of shaking my pom pons and getting you excited about ICD-10 again - since we still don't have a final rule yet.  I'm still plowing ahead and getting ready and I think the least I can do is make a little fun for my readers.

If you found a code that tickles your funny bone, send it to me at codercoach@gmail.com!

What's New With ICD-10?

You may be wondering where I've been. Well, I've largely been off Twitter and the Coder Coach Facebook page and I obviously haven't been blogging. But like many other current coding professionals I've been very busy. For those of us preparing for ICD-10, it's being done in addition to our daily jobs. For me, that means switching hats between performing ICD-10 documentation reviews (I've coded over 300 records in ICD-10 so far!), writing training material, and presenting training to coders on ICD-9-CM and CPT subjects. I continue to chair the ICD-10 Task Force for the state of Colorado, although I now have a co-chair thanks to a very motivated and active task force.

Last month we received "the announcement" that the ICD-10 implementation is going to be pushed back. But so far, it's still a guessing game on when that will be. I have folks from organizations and students from schools asking me what this means. And you may also be wondering, what has changed with the announcement that ICD-10 is going to be delayed? Well, as of this writing, I can tell you in a two words: absolutely nothing.

Most experts agree that the thing to do now is stay the course and keep preparing for ICD-10 as if it will be implemented on October 1, 2013. Most speculations are that there will be a one-year delay, which means 1 more year for training and testing. Some providers here in Colorado are planning for dual coding of claims if they have extra time. Most agree that we are already so far behind as an industry that a short delay at this time would mean a sigh of relief for most providers. But let's be clear about one thing: this additional time is only a good thing if we keep pace with our current ICD-10 preparations.

The American Medical Association's efforts to stop ICD-10 have been well documented as have concerns from other associations alerting CMS that we need more time for testing and implementation. I would encourage everyone to become educated on the history of ICD-10 in the United States, as it dates back to 1993. That's right, nearly 20 years ago. That means that when I took my first coding class in 1993, we were talking about the impending conversion to ICD-10. Testing of the system started in 1997. In a letter to Secretary Kathleen Sebelius, the National Committee of Vital Health Statistics presented a timeline of ICD-10 in the US. The insurance industry has reportedly already spent billions of dollars in the ICD-10 transition process. So for every argument you hear against adoption of ICD-10, there is an argument for it.

Will There Ever be an ICD-10?
If you're wondering if ICD-10 is really going to be a go, here's my two cents. Yes. It will be a go. There are various government health care initiatives on the horizon that require it. Every other industrialized country besides us uses it and we need it to compare data with them. In order to make sense of SNOMED-CT codes, which are used in electronic health records, we need ICD-10.

What About ICD-11?
ICD-11 is slated for release by the World Health Organization in 2015. Once published, the US will adapt the clinical modification (CM) we utilize here in the States. That conversion will take years. Most experts agree that we can't wait for ICD-11.

Should You Become a Coder Right Now?
If you're wondering if now is a good time to enter the coding profession, I still offer a resounding yes. Learn the basics now - there is so much to learn in ICD-9 that will carry over to ICD-10. Take the time to learn about disease process and procedures because, as I recently told someone, ICD-10 is going to separate the men from the boys. After coding ICD-10 almost full time for the last couple of months there are days when I want to cry and when it seems that no amount of googling will answer my question about a procedure. If you are the analytical type who isn't afraid of research, this could be the profession for you.

In addition, many organizations are taking advantage of this possible delay by implementing computer assisted coding (CAC) systems. When I first saw a CAC about 10 years ago I was not impressed. But I looked at a couple at the AHIMA conference in October and they have really come a long way. I was looking at the systems different from most of my colleagues. I was specifically looking at them as a training tool for fresh faced coders who are right out of school and I see a lot of potential there for newbies. So get your foot in the door now and start learning!

What's new with ICD-10? I say nothing. We're still moving forward as if October 1, 2013 is our deadline. Because one thing is for sure. If we - that is, an industry prone to procrastination - are given another delay, we don't want to be caught unprepared. And I don't think CMS will be gracious about allowing further deadline changes.

I Bet You're Wondering What I've Been Up To...

Oh wow, has this been a crazy fall! Up until this year, "Rocktober" was a term we used in Colorado whenever our beloved Colorado Rockies made it to the playoffs. This year Rocktober took on a whole new meaning for me. And while it was a great month, I am so happy to say it's over and now I can concentrate on the less busy holiday season. Yes, October was that busy!

As you saw from some of my blog postings, I kicked off October in true coder fashion by attending the AHIMA Convention and Exhibit in Salt Lake City. What a great opportunity to learn the newest, latest, and greatest from some of the nation's best HIM and coding minds and get in some serious networking as well. This year was particularly busy at convention as I was honored with an AHIMA Triumph Award for mentoring, mainly due to my efforts with the Coder Coach blog and some of the networking and educational events I've hosted over the last couple of years. It was an incredible honor and to help commemorate the occasion, I took my personal and professional mentor - my mom (pictured here with me) - along with me. It's hard to tell who was more excited about my award!

This was also the first year that I was chosen to speak at the national level. I presented an outpatient track at the coding meeting on the overlap between coding and charging in the cardiac cath lab. As if that wasn't enough, I just couldn't say no when another Triumph Award recipient and fellow Coloradan, Dee Johnson, asked me to be a part of the Student Academy. Dee is a student at Arapahoe Community College, my alma mater here in Colorado, and was a key planner in this year's Student Academy. The academy is a free event for students in AHIMA programs at the convention each year. I was a part of the mentor lightning rounds where several established professionals spent a few minutes with each group of students to share our experience and answer questions. All of that and Apolo Anton Ohno too! The Olympic athlete and Dancing with the Stars champion was our closing keynote speaker and he had an inspiring message about giving it your all.

