Word from Washington: Sights Set on ICD-10-CM/PCS

463105901Now that the new year is well underway, most of us have probably settled on our resolutions and are working hard to achieve them. Hopefully ICD-10-CM/PCS preparation is high on the list of priorities for healthcare providers.

At its meeting on September 23 to September 24, 2014, the ICD-10 Coordination and Maintenance Committee addressed a number of new proposed ICD-10-CM and ICD-10-PCS codes and other code modifications, as well as ICD-10-CM/PCS implementation preparation updates from the Centers for Medicare and Medicaid Services (CMS). Highlights of this meeting, as well as AHIMA’s response to a few of the code proposals, are described below. For additional highlights from this meeting, including discussion on the “meaningful use” EHR Incentive Program, see the Word from Washington column in the Journal‘s February issue.


ICD-10-PCS Proposed Modifications

Although AHIMA generally supports many of CMS’ PCS proposals, the association opposes the following changes:

  • Minimally-invasive cardiac valve surgery. AHIMA opposes creating any unique codes prior to a clinical consensus on the definition of “minimally invasive.”
  • Face transplants. AHIMA opposes a single code for partial face transplant, as one code would not capture the variability in the specific procedure performed.
  • Administration of Ceftazidime-Avibactam. AHIMA opposes the creation of a unique code and instead supports use of a drug terminology, such as the National Drug Codes, to capture this information.

AHIMA recommends delaying implementation of all new codes approved at the September Coordination and Maintenance Committee meeting until October 1, 2016, after the code set freeze ends. Any new codes or code changes implemented on October 1, 2015 could complicate the transition process.


ICD-10-CM Proposed Modifications

Nearly all of the new ICD-10-CM codes presented at the September ICD-10 Coordination and Maintenance Committee meeting were proposed by physician groups, such as medical specialty societies. As with ICD-10-PCS, AHIMA recommends delaying implementation of all new ICD-10-CM codes approved at the September Coordination and Maintenance Committee meeting until October 1, 2016.

Highlights of the association’s comments on the proposed ICD-10-CM changes include the following:

  • National Institutes of Health Stroke Scale (NIHSS). Given that the NIHSS score is a predictor of outcomes, several industry organizations requested the creation of new ICD-10-CM codes to capture the NIHSS score. AHIMA supports the creation of these codes, and also recommends that guidelines on the appropriate use of the stroke scale codes be added to the ICD-10-CM Official Guidelines for Coding and Reporting.
  • Mastocytosis and certain other mast cell disorders. AHIMA is concerned about proposed expansions that would include significant information not typically documented in the medical record.
  • Encounter for observation and evaluation for newborn for suspected diseases and conditions ruled out. AHIMA supports the creation of new category Z05. However, it supports a revised instructional note for codes P00-P04 indicating that these codes shouldn’t be reported for suspected conditions that have been ruled out.
  • Sarcopenia. AHIMA opposes the creation of a new code without the input of relevant medical specialty societies.
  • Indexing for ‘use of alcohol.’ AHIMA opposes indexing this information to code Z72.89, Other problems related to lifestyle. Merely using alcohol is not a problem. If the alcohol use causes problems related to lifestyle or other issues, coders should assign the appropriate code based on documentation.

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