CODING CORNER… NOVEMBER 2016

By Betsy Priest, Coding Manager

As of Oct 1, 2016, updates to the ICD-10 codes were put in to effect.  Some areas that may be of interest to you are:

  • Code assignment/Clinical criteria – A diagnosis will be added when a provider states that a condition exists. It is no longer dependent on showing the clinical criteria that brings the Physician to that diagnosis.
  • Laterality – The laterality of any injury needs to be documented to assign a code. If one side is treated and no longer is an issue, then the documentation needs to change from bilateral to the side that is now affected (cataracts are a good example).
  • Pathologic Fractures – 7th character A is for when the patient is receiving active treatment – not whether the provider has seen the patient before. 7th character D is for after the patient has completed active treatment.
  • Long Term use of Insulin – This needs to be documented so that it can be coded.

In addition to the above bullets, some diagnoses have been added, now requiring a 4th, 5th and 6th digit. It is important to look at any and all code lists that you use to ensure that they include all of the most up to date codes.

If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 or Betsyp@pracfir

CODING CORNER….FOCUS ON ICD-10 NOVEMBER 2015

By Tom Maher, President and CEO

ICD-10 HAS ARRIVED!!

By now, ICD-10 is likely fully operational in your practices.  Practicefirst’s offers you the following tips while using the new code set:

  1. BE SPECIFIC-the layers in ICD-10 are deep. Accurate reporting is a CMS expectation.
    1. Tell us if a motor vehicle accident happened in a car, suv, pickup truck or van
    2. Cellulitis vs. Abscess
      1. ICD-10 gives different codes for each whereas they were combined in ICD-10.
      2. Do NOT use the term CELLULITIS & ABSCESS in your documentation interchangeably.
    3. Sprain vs. Strain:
      1. ICD-10 classifies these as different.
      2. Specify STRAIN vs. SPRAIN
    4. FRACTURES:
      1. More specificity, please! See the fracture section of your ICD-10 manuals for elaboration.  This is a highly expanded section containing much detail.

Diagnosis Coding Tips:

  • Always code each health care encounter to the level of certainty known for that encounter. All providers are expected to code correctly and have sufficient documentation to support the codes selected.
  • Medicare did not require external cause reporting in ICD-9-CM and does not require external cause reporting in ICD-10-CM. Similar to ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless you are subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, you are not required to report ICD-10-CM codes found in Chapter 20 of the ICD-10-CM, External Causes of Morbidity.
  • In both ICD-9-CM and ICD-10-CM, sign/symptom and unspecified codes have acceptable, even necessary, uses. While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter.
  • If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example, a diagnosis of pneumonia has been determined but the specific type has not been determined). In fact, you should report unspecified codes when such codes most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It is inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing to determine a more specific code.

If you are not currently a coding client of Practicefirst, call us to find out how you can become one!

If you would like more information about how we can tailor our services to meet your needs, please contact Practicefirst at 716.834.1193 or tom@pracfirst.com

CODING CORNER…FOCUS ON ICD-10…OCTOBER 2015

The wait is over! ICD-10 has arrived!

Practicefirst’s is pleased to announce that all coders coding beyond 10/1/2015 are ICD-10 proficient!

REMINDERS TO ALL CLIENTS:

  1. EXERCISE CAUTION when choosing ICD-10 codes from your EMR. The lists are VERY detailed and it is very important the chosen code contains ALL characters and that it does not conflict with any other documentation in the patient’s record.
  2. UNDERSTAND CODING GUIDELINES AND SEQUENCING RULES!! Every practice should have a current ICD-10 book and/or subscribe to an online service such as encoderpro.com.
  3. Be sure your SUPERBILL’s dated 10/1/2015 (date of service) and forward indicate ICD-10 codes otherwise they will be returned to you.
  4. Ask these questions before assigning an ICD-10 code:
    • Presence or absence of complication = potential combination code?
    • Any Manifestations?
    • Is there a causal relationship?
    • Have I indicated the episode of care (initial, subsequent, late effect) where appropriate (e.g. injuries?)
    • Have I defined subsequent fracture care appropriately (healing status)?

