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…)

This time last year the Journal surveyed members on their top coding challenges. High on the list were staffing shortages, with respondents citing trouble finding qualified coders. This year the Journal again informally polled a group of members, this time focusing on the state of coder staffing.

The long-standing coding shortages weren’t magically solved in the past year. Only 60 percent of respondents to this year’s poll reported that their departments are completely staffed for all approved positions. About a quarter (23 percent) have coding positions that have been open for more than 3 months. The balance reported positions that have been open 3 months or less. (more…)

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.”