Once I was back at home, there was no rest for the weary as I delved into not one, not two, but FIVE client trainings. For those who aren't aware, training sessions take about 4-5 times as long to prepare as they do to present but the work is always well worth it when I get to training. That is my favorite part of my job because it combines two of my great talents: coding and talking! My last week of training involved three training sessions, work-related road travel, a snow storm, and, of course, that inevitable sinus infection as a result of a crazy month. I would love to tell you that following that last training on October 28 I headed out for happy hour with my friends, but truth be told, I had a nice evening vegging out on the sofa and catching up on all my DVR'd shows!

So here we are in November and I'm trying to wrap a few things up before the holidays. Last weekend I met with a fantastic group of super coder geeks (birds of a feather!) who were so amazing to not only spend their own time coding some records in ICD-10, but to also give up a Saturday to come together and talk about the results. This is a project that the Colorado Health Information Management Association's (CHIMA) ICD-10 Task Force has undertaken to assess documentation readiness for ICD-10. I have had a great year chairing this task force and working with an enthusiastic group who is making great strides as a clearinghouse for ICD-10 information in the state of Colorado.

Last week I was interviewed by ICD-10 Watch, a terrific resource for anyone interested in ICD-10. We specifically chatted about the fantastic opportunities that await coders as we transition to ICD-10. The interview is recounted in the blog posting How ICD-10 can create opportunities for medical coders.

Whew, I think I need to take a nap now that I've recounted the previous month's events! I plan to get back to the ICD-10-PCS series in another week or two, but bear with me - November's calendar is starting to fill up, so it might be 2012 before I can give the series the attention it deserves. In the meantime, I hope everyone has a terrific holiday season.

ICD-11 is Coming...

That was a key message this morning in a presentation by Dr. T.B. Ustun from the World Health Organization (WHO) at the AHIMA convention general session. Yes we are still on track for implementing ICD-10 in the US on October 1, 2013 (just under 2 years for those of you keeping score at home) but while the US works to catch up with the rest of the industrialized countries who have been using ICD-10 for several years, the WHO is already looking at ICD-11. Does that worry you as a current or future coding professional?

I know a few current students are concerned about learning ICD-9 in school and then trying to get a position as a coder using ICD-10. Should they go ahead and start working now using ICD-9 or wait until 2013 and use ICD-10? Well, from my perspective, the critical thinking skills that make a coder a good coder will not change even though the codes themselves do. And yes, ICD-10 - especially from the procedure perspective (ICD-10-PCS) requires more anatomy and physiology, medical terminology, and procedural knowledge but you can learn that over the next couple of years as you code in ICD-9-CM. Plus, most employers have plans for training their workforce and getting a coding position now gives you a starting point for learning ICD-10.

So go ahead and go for that open coding position now. Do whatever you can to position yourself for the transition and get ready for a career of continuing education. Not only will you need to book continuing education units to maintain any coding credentials you have, the codes change at least annually, so change is constant. And be ready to adopt ICD-11....

From the Green Room at AHIMA

Today is a big day as the AHIMA conference General Session kicks off. At the moment, I'm hanging out in the green room backstage with the Triumph Award recipients. I am very honored this year to have been awarded one of the Triumph Awards for mentoring for my work with the Coder Coach. This is a new experience for me - to be backstage and a part of the presentation. And I'm very excited to have one of my mentors (and favorite people in general) with me to celebrate - my mother, who is also a retired RHIT. I will post more pictures later, but here's a super secret green room photo!

Networking at the AHIMA Student Academy

Today I spent a couple of hours at the AHIMA Student Academy as a mentor for their lightning rounds. AHIMA's Student Academy is a one day free event for students in AHIMA based programs. Several mentors including myself were asked to spend time giving advice on certification, career planning, volunteering, and networking - you know, a lot of the things I blog about through the Coder Coach!

It was great to network with the future of our profession and see so many people excited about their future careers.

So here's a little recap from the mentors' advice to students today:
-Follow your bliss - if a particular area interests you, pursue it, even if the pay isn't great. If you go for a job that you're passionate about, the money will follow.
-Certification is a must if you want to be taken seriously and want to excel.
-Network, network, network. Communicating and networking with current pros is key.
-Volunteer. You would be amazed at the doors that will open for you when you volunteer either with coding/HIM departments or with your local coding/HIM associations.
-Stay positive and avoid being defensive. People pick up on attitude quickly. If you are looking for a job and have been for a long time it's easy to let bitterness creep into your conversations. So be careful to keep positive and hopeful.

More from AHIMA in Salt Lake City coming soon!

Live from AHIMA Salt Lake City!

Today marks the first day of AHIMA's Coding Community meeting, which kicks off the annual convention. This year we're meeting in Salt Lake City and as usual, I am like a little kid in a candy store here. Every year AHIMA is a bigger deal to me since it's a chance to reconnect with former coworkers and meet new professional contacts. And since this year my focus is heavily on workforce development, I thought it would be fun to send out reports from my experiences through my blog and maybe you can join me at AHIMA next year.

So here goes...

This afternoon I will be presenting on coding and charging in the cardiac cath lab and I'm sure my audience will find it the best presentation at this conference (tongue in cheek!). But for me, my favorite presentation happened this morning with the national coding update. Every year we have the coding gurus from AHIMA, the American Hospital Association and the AMA talking about upcoming coding changes for ICD-9-CM and CPT. I love getting that firsthand information and feel a little like I'm getting some super secret information - along with the other 500 people in the room.

More for SLC as the conference progresses... Stay tuned!