 

Last minute TIP….ASTHMA:

Have you classified the patient’s asthma properly? Please see the guidelines below

Stages of asthma

National Asthma Education & Prevention Program Guidelines

CLASSIFICATION SEVERITY OF SYMPTOMS NIGHT SYMPTOMS FEV
Mild Intermittent Symptoms < 2X week asymptomatic Symptoms < or = 2X monthly >80%
Mild Persistent Symptoms > 2X daily to < 1X daily Symptoms > or + 2X monthly >80%

>Variability 20-30%

Moderate Persistent Daily symptoms

Daily use of beta 2 agonist

Symptoms > 1X week 60-80%
Severe Persistent Continual symptoms

Limited physical activity

Frequent <60%

WHY CHANGE? Because

  1. ICD-9CM is outdated and has obsolete terminology
  1. ICD-10 provides more specific data, better reflects current medical practices, contains updated medical terminology and has improved accuracy in the definition/classification of diseases.
  1. Expanded data capture for reimbursement and data reporting!! Do not miss this!
  1. Continued reporting of ICD-10 codes that lack specificity may contribute to a downward adjustment (Value Based Modifier) and may impact any PQRS reporting your practice is currently doing or would like to do in the future.
  1. Quality is being measured!

If you are not currently a coding client of Practicefirst, call us to find out how you can become one!

If you would like more information about how we can tailor our services to meet your needs, please contact Practicefirst at 716.834.1193 or tom@pracfirst.com

 

 

CODING CORNER REMINDER…ICD-10

By Lisa Kropp, Coding and Credentialing Manager

Last Call for ICD-10

  • It is predicted that the ICD-10 transition will make a significant impact on cash flow due to delayed payment and claims adjudication. Although testing occurs, the industry cannot be certain that claims will process as correct and timely as they do now.  Therefore, it is our recommendation that every practice ensure cash reserves and lines of credit are available to keep your practice operational for 3-4 months in the event there is a disruption in cash flow due to delayed payments and/or denials.
  • Billing Clients: Practicefirst will expect all dates of service 10/1/2015 forward to contain ICD10 diagnosis codes on your billing sheets.  Any claims submitted with ICD-9 codes will be returned to the office for correction.
  • Coding Clients: Practicefirst will continue to be a resource for questions. Training has occurred either in person or via telephone.  If you have not received your session, you must contact PF at 716.834.1191.

&nbs

CODING CORNER…FOCUS ON ICD-10 – SEPTEMBER 2015

By Lisa Kropp, Coding and Crredentialing Manager

What to Expect in September:

  • Coding Clients: PF will continue to be a resource for questions.  Training has occurred either in person or via telephone.  If you have not received your session, you must contact PF at 716.834.1191.
  • Billing Clients: PF will expect all dates of service 10/1/2015 forward to contain ICD10 diagnosis codes on your billing sheets.

The BEST Resource at this stage:

  1. CMS’s Road to 10
    1. http://www.roadto10.org/Aligning Clinical Documentation and ICD-10:

DIABETES MELLITUS, HYPOGLYCEMIA AND HYPERGLYCEMIA….Increased Specificity

The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system.

When documenting diabetes, include the following:

TYPE: e.g. Type 1 or Type 2 disease, drug or chemical induced, due to underlying condition, gestational

  1. COMPLICATIONS: What (if any) other body systems are affected by the diabetes condition? e.g. Foot ulcer related to diabetes
  2. TREATMENT: Is the patient on insulin?
  • A second important change is the concept of “hypoglycemia” and “hyperglycemia.”
  • It is now possible to document and code for these conditions without using “diabetes mellitus.”
  • You can also specify if the condition is due to a procedure or other cause.
  • The final important change is that the concept of “secondary diabetes mellitus” is no longer used; instead, there are specific secondary options.

ICD-10 DIABETES CODE EXAMPLES:

E08.65            Diabetes mellitus due to underlying condition with hyperglycemia

E09.01             Drug or chemical induced diabetes mellitus with hyperosmolarity with coma

R73.9              Transient post-procedural hyperglycemia

R79.9              Hyperglycemia, unspecified

INJURIES….Increased Specificity

ICD-9 used separate “E codes” to record external causes of injury. ICD-10 better incorporates these codes and expands sections on poisonings and toxins.

When documenting INJURIES, include the following:

  • Episode of Care:                     Initial, subsequent, sequelae (late effect)
  • Injury Site:                              Be as specific as possible
  • Etiology:                                 How was the injury sustained?
  • Place of Occurrence:               e.g. School, work, etc.

