EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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ICD-10 End-to-End Testing Week Shows Few Coding Errors

ICD-10 End-to-End Testing Week Shows Few Coding Errors | EHR and Health IT Consulting |

The Centers for Medicare & Medicaid Services (CMS) has released the results of its second effective Medicare FFS ICD-10 end-to-end testing week, which took place at the end of April.

Starting on April 27 and ending on May 1, clearinghouses, payers, billing agencies, and Medicare Fee-For-Service healthcare providers participated in CMS’ second successful ICD-10 end-to-end testing week.  Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor assisted the individual entities during this end-to-end testing.

CMS was able to work with a wide range of providers, submitters, and claim types, as it served the majority of volunteers. The second ICD-10 end-to-end testing week shows that the federal agency will be able to successfully accept claims when the ICD-10 implementation deadline rolls around.

With 875 participants in the ICD-10 end-to-end testing period, more than 23,000 test claims were submitted at the end of April. To see the results, click here. For the most part, participants were able to send their ICD-10 claims effectively and these were processed by Medicare billing systems without any major issues, CMS reports.

In fact, the results show that the acceptance rate was higher in April than the prior ICD-10 end-to-end testing rate from January. There were less errors related to diagnosis codes on the latest batch of end-to-end testing claims.

Out of any errors that did occur, the majority were unrelated to ICD-9 or ICD-10 diagnosis codes, CMS states. Providers who are still looking to participate in ICD-10 testing with the federal agency are encouraged to take part in acknowledgement testing, which can be performed at any time until the October 1 deadline.

The last ICD-10 end-to-end testing week with CMS will take place on July 20 to July 24, 2015. The ability to volunteer for this testing week has already ended. However, any participants from January or April are welcome to participate in the July ICD-10 end-to-end testing session again and are automatically eligible to test their systems an additional time.

It is vital to continue preparing for the ICD-10 transition over the coming months. Starting on October 1, any Medicare claims that do not use an ICD-10 diagnosis code will be invalid. The Medicare claims processing systems will be unable to accept ICD-9 codes after the deadline. The last day providers can submit ICD-9 codes to CMS is September 30, 2015. Dual coding will also not be accepted after this deadline.

While there is only four months left to prepare for the ICD-10 transition, providers can still take advantage of the many resources offered by the federal agency. The Road to 10 website, for instance, is a very useful tool in preparing for the ICD-10 implementation. CMS offers a variety of solutions for providers that are struggling to meet the ICD-10 transition deadline.

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Why Postponing ICD-10 Compliance Deadline Causes Setback

Why Postponing ICD-10 Compliance Deadline Causes Setback | EHR and Health IT Consulting |

Due to the legislative motions and prior delays to the ICD-10 compliance deadline, there are many healthcare organizations across the country that may not have made as much progress in preparing for the new medical coding set scheduled to begin on October 1, 2015. Even over the last few weeks, Representative Ted Poe (R-TX) introduced a bill into the House that called for putting an end to the ICD-10 transition altogether.

There has been a fair amount of speculation as to the need for the new medical codes throughout the political spectrum and the delays from the last two years have also brought many medical facilities to doubt whether the current ICD-10 compliance deadline will stand still.

The Journal of AHIMA reports that the ICD-10 delays have set back some organizations financially and led them to lose their momentum. Janis Leonard, RHIT, CCS, director of HIM at Albany Medical Center, told the source that any more pushback against the ICD-10 compliance deadline including a postponement would cause severe disruption and a monetary hit due to all of the funds the medical system invested in ICD-10 training among their staff.

Leonard said that if another delay to the ICD-10 compliance deadline were to occur, it “would be tough to re-engage.” The Albany Medical Center is working toward ensuring that ICD-10 conversion on October 1 is a go and that another postponement does not take place.

“Even the director of patient financial services sent a letter to our Congressmen recently again saying ‘do not delay,’ so we have our financial people as well as our coders engaged in that initiative,” Leonard told the news source.

Additionally, physicians at this particular organization have been supporting the transition toward ICD-10 coding from the beginning and are conducting ongoing documentation improvement initiatives.

Online modules are also being used to offer more training opportunities for medical coders to ensure they are prepared for the ICD-10 transition. In particular, more training information on medical terminology, pharmacology, anatomy, and physiology is being offered at Albany Medical Center to ensure coders will be able to handle the increased specificity of the ICD-10 diagnostic codes.

For more than a year, Leonard and her team focused on dual coding throughout the organization requiring coders to use both ICD-9 and ICD-10 for coding 10 percent of a workday’s cases. Additionally, weekly training sessions are offered where coders can use ICD-10 to code scenarios and review their work with an instructor.

When it comes to retaining a strong workforce of medical coders within a healthcare facility, Albany Medical Center focused on restructuring the career ladder and offering more incentives.

“When we did this, we based [the job positions] on new qualifications, credentials and experience, and we swaddled people into their new roles,” stated Leonard. “And more than half of coders received an increase in pay. We also provided a recruitment and a retention bonus that was paid out over two years with a work commitment of two years to incentivize our coders to stick around after ICD-10 [transition].”

