The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention have proposed freezing both the ICD-9-CM and ICD-10-CM/PCS code sets prior to ICD-10-CM/PCS implementation. The proposal was announced at the March 9 meeting of the ICD-9-CM Coordination and Maintenance Committee, which maintains the code sets in the US.

Freezing the code sets will allow organizations to focus on the system change without managing code updates at the same time. The implementation deadline for ICD-10-CM/PCS is October 1, 2013.

Under the proposal, the last regular update of ICD-9-CM and ICD-10-CM/PCS prior to ICD-10 implementation would occur October 1, 2011.

Limited updates to incorporate new diseases and new technology would be permitted on October 1, 2012, and October 1, 2013.

Regular updates of ICD-10-CM/PCS would resume in 2014.

The proposal is similar to recommendations AHIMA published last November, although AHIMA recommended that only urgent updates be considered in 2012 and 2013.

CMS and CDC are soliciting comments on the code set freeze proposal. Comments may be e-mailed to Pat Brooks at CMS and Donna Pickett at CDC. The proposal may be published in the IPPS rule this spring, although that was not certain at the time of the meeting. A final decision is expect no later than this summer.

Kathy DeVault, RHIA, CCS, provides an overview of the 2010 CPT coding updates in the February 2010 issue. DeVault is manager of practice resources at AHIMA.

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Changes to CPT codes for 2010 include 219 additions, 141 revisions, and 63 deletions. This article highlights some of the more notable changes; a comprehensive list can be found in appendix B of the 2010 CPT coding book. The changes took effect January 1.

Resequencing

The most notable change, and a new concept to CPT, is resequencing. Resequencing allows related concepts to be placed in a numerical sequence regardless of the availability of numbers for sequential numerical placement. It supports the integrity of the data inherent in codes and descriptors by eliminating the disruption of the code history caused by renumbering. The resequencing will extend the current five-digit numbering scheme while improving the growth and flexibility of CPT content and the use of CPT codes in electronic products.

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Organizations can find examples of complexity in applied mappings and a glossary of terms in the online version of the March practice brief  “Putting the ICD-10-CM/PCS GEMs into Practice.”

According to the practice brief, “A single one-size fits all map might seem like a reasonable solution; however, such a map would mean the code sets were so similar that there would be no point in transitioning to ICD-10-CM/PCS. The correlation of specificity and meaning between the two code sets is not that simple.”

Appendix A, “Examples of Complexity in Applied Mappings,” outlines examples of complexity in applied mappings, which illustrate why a one-size-fits-all map is not possible.

Appendix B, “Glossary of Terms,”  outlines  definitions for the terms used in the brief.

Confusion and disagreement about the proper use of consultation codes has persisted since their development in 1990. Now the Centers for Medicare and Medicaid Services has a solution: cancel them.

CMS finalized its decision to eliminate the use of all consultation codes with the exception of telehealth consultation G codes. CMS will not reimburse for consultation codes submitted on Medicare claims beginning January 1, 2010. Physicians should cease submitting consultation codes on their Medicare claims and employ the appropriate visit code in their place.

CMS published the change in the Medicare physician fee schedule updates for 2010. Read more in the latest issue of AHIMA CodeWrite e-newsletter.

One step to help the industry make the transition to ICD-10-CM/PCS will be temporarily suspending updates to the code set as the October 2013 deadline gets closer.

Freezing both the current ICD-9-CM and the new ICD-10-CM/PCS code sets will save organizations further cost and complexity by enabling them to focus on the system change without simultaneously managing code updates. The Centers for Medicare and Medicaid Services has been receiving recommendations on whether to freeze the code sets and, if so, for how long.

In a recently released statement, AHIMA recommends that:

• The final ICD-9-CM update should be FY 2012 (beginning October 2011, in conjunction with the federal government’s fiscal year).
• No updates should be made to ICD-10-CM/PCS for FY 2013 or FY 2014 (i.e., beginning October 2012).
• Updates to ICD-10-CM/PCS should resume in FY 2015 (October 2014). (more…)

Organizations looking to begin the transition to ICD-10-CM/PCS can find project management resources in the October practice brief “Transitioning ICD-10-CM/PCS Data Management Processes.” Web-only resources include:

• Sample project communication plan
• Sample project plan
• Sample project progress report
• Sample issues log

The online version also includes a list of communication aids that organizations may use in the transition to ICD-10-CM/PCS and a contact form for the major stakeholders leading the ICD-10-CM/PCS implementation.

As the practice brief notes, planning for the transition to ICD-10-CM/PCS is a multifaceted effort. Defining the organization’s data management plan will facilitate a smooth transition to ICD-10-CM/PCS and optimize its greater specificity.

Like the rest of us, MS-DRGs have to transition to ICD-10-CM/PCS. Their conversion is off to a good start, with a preliminary version already available.

The conversion project offered an early test of the General Equivalence Mappings and provides organizations with a process for converting their own applications to ICD-10-CM/PCS.

Rhonda Butler and Janice Bonazelli, senior clinical analysts at 3M Health Information Systems, offer an overview of the conversion in this early look into the upcoming November/December issue of the Journal.

Medicare expects its fee-for-service systems will be tested and fully operational on the X12 5010 standard by January 1, 2011. That’s bad news for health plans that may have been hoping the big payer would run late and create an industry-wide delay.

The upgrade to the HIPAA transaction 5010 standard was announced in tandem with the January 2009 final rule mandating the upgrade to ICD-10-CM and -PCS. The 5010 standard is necessary to support ICD-10.

According to a timeline published in the final rule, by the end of 2010 covered entities should have completed internal testing and can send and receive compliant transactions (“level 1″ testing). In January 2011 they begin testing with trading partners and move into production (level 2). The compliance date for all covered entities is January 2012, one year in advance of the ICD-10 deadline.

Read more in the current issue of AHIMA ICD-TEN newsletter.

In the September print issue, Lou Ann Schraffenberger, MBA, RHIA, CCS, CCS-P, FAHIMA, reviewed the ICD-9-CM diagnosis code changes for FY 2010. She offers an extended version of the article “New ICD-9-CM Diagnosis Codes for FY 2010” in the AHIMA Body of Knowledge. She also highlights ICD-9-CM procedure code changes in a special, Web-only article.

Revisions to both code sets go into effect October 1. The 2009 addenda with all the changes to the ICD-9-CM tabular and alphabetic index (volumes 1 and 2) are located on the National Center for Health Statistics Web site. The 2009 addenda with all changes to the ICD-9-CM procedure tabular and alphabetic index (volume 3) are located on the Centers for Medicare and Medicaid Services Web site.

Strike when the ink is wet. 

That is the motto of the clinical documentation improvement specialists (CDSs) at Shands Hospital, based in Jacksonville, FL. They routinely “shadow” physicians as part of their clinical documentation improvement program (CDIP), seeking clarification in real-time and making recommendations for how physicians can fine-tune documentation to enable more accurate coding.

CDIPs are popular in healthcare facilities looking to capture better documentation. Physicians know the documentation they need for treatment and continuity of care, but CDSs are anticipating additional detail that will later produce more complete and accurate coding. A more thorough description can enhance reimbursement and more correctly reflect the facility’s quality of care indicators.

Officials at Shands and other facilities using this technique say they get more out of their CDIPs when documentation specialists are present with physicians in real-time, not querying later via e-mail or paper forms left in the chart. But some challenges, like time management and physician buy-in, also come with the successes. (more…)