Initial Encounters may also require, where appropriate:

  • Intent:                                     e.g. Unintentional or accidental, self-harm, etc.
  • Status                                     e.g. Civilian, military, etc.

Injury CODE EXAMPLE:

Example: A left knee strain injury that occurred on a private recreational playground when a child landed incorrectly from a trampoline:

  • Injury: S86.812A, Strain of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
  • External cause: W09.8xxA, Fall on or from other playground equipment, initial encounter
  • Place of Occurrence: Y92.838, Other recreation area as the place of occurrence of the external cause
  • Activity: Y93.44, Activities involving rhythmic movement, trampoline jumping   

For additional examples, by specialty, please visit: https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.htm

If you would like more information about how we can tailor our services to meet your needs, please contact Practicefirst at 716.834.1191 or tom@pracfirst.com<

CODING CORNER…FOCUS ON ICD-10 – AUGUST 2015

 By Lisa Kropp, Coding and Credentialing Manager
Practicefirst’s Implementation Assistance Plan

  • On or around June 1, 2015, your practice should have received a report containing the 20+ most commonly billed ICD-9’s by your practice in 2014.  We included the ICD-10 mappings that may be applicable.  The purpose of this is to assist you in identifying the impact to your practice.  In many cases, there are direct mappings (ICD-9 to ICD-10).  In other cases, where more complex conditions & manifestations are present, there are NOT direct mappings and you will have to investigate these further.
  • If you did not receive a report, please contact Lisa Kropp 716.348.3904 or lisak@pracfirst.com

What to Expect in August:

  • Coding Clients: Scheduling of telephone or on site session to provide specialty specific ICD-10 information.
  • Billing Clients: Contact by a member of the billing team to discuss your practice’s readiness.

New VIDEO ICD-10 resources: https://www.youtube.com/watch?v=_pLwSh09sGo&list=PLw4-yeXdND_pd1Jp_TZmjJb_Wm-ncFQtG
Available Articles:

  1. Road to 10
  2. Introduction to ICD-10 Coding
  3. ICD-10 Coding and Diabetes
  4. ICD-10 Coding Basics & More
  5. ICD-10 and Clinical Documentation

ICD-10 Resource List

  1. http://www.cms.gov/Medicare/Coding/ICD10/
    1. Contains videos for small practices, resource flyers as well as a clinical documentation video.
  2. https://www.aapc.com/icd-10/
    1. Robust resources for practices of all sizes including options to purchase physician training, ICD-10 manuals
  3. https://www.aapc.com/icd-10/crosswalks/
    A.  Laminated ICD-10 crosswalk cards available for purchase ($24.95-specialty
    specific)

Below are suggested links you should begin using now as ICD-10 nears:

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfirst.com<

CODING CORNER JULY 2015….FOCUS ON ICD-10

By Lisa Kropp, Coding and Credentialing Manager

Practicefirst’s Implementation Assistance Plan

  • On or around June 1, 2015, your practice should have received a report containing the 20+ most commonly billed ICD-9’s by your practice in 2014.  We included the ICD-10 mappings that may be applicable.  The purpose of this is to assist you in identifying the impact to your practice.  In many cases, there are direct mappings (ICD-9 to ICD-10).  In other cases, where more complex conditions & manifestations are present, there are NOT direct mappings and you will have to investigate these further.
  • If you did not receive a report, please contact Lisa Kropp 716.348.3904 or lisak@pracfirst.com

What to Expect This Month:

  • Direct contact by Practicefirst to gain more information regarding your implementation readiness.
  • More ICD-10 fun facts!
  • ICD-10 resources

Need ICD-10 Practice?

CMS has launched the following site to provide interactive case studies with questions & answers (e.g. how to assign an ICD-10 for a patient with strep pharyngitis & tonsillitis).

Cases are updated weekly!