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Four Ways Vendors Should Help the ICD-10 Transition

Four Ways Vendors Should Help the ICD-10 Transition | EHR and Health IT Consulting |

ICD-10 is a lightning rod for many of the slow-to-launch initiatives promising to modernize health technology. In recent weeks, I've read wearily about 10-year interoperability roadmaps from the Office of the National Coordinator for Health IT and belabored testimony over the Medical Electronic Data Technology Enhancement for Consumers' Health (MEDTECH) Act, which, if it succeeds, would end years of regulatory uncertainty from the FDA over medical devices. So I was disheartened—though not entirely surprised—to hear that ICD-10 may be deferred yet again if powerful physician lobbies like the AMA have their way in Washington, D.C.

Policy delays are yet another variable in an already unstable landscape of rising costs, declining reimbursements, and clinical consolidation threatening the viability of many practices. As a nurse and practice manager for a small pediatric practice, ICD-10 is a policy mandate I simply can't afford to ignore. Yes, it's true that many providers are struggling with technology that isn't equipped for an Oct. 1, 2015, transition date. I feel for those providers and don't want to see them punished for the shortcomings of their laggard vendors. But rather than willfully kicking the ICD-10 can down the road, I believe that providers must prepare for the inevitable by shopping now for services that can accommodate them.

Certainly, providers have their fair share of ICD-10 preparatory work to do on their own. It's in their best interest, however, to take a long, hard look at what their vendors are offering to make the ICD-10 shift easier. Here are a few areas to think about:

Your EHR Should Know You

ICD-10 is roundly forecast to be an administrative nightmare, but it doesn't have to be. When CMS implements ICD-10, the codes which all U.S. healthcare providers use to describe diagnoses and treatment will increase overnight by from 14,000 to over 68,000. Based on your current, most commonly documented diagnoses, your EHR should know which codes you're most likely to need on come October and surface them directly into your work flow. Scrolling through a full menu of thousands of possible codes is simply untenable. EHRs which are compatible with SNOMED — a physician-friendly classification system which maps to ICD-10 — will and should provide a shorthand "crosswalk" between ICD-9 and ICD-10 codes. These product updates should be available now, so that you and your staff can begin practicing.

Your Vendor Should Curate Knowledge Just for You

Is there a resource hub full of the information you need about ICD-10? Do you have best practice configurations, which will ensure that your EHR is configured with the right clinical content based on your needs? While your vendor can't code for you, it should provide training and practice exercises to teach best practices, identify potential hot spots in your work flow, and fix problem areas before they happen.

Your EHR Should Be Prepared For a Range of Payer Compliance

Your vendor should be well underway testing payers' and clearinghouses' system flexibility and readiness to manage both ICD-9 and ICD-10 codes, given that some will linger in a bilingual ICD-9/ICD-10 environment. Vendors should have the knowledge and payer roadmap to ensure that, whatever a payer's readiness or ICD-10 compliance status is, claims are being coded in a way that will not delay payment.

Your Vendor Should Guarantee Your Success

Unlike like meaningful use certification, government mandated for all EHRs, there is no comparable test for ICD-10. It's imperative that vendors guarantee their ability to create ICD-10-compliant claims and orders to HIPAA-covered entities. If it can't, it should pledge to waive your fee. Those vendors which recommend taking out a line of credit to ease revenue cycle hiccups aren't true partners.

In the ICD-10 echo chamber, providers shouldn't be paying attention to policymakers or pundits, but to their vendors. Good technology should insulate them from the revenue cycle disruption, delayed reimbursements, incorrect documentation, and clinical work flow issues ICD-10 threatens. EHRs, practice management services, analytics tools, clinical data exchange services, clearinghouses, and payers all need to be held to account for providers' success, failure, or pain along the way.

Vendors should be taking measure, and even competing with one another, to be among the most stalwart partners for physicians as they prepare for the seismic shift about to occur in clinical documentation. ICD-10 was never meant to be the province of the provider alone. The administrative burden is potentially mammoth. Does your vendor make the cut?

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Five Ways to Improve Coding at Your Medical Practice

Five Ways to Improve Coding at Your Medical Practice | EHR and Health IT Consulting |

Supplier discounts and staffing strategies are all well and good, but if you're looking to combat rising business costs in a meaningful way your best bet is effective coding. The procedural (CPT) and diagnostic (ICD-9) codes used to submit claims for reimbursement dictate how much and whether your providers get paid for the work they do. Thus, it's important to ensure your front- and back-office coding procedures are optimized for success.

That means taking steps to minimize denials, training to ensure you're not undercoding (a common problem), and readying your defenses to appeal rejected claims as needed. Such efforts can make or break your bottom line as the industry transitions to the more complex ICD-10 code set this fall.

Here's how billing and coding experts say practices can begin to code more accurately, and effectively:


According to the Medical Group Management Association (MGMA), better-performing practices report a claims denial rate of fewer than 5 percent. If your rate is higher, you must diagnose the problem. The most common reasons for rejected claims can be easily remedied by using software that flags errors and omissions before they go out the door, says Mary Pat Whaley, a certified professional coder and medical practice consultant with Manage My Practice in Durham, N.C. That includes missing information, (such as prior authorization or dates of service), insufficient documentation, