New ICD-10 Code Updates: Ask the Right Questions to Get the Right Code
- Non-pressure ulcers now have 3 new code subcategories to include those ulcers that are down to the muscle or bone but do not have necrosis and for those ulcers that have tendon/ligaments showing. The clinician should always document the severity of the non-pressure ulcer in terms of skin breakdown, fatty layer, muscle exposed, muscle exposed with necrosis, bone exposed, bone exposed with necrosis, or other appropriate descriptive terms (tendon/ligament, hard eschar, slough obscuring wound bed, etc.).
- C Diff is now being captured as being recurrent or not stated as being recurrent. Recurrence is defined by complete resolution of C diff symptoms while on appropriate therapy, followed by subsequent return of diarrhea and other symptoms after treatment has been stopped. Recurrence usually occurs within one week after treatment stops but may happen up to 8 weeks later. The physician would need to confirm whether C diff is recurrent or not.
- Types of myocardial infarctions now play a role in determining the appropriate ICD-10 code. Type 1 is the most common MI which is associated with ischemia and due to primary coronary even. Type 2 MI is due to imbalance in supply and demand of oxygen. Type 3, (which we wouldn’t see in home health), is sudden cardiac death, including cardiac arrest. Type 4 MIs are associated with percutaneous coronary intervention while type 5 MIs are associated with a CABG procedure.
- Secondary pulmonary hypertension diagnosis code has been further detailed to describe what the condition is that is causing the secondary pulmonary hypertension, including left heart disease, lung disease, etc.
- Lumbar stenosis should be classified with or without neurogenic claudication. Neurogenic claudication is leg pain with walking. The physician must confirm neurogenic claudication for it to be coded.
- Bowel obstructions can now be captured as complete or incomplete/partial. Complete bowel obstructions would need surgery to correct while incomplete/partial bowel obstructions can be sent home for it to resolve. The coding specialists need to know whether a bowel obstruction is resolved upon discharge from the hospital. Resolved conditions cannot be coded in home health except for in OASIS items M1011 and M1017 when they reflect the patient’s recent history.
- New coding guidelines state that if a patient’s visual category is not documented then coding specialists can only code unqualified visual loss. It would be beneficial to query the physician to determine patient’s visual category to be more specific with coding of low vision and blindness. Also, the laterality of the low vision and blindness is necessary in retrieving the most specific code.
- Query the provider for specifics that are not included in the physician documentation prior to completing assessment.
- Specify sites and laterality of wounds
- Specify etiology of wounds (surgical, traumatic, diabetic, arterial, venous, etc)
- Query the provider for late effects of CVA if there are none documented in clinical paperwork
- List the type of MI the patient experienced
- Always document patient’s smoking/tobacco use status (current or history of, and what product)
- Don’t list diagnoses on the plan of care that are not actively being addressed or impacting the plan of care
- If there are diagnoses listed on the plan of care that will likely impact it, but no direct interventions regarding those conditions are present, document how they will impact the POC
- Document if patient’s substance disorders are in remission per physician documentation or query to determine this.
- Document the specific type of heart failure a patient has been diagnosed with
- Specify which type of diabetes a patient has been diagnosed with, and what, if any, manifestations are present.
OASIS C2 and Active Diagnoses
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What is Medical Coding? - Coding and OASIS Review Services
With the implementation of ICD-10 have we seen an increase in patient outcomes?
ICD-10Since the implementation of ICD-10 by the Centers for Medicare & Medicaid Services (CMS) on October 1, 2015 have we seen an increase in the shear number of procedural and diagnosis codes. Currently, there are 68,000 ICD-10-CM codes and 87,000 ICD-10-PCS codes compared to 14,000 ICD-9-CM codes and 4,000 ICD-9-PCS codes available (ACR, 2012). Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc. (AAPR, 2017). But, have we seen an increase in patient outcomes?
Quality Outcomes MatterLuckily for our clients, Select Data had been preparing for the ICD-10 increase of codes months prior to the implementation. In addition, our professional medical coders & billers have an average of 8+ years of Coding experience. Furthermore, the Select Data Coding and OASIS Review service improved revenue for our clients on average of 6% and a reported 40% reduction rate in hospital readmissions.
Our ProcessIt is not enough to review the entire integrated OASIS assessment for completeness and conguency. We query the agency clinician on incongruencies between the physician orders, clinical record and patient's condition. Our process changes the behavior because we engage the clinician when suggesting changes. So that you can focus on patient outcomes.
Our MottoDriving outcomes guided by compassion, values and a sense of stewardship. Because patients are more than a number. Each deserves their own portrait. At Select Data, we code with an artist's brush, not a rubber stamp. Coding and OASIS Assessment review services today!
October 1, 2015, began the live implementation of ICD-10 across the healthcare continuum of care. After years of planning and delays, the greater expansion of codes and more sophisticated architecture presents the ability to have increased specificity of detail of disease and condition capturing patient acuity with improved detail and accuracy… finally. It has been a 20 year journey. Errors from incorrect coding are now very real, as 69,000 new ICD-10-CM codes vs 16,000 ICD-9-CM codes enter the playing field. Some agencies mistakenly believed the General Equivalency Mapping (GEMs) from ICD-9-CM to ICD-10-CM would be a direct crosswalk only to learn later that the crosswalk was meant to be a user tool for assisting coders to make their coding decisions based upon patient care needs and care complexity. It should be noted that some physicians were given a one-year leeway, but be careful. That July 2015, CMS regulatory guidance stated that for one year after Oct. 1, 2015, Medicare would not deny Part B claims from physicians or other practitioners “based solely on the specificity of the ICD-10 diagnosis code,” as long as providers use valid codes “from the right family.” First of all, note this applies to Part B only and also, what does “from the right family mean?” The “family of codes” is the same as the ICD-10 three-character category states the CMS FAQ, but there is more involved. One aspect noted quickly is that with the increased specificity and complexity of the codes, coding specialists must spend additional time abstracting information from the clinical record. A lack of adequate clinical documentation can result in delays as the coder must confirm the inconsistent, inadequate, or incongruent information. Are your coding specialists proficient on what documentation is needed for each diagnosis? For example: If the diagnosis is COPD, was it an acute exacerbation? Decompensated?. Is there an acute respiratory infection? If yes, what organism? And of course there are 6 other items to clarify. For ALL of your ICD-10-CM Coding needs and to educate your clinicians as to specific documentation needed to code ICD-10-CM diagnoses, contact Select Data at 1-800-332-3555
With the implementation of ICD-10 scheduled to take place October 1, 2015 the question looms, has your agency properly prepared? CMS has stated that ICD-10 “may result in significant impact to cash flow. This may require the need for reserve funds or lines of credit to offset cash flow challenges.” CMS anticipates a 10% revenue hit due to coding specificity errors. ICD-10 requires that all coders be aware of an additional 53,000 codes. These codes are alphanumeric, may be up to 7 characters in length, are HIPAA compliant, and have a different structure with far more specificity. CMS already predicts that 10% of all claims will be rejected within the first 90 days of ICD-10 implementation due solely to errors in coding specificity. You need specialists to assist you in preparing for ICD-10 CM
- Your agency should have already established an ICD-10 team as well as completed a GAP Analysis by the end of 2013.
- A complete audit of your agency should be completed within the first few months of the New Year.
- Clinician documentation will need to be clear, in-depth, and specific to comply with ICD-10 standards.