Visit: http://www.roadto10.org/ics/

ICD-10 Differences:

  • Injuries are grouped by anatomical site rather than by type of injury
  • Category restructuring and code reorganization occur in a number of ICD-10 chapters, resulting in the classification of certain diseases and disorders that are different from ICD-9
  • Certain diseases are reclassified to different chapters or sections to reflect current medical knowledge
  • New code definitions (for example, definition of AMI is now 4 weeks rather than 8 weeks)
  • The codes corresponding to ICD-9 “V” codes (Factors influencing health status & contact w/health services) and E codes (External causes of injury and poisoning) are incorporated into the main classification (in ICD-9, they were separated into supplementary classifications

ICD-10 Resource List

  1. http://www.cms.gov/Medicare/Coding/ICD10/
    1. Contains videos for small practices, resource flyers as well as a clinical documentation video.
    2. https://www.aapc.com/icd-10/
      1. Robust resources for practices of all sizes including options to purchase physician training, ICD-10 manuals
      2. https://www.aapc.com/icd-10/crosswalks/
        1. Laminated ICD-10 crosswalk cards available for purchase ($24.95-specialty specific)

Below are suggested links you should begin using now as ICD-10 nears:

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfir

CODING CORNER JUNE 2015…

ICD-10 CORNER

STRUCTURE COMPARISON:

  • ICD-9-CM Diagnoses Codes:

                Are 3–5 digits;
                The first digit is alpha (E or V) or numeric (alpha characters are not case 
                sensitive);
                Digits 2–5 are numeric; and
                A decimal is used after the third character.

  •  ICD-10-CM Diagnosis Codes:

                Are 3–7 digits;
               Digit 1 is alpha;
               Digit 2 is numeric;
               Digits 3–7 are alpha or numeric (alpha characters are not case sensitive); and
                A decimal is used after the third character.

 NEW FEATURES IN ICD-10-cm WITH EXAMPLES

1) Laterality (Left, Right, Bilateral)

                C50.511 – Malignant neoplasm of lower-outer quadrant of RIGHT female breast;

                H16.013 – Central corneal ulcer, BILATERAL; and

                L89.012 – Pressure ulcer of RIGHT elbow, stage II.

2) Combination Codes For Certain Conditions and Common Associated Symptoms and Manifestations

                K57.21 – Diverticulitis of large intestine WITH perforation and abscess with
                bleeding;

                E11.341 – Type 2 diabetes mellitus WITH severe nonproliferative
                diabetic retinopathy with macular edema; and

                I25.110 – Atherosclerotic heart disease of native coronary artery WITH unstable
                angina pectoris.

3) Combination Codes for Poisonings and Their Associated External Cause

                T42.3x2S – Poisoning by barbiturates, intentional self-harm, sequela.

4) Obstetric Codes Identify Trimester Instead of Episode of Care

                O26.02 – Excessive weight gain in pregnancy, SECOND TRIMESTER.

5) Character “x” is Used as a 5th Character Placeholder in Certain 6 Character Codes to Allow for Future Expansion and to Fill in Other Empty Characters (For Example, Character 5 and/or 6) When a Code That is Less Than 6 Characters in Length Requires a 7th Character

Examples:

                T46.1x5A – Adverse effect of calcium-channel blockers, initial encounter; and

                T15.02xD – Foreign body in cornea, left eye, subsequent encounter.      

6) Two Types of Excludes Notes

  • Ø Excludes 1 – Indicates that the code excluded should never be used with the code where the note is located (do not report both codes).

Example: Q03 – Congenital hydrocephalus.

  • Excludes 1: Acquired hydrocephalus (G91.-).
  • Excludes 2 – Indicates that the condition excluded is not part of the condition represented by the code but a patient may have both conditions at the same time, in which case both codes may be assigned together (both codes can be reported to capture both conditions).

               Example: L27.2 – Dermatitis due to ingested food. Excludes 2: Dermatitis due to
               food in contact with skin (L23.6, L24.6, L25.4)

7) Inclusion of Clinical Concepts That Do Not Exist in ICD-9-CM (For Example, Underdosing, Blood Type, Blood Alcohol Level)

                T45.526D – Underdosing of antithrombotic drugs, subsequent encounter;

                Z67.40 – Type O blood, Rh positive; and

                Y90.6 – Blood alcohol level of 120 – 199 mg/100 ml.

8) A Number of Codes Are Significantly Expanded (For Example, Injuries, Diabetes, Substance Abuse, Postoperative Complications)

                E10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy;

                F10.182 – Alcohol abuse with alcohol-induced sleep disorder; and

                T82.02xA – Displacement of heart valve prosthesis, initial encounter.

