AHIMA representatives to the World Health Organization participate in the development and maintenance of classifications that create consistent data worldwide. In the July print edition, Sue Bowman and Rita Scichilone describe three work groups on which they serve. This online version of the story includes additional information on each group’s specific charges.

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The World Health Organization maintains the Family of International Classifications, a suite of classification products that may be used in an integrated fashion to compare health information internationally and nationally. The International Classification of Diseases is published and maintained by WHO-FIC. ICD-10 is the current edition, and ICD-11 is in development.

Internationally endorsed classifications such as those in WHO-FIC facilitate the storage, retrieval, analysis, and interpretation of data; they enable the comparison of data within populations over time and between populations at the same point in time. Their use results in the compilation of internationally consistent data. (more…)

The Centers for Medicare and Medicaid Services (CMS) hopes to start Recovery Audit Contractor (RAC) automated reviews in late June and July, with more complex reviews rolling out later, according to a May 29 Health Leaders report. CMS expects to begin certain complex reviews like coding and DRG validation this fall. Medical necessity complex reviews will not begin until early 2010.

“The automated reviews are less burdensome on the provider, because there’s no request for medical records,” said Marie Casey, deputy director of the Division of Recovery Audit Operations at CMS, in the news item. “They’re also easier for the RACs to manage.”

The delay for medical necessity auditing is due to the complexity of the reviews. “We’re delaying because it’s more difficult,” Casey said. “We are really trying to ensure that when there is a difference of opinion [on the medical necessity determination of the case], the RAC clearly documents their rationale.”

The delay will also help CMS roll out an issue review team, a group comprised of members from various agency divisions that will look at policy questions, such as whether the RACs have been correct in the interpretation of coding guidelines. These teams will look comprehensively at the questions before approving new issues for RAC review, according to Kathleen Wallace, a CMS representative who spoke at a May 28 Region D RAC training session held in Helena, MT.

When record requests do come, they will start sporadically but eventually fall into a pattern, at least in Region D, said HealthDataInsights president and CEO Andrea Denko, during the Helena training session.

“Present on admission indicators, hospital-acquired conditions, serious reportable events, and ‘wrong’ surgical events are each hot topics,” write the authors of a “Coding Notes” column in this month’s print issue. “However, they also can be a hot topic together, because a number of these reporting requirements are interrelated.”

Jane Cook, Cheryl D’Amato, Gail Garrett, Becky Ruhnau-Gee, Linda Hyde, and Natalie Novak sort out the relationship of POA, HACs, SREs, and “wrong” surgical site policies in “Understanding National Coverage Policies.”

For the past two days the National Committee on Vital and Health Statistics has been hearing testimony from the industry on what constitutes the “meaningful use” of health IT. Defining the term is no small matter, as it triggers $17 billion in Medicare and Medicaid incentives for the adoption of electronic health record systems. The incentives are part of the American Recovery and Reinvestment Act, or ARRA.

Under the provision, an eligible professional can receive $44,000 in incentives beginning in 2011. After several years, that carrot turns into a stick. In 2015 eligible providers who are not meaningful EHR users will begin receiving reduced reimbursement. Reductions will reach 97 percent of the fee schedule in 2017.

Speaking at Tuesday’s hearings, newly named national coordinator for health IT David Blumenthal noted that defining meaningful use would also affect EHR product certification, funding, and training.

AHIMA offered comments during the hearings, advising that the elements of meaningful use improve the coordination of care, promote health information exchange, and improve the capture and use of data for secondary purposes such as quality and public health reporting. (more…)

The ICD-10-CM/PCS final rule requires a major transition in academic programs as well as in the field. Institutions currently teaching ICD-9-CM in baccalaureate, associate, and certificate programs must transition their curricula to ICD-10-CM/PCS in coordination with the industry’s transition to the new coding systems. Educators will be among the first in the country who need to learn ICD-10-CM/PCS.