9) Codes for Postoperative Complications Are Expanded and a Distinction is Made Between Intraoperative Complications and Postprocedural Disorders

                Examples:

                D78.01 – Intraoperative hemorrhage and hematoma of spleen complicating a
                procedure on the spleen; and

                D78.21 – Postprocedural hemorrhage and hematoma of spleen following a
                procedure on the spleen.

 ICD-10 Resource List

 

  1. http://www.cms.gov/Medicare/Coding/ICD10/
    1. Contains videos for small practices, resource flyers as well as a clinical documentation video.
    2. https://www.aapc.com/icd-10/
      1. Robust resources for practices of all sizes including options to purchase physician training, ICD-10 manuals
      2. https://www.aapc.com/icd-10/crosswalks/  
        1. Laminated ICD-10 crosswalk cards available for purchase ($24.95-specialty specific)

 Below are suggested links you should begin using now as ICD-10 nears:

 It is predicted that the ICD-10 transition will make a significant impact on cash flow due to delayed payment and claims adjudication.  Although testing occurs, the industry cannot be certain that claims will process as correct and timely as they do now. 

Therefore, it is our recommendation that every practice reserve at least enough money to cover everything required to keep your practice operational for 3-4 months in the event there is a disruption in cash flow due to delayed payments and/or denials.

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfirst.com

CODING CORNER – FEBRUARY 2014

By Lisa Kropp, Coding and Credentialing Manager

2014 DELETED HCPCS CODES:

Below, you will find a listing of all the 2014 deleted HCPCS codes.  Please see your HCPCS books for revisions or additions.  This information will be available to you, upon request.

*Highlights:  G8553 (Prescription(s) generated and transmitted via a qualified ERX system) is a DELETED HCPCS code for 2014.  With implementation of Meaningful Use Stage 2 came the end in reporting for the eRX incentive.

Code Description Deleted Date Cross-Reference
C1204 Technetium Tc 99m tilmanocept, diagnostic, up to 0.5 millicuries 1/1/2014 To report, see A9520
C9130 Injection, immune globulin (Bivigam), 500 mg 1/1/2014 To report, see J1556
C9131 Injection, ado-trastuzumab emtansine, 1 mg 1/1/2014 To report, see J9354
C9292 Injection, pertuzumab, 10 mg 1/1/2014 To report, see J9306
C9294 Injection, taliglucerase alfa, 10 units 1/1/2014 To report, see J3060
C9295 Injection, carfilzomib, 1 mg 1/1/2014 To report, see J9047-
C9296 Injection, ziv-aflibercept, 1 mg 1/1/2014 To report, see J9400
C9297 Injection, omacetaxine mepesuccinate, 0.01 mg 1/1/2014 To report, see J9262
C9298 Injection, ocriplasmin, 0.125 mg 1/1/2014 To report, see J7316
C9736 Laparoscopy, surgical, radiofrequency ablations of uterine fibroid(s), including intraoperative guidance and monitoring, when performed 1/1/2014
G0275 Renal angiography, nonselective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins (ostia) of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation (List separately in addition to primary procedure) 1/1/2014
G8459 Clinician documented that patient is receiving antiviral treatment for hepatitis C 1/1/2014
G8462 Clinician documented that patient is not an eligible candidate for counseling regarding contraception prior to antiviral treatment; patient not receiving antiviral treatment for hepatitis C 1/1/2014
G8463 Patient receiving antiviral treatment for hepatitis C documented 1/1/2014
G8553 Prescription(s) generated and transmitted via a qualified ERX system 1/1/2014
G8556 Referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation 1/1/2014
G8557 Patient is not eligible for the referral for otologic evaluation measure 1/1/2014
G8558 Not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given 1/1/2014
G8588 Most recent systolic blood pressure < 140 mm Hg 1/1/2014
G8589 Most recent systolic blood pressure >= 140 mm Hg 1/1/2014
G8590 Most recent diastolic blood pressure < 90 mm Hg 1/1/2014
G8591 Most recent diastolic blood pressure >= 90 mm Hg 1/1/2014
G8592 No documentation of blood pressure measurement, reason not given 1/1/2014
G8596 LDL-C was not performed 1/1/2014
G8603 Score on the spoken language comprehension functional communication measure at discharge was higher than at admission 1/1/2014
G8604 Score on the spoken language comprehension functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8605 Patient treated for spoken language comprehension but not scored on the spoken language comprehension functional communication measure either at admission or at discharge 1/1/2014
G8606 Score on the attention functional communication measure at discharge was higher than at admission 1/1/2014
G8607 Score on the attention functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8608 Patient treated for attention but not scored on the attention functional communication measure either at admission or at discharge 1/1/2014
G8609 Score on the memory functional communication measure at discharge was higher than at admission 1/1/2014
G8610 Score on the memory functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8611 Patient treated for memory but not scored on the memory functional communication measure either at admission or at discharge 1/1/2014
G8612 Score on the motor speech functional communication measure at discharge was higher than at admission 1/1/2014
G8613 Score on the motor speech functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8614 Patient treated for motor speech but not scored on the motor speech comprehension functional communication measure either at admission or at discharge 1/1/2014
G8615 Score on the reading functional communication measure at discharge was higher than at admission 1/1/2014
G8616 Score on the reading functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8617 Patient treated for reading but not scored on the reading functional communication measure either at admission or at discharge 1/1/2014
G8618 Score on the spoken language expression functional communication measure at discharge was higher than at admission 1/1/2014
G8619 Score on the spoken language expression functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8620 Patient treated for spoken language expression but not scored on the spoken language expression functional communication measure either at admission or at discharge 1/1/2014
G8621 Score on the writing functional communication measure at discharge was higher than at admission 1/1/2014
G8622 Score on the writing functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8623 Patient treated for writing but not scored on the writing functional communication measure either at admission or at discharge 1/1/2014
G8624 Score on the swallowing functional communication measure at discharge was higher than at admission 1/1/2014
G8625 Score on the swallowing functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8626 Patient treated for swallowing but not scored on the swallowing functional communication measure at admission or at discharge 1/1/2014