The April practice brief “Transitioning to ICD-10-CM/PCS—An Academic Timeline” outlines how and when HIM academic programs should begin integrating ICD-10-CM/PCS education into their curriculum. The article lays out the academic transition into three phases: preparation, hybrid, and full implementation. The countdown to integrating ICD-10-CM/PCS begins on August 1, 2010, when educators should start expanding curriculum content on courses affected by ICD-10-CM/PCS changes. (more…)

There won’t be a delay on the ICD-10 final rules, according to the Centers for Medicare and Medicaid Services. The final rule for implementing ICD-10-CM and ICD-10-PCS will go into effect March 17.

The policies in the final rule are considered to be officially adopted on that date. The regulations for the HIPAA electronic transaction standards—published the same day in a separate rule—will go into effect at the same time. The HIPAA transactions must be updated to accommodate the use of the ICD-10-CM and ICD-10-PCS code sets. 

Before becoming official, the rules had been subject to a regulatory review by the new presidential administration, as well as a 60-day hold for Congressional review required by HIPAA. The final rules were published January 16, 2009.

ICD-10-CM/PCS must be implemented by October 1, 2013; the HIPAA electronic transaction standards must be operational by January 2012 and January 2013.

For more on the preparation for the ICD-10 transition, visit AHIMA’s ICD-10 Web site for analysis, tools, training, education, resources, and information.

AHIMA mailed the first issue of ICD-TEN today, a free e-newsletter on preparing for the transition to ICD-10-CM and ICD-10-PCS. You can subscribe with just an e-mail address.

Each issue contains news, practical coding information, the steps for implementation, educational resources, and more. The newsletter comes out monthly.

AHIMA also offers a wide range of ICD-10 information on its Web site.

AHIMA has posted a 13-page analysis of the final rule on the implementation of ICD-10-CM and ICD-10-PCS. The summary is a good overview of the lengthier final rules published in the Federal Register.

The final rule was published January 16. It designates ICD-10-CM and ICD-10-PCS as medical data code sets under HIPAA, replacing the 30-year-old ICD-9-CM set. There is a single compliance date of October 1, 2013.

In the final rule, the Department of Health and Human Services states that the greater detail and granularity of ICD-10-CM/PCS will enhance the ability to measure quality outcomes and provide more precision for value-based purchased initiatives such as the hospital-acquired condition payment policy. (more…)

The Centers for Medicare and Medicaid Services issued a final rule for implementation of ICD-10-CM and -PCS this morning, with an implementation date of October 1, 2013.

The new code set will replace the 30-year-old ICD-9-CM set. CMS had originally set a 2011 deadline in its notice of proposed rule making last year. The final rule summarizes the varied industry response that proposal received.

A second rule sets implementation dates for HIPAA transaction standards necessary to support ICD-10. Upgrade to the X12 version 5010 standard has a deadline of January 2012. Implementation of NCPDP version D.0 is required in January 2013.

HHS offers a fact sheet summarizing both rules.

(This story was updated 1/16/2009 with links to the published rules.)

Anita Majerowicz, MS, RHIA, is director of clinical coding and reimbursement at AHIMA. She offers this look at the 2009 CPT updates in the upcoming February print issue of the Journal.

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Changes to CPT codes for 2009 include 293 additions, 133 revisions, and 92 deletions. This article highlights some of the more notable changes; a comprehensive list can be found in appendix B of the 2009 CPT code manual. The changes took effect January 1.

E/M Codes

Numerous changes were made to the pediatric E/M codes, including newborn care services, delivery and birthing room attendance and resuscitation services, pediatric critical care patient transport, and inpatient neonatal and pediatric critical care services. Coding professionals should read the extensive revisions to the instructional notes, as many codes were renumbered for 2009.

A new section titled “Newborn Care Services” was added to report the physician services provided to newborns in a variety of settings from birth through the first 28 days of life. These services are reported using codes 99460–99463, replacing deleted codes 99431–99435. They include the maternal and fetal history, newborn history and physical examination, ordering of diagnostic tests and treatments, discussions with the family, and documentation in the patient’s health record.

(more…)