G8642 The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5) (a) of the Social Security Act 1/1/2014
G8643 The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption for the application of the payment adjustment under section 1848(a)(5) (a) of the Social Security Act 1/1/2014
G8644 Eligible professional does not have prescribing privileges 1/1/2014
G8741 Patient not treated for spoken language comprehension disorder 1/1/2014
G8742 Patient not treated for attention disorder 1/1/2014
G8743 Patient not treated for memory disorder 1/1/2014
G8744 Patient not treated for motor speech disorder 1/1/2014
G8745 Patient not treated for reading disorder 1/1/2014
G8746 Patient not treated for spoken language expression disorder 1/1/2014
G8747 Patient not treated for writing disorder 1/1/2014
G8748 Patient not treated for swallowing disorder 1/1/2014
G8790 Most recent office visit systolic blood pressure < 130 mm Hg 1/1/2014
G8791 Most recent office visit systolic blood pressure, 130-139 mm Hg 1/1/2014
G8792 Most recent office visit systolic blood pressure >= 140 mm Hg 1/1/2014
G8793 Most recent office visit diastolic blood pressure, < 80 mm Hg 1/1/2014
G8794 Most recent office visit diastolic blood pressure, 80-89 mm Hg 1/1/2014
G8795 Most recent office visit diastolic blood pressure >= 90 mm Hg 1/1/2014
G8796 Blood pressure measurement not documented, reason not given 1/1/2014
G8799 Anticoagulation ordered 1/1/2014
G8800 Anticoagulation not ordered for reasons documented by clinician 1/1/2014
G8801 Anticoagulation was not ordered, reason not given 1/1/2014
G8812 Patient is not eligible for follow-up CTA, duplex, or MRA (e.g., patient death, failure to return for scheduled follow-up study which will meet numerator criteria has not yet occurred at the time of reporting) 1/1/2014
G8813 Follow-up CTA, duplex, or MRA of the abdomen and pelvis performed 1/1/2014
G8814 Follow-up CTA, duplex, or MRA of the abdomen and pelvis not performed 1/1/2014
G8827 Aneurysm minor diameter <= 5.5 cm for women 1/1/2014
G8835 Asymptomatic patient with no history of any transient ischemic attack or stroke in any carotid or vertebrobasilar territory 1/1/2014
G8919 Most recent systolic blood pressure < 140 mm Hg 1/1/2014
G8920 Most recent systolic blood pressure >= 140 mm Hg 1/1/2014
G8921 Most recent diastolic blood pressure < 90 mm Hg 1/1/2014
G8922 Most recent diastolic blood pressure >= 90 mm Hg 1/1/2014
G8945 Aneurysm minor diameter <= 6 cm for men 1/1/2014
G8954 Complete and appropriate patient data were reported to a qualified clinical database registry 1/1/2014
J0152 Injection, adenosine for diagnostic use, 30 mg (not to be used to report any adenosine phosphate compounds; instead use A9270) 1/1/2014 To report, see J0151
J0718 Injection, certolizumab pegol, 1 mg 1/1/2014 To report, see J0717
J1440 Injection, filgrastim (G-CSF), 300 mcg 1/1/2014 To report, see J1442
J1441 Injection, filgrastim (G-CSF), 480 mcg 1/1/2014 To report, see J1442
J3487 Injection, zoledronic acid (Zometa), 1 mg 1/1/2014 To report, see J3489
J3488 Injection, zoledronic acid (Reclast), 1 mg 1/1/2014 To report, see J3489
J9002 Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg 1/1/2014 To report, see Q2050
L0430 Spinal orthotic, anterior-posterior-lateral control, with interface material, custom fitted (DeWall Posture Protector only) 1/1/2014
Q0090 Levonorgestrel-releasing intrauterine contraceptive system, (Skyla), 13.5 mg 1/1/2014 To report, see J7301
Q0165 Prochlorperazine maleate, 10 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0168 Dronabinol, 5 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0170 Promethazine HCl, 25 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0171 Chlorpromazine HCl, 10 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0172 Chlorpromazine HCl, 25 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0176 Perphenazine, 8 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen 1/1/2014
Q0178 Hydroxyzine pamoate, 50 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q2027 Injection, Sculptra, 0.1 ml 1/1/2014 To report, see Q2028
Q2033 Influenza vaccine, recombinant hemagglutinin antigens, for intramuscular use (Flublok) 1/1/2014 To report, see
Q2051 Injection, zoledronic acid, not otherwise specified, 1 mg 1/1/2014 To report, see J3489
Q3025 Injection, interferon beta-1a, 11 mcg for intramuscular use 1/1/2014 To report, see Q3027
Q3026 Injection, interferon beta-1a, 11 mcg for subcutaneous use 1/1/2014 To report, see Q2038
S3625 Maternal serum triple marker screen including alpha-fetoprotein (AFP), estriol, and human chorionic gonadotropin (HCG) 1/1/2014
S3626 Maternal serum quadruple marker screen including alpha-fetoprotein (AFP), estriol, human chorionic gonadotropin hCG) and inhibin A 1/1/2014
S3833 Complete APC gene sequence analysis for susceptibility to familial adenomatous polyposis (FAP) and attenuated fap 1/1/2014
S3834 Single-mutation analysis (in individual with a known APC mutation in the family) for susceptibility to familial adenomatous polyposis (FAP) and attenuated FAP 1/1/2014

 

ICD-10 READINESS

Practicefirst would like to provide you with an update regarding our plans to be ready for ICD-10.

With regards to our Coding Clients, it is Practicefirst’s policy to employ Certified Professional Coders to code your documentation.  We will ensure that all of our coders are ICD-10 trained and ready by the end of the 2nd Quarter of 2014.  Each coder will participate in an overview class of Anatomy & Physiology, formal training in ICD-10 guidelines/conventions and be required to pass AAPC’s ICD-10 proficiency exam.

Beginning in June 2014, Practicefirst will assist our non-Coding Clients in this transition by offering the following:

  • Reporting of the 20 most common ICD-9’s billed by your practice in 2013 with any direct ICD-10 mappings that may be applicable.  The purpose of this is to assist you in identifying the impact to your practice.  In many cases, there are direct mappings (ICD-9 to ICD-10).  In other cases, where more complex conditions & manifestations are present, there are NOT direct mappings and you will have to investigate these further.  These reports will be available to you beginning June 2014 or earlier upon request.
  • Assist in revising office fee slips/super-bills that list ICD-9 codes to make them ICD-10 ready as of 10/1/2014.

Below are suggested links you should begin using now as ICD-10 transition nears:

Helpful Hints/Tips regarding ICD-10:

  • ICD-10 CM specificity and detail have significantly expanded more than 68,000 codes.
  • ICD-10 uses 4-7 digit alpha-numeric codes instead of the 4-5 digit numeric codes used in ICD-9.
  • ICD-10 provides new tabulation lists.
  • ICD-10 transfers conditions among the classifications. It may be necessary to search for conditions in various sections.
  • ICD-10 utilizes “includes notes” and two types of “excludes notes”.

Advantages of ICD-10:

  • Introduction of codes with details on socioeconomic conditions, family relationships, ambulatory care conditions, problems related to lifestyle, and screening test results.
  • Introduction of new categories for post-procedural disorders.
  • Introduction of laterality (right, left, bilateral).
  • Creation of combination diagnostic codes with symptoms in order to reduce the number of codes needed to describe the condition.

Differences between ICD-9 & ICD-10

Feature

ICD-9-CM

ICD-10-CM

Min. # of digits/characters

3

3

Max. # of digits/characters

5

7

Number of chapters

17

21

Supplemental Classification

V codes & E Codes

Included in the classification

Laterality

No

Yes

Alphanumeric vs. Numeric

Numeric (except V & E codes)

All codes are alphanumeric

Excludes Notes

Yes

Excludes 1 & Excludes 2 Notes

Placeholders

No

“X” Serves as a dummy placeholder

Total # of codes

14,567

69,832

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfirst.com

 

PRACTICEFIRST CODING CORNER… AUGUST 2013

By Lisa Kropp

As we prepare for ICD-10-CM, Practicefirst will begin to provide tips & tools to help your practice transition to ICD10!

Benefits to ICD-10-CM

The new, up-to-date classification system will provide much better data needed to:•

  • Measure the quality, safety, and efficacy of care
  • Reduce the need for attachments to explain the patient’s condition
  • Design payment systems and process claims for reimbursement
  • Conduct research, epidemiological studies, and clinical trials
  • Set health policy
  • Support operational and strategic planning
  • Design health care delivery systems
  • Monitor resource utilization
  • Improve clinical, financial, and administrative performance
  • Prevent and detect health care fraud and abuse
  • Track public health and risks

Structure of ICD-10-CM

  • 3–7 digits;
  • Digit 1 is alpha; Digit 2 is numeric;
  • Digits 3–7 are alpha or numeric (alpha characters are not case sensitive); and
  • Decimal is used after third character.

Examples:

  1. A78 – Q fever;
  2. A69.21 – Meningitis due to Lyme disease; and
  3. S52.131A – Displaced fracture of neck of right radius, initial encounter for closed fracture.

Some New Features Found in ICD-10-CM

  1. Laterality (left, right, bilateral).
    1. Example:  C50.511 – Malignant neoplasm of lower-outer quadrant of right female breast
  2. Combination  Codes for certain conditions and common associated      symptoms and manifestations.
    1. Example: I25.110 – Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
  3. Combination  codes for poisonings and their associated external cause
    1. Example: T42.3x2S – Poisoning by barbiturates, intentional self-harm, sequel
  4. Obstetric codes identify trimester instead of episode of care
    1. Example: O26.02 – Excessive weight gain in pregnancy, second trimester
  5. Inclusion of clinical concepts that do not exist in ICD-9-CM (e.g., underdosing, blood type, blood alcohol level)
    1. Example: T45.526D – Underdosing of antithrombotic drugs, subsequent encounter
  6. Significantly expanded codes (e.g., injuries, diabetes, substance abuse, postoperative complications)
    1. Example: E10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy
    2. Example: F10.182 – Alcohol abuse with alcohol-induced sleep disorder
    3. Example: T82.02xA –  Displacement of heart valve prosthesis, initial encounter
  7. Codes for postoperative complications have been expanded and a distinction made between intraoperative complications and postprocedural disorders
    1. Example: D78.01 –  Intraoperative hemorrhage and hematoma of spleen complicating a procedure on the spleen
    2. Example: D78.21 – Postprocedural hemorrhage and hematoma of spleen following a procedure on the spleen.

 With 15 months until implementation, how are you preparing for ICD10? 

Contact Lisa at 716.348.3904 or lisak@pracfirst.com for more information on how our coding service can partner with your practice!

 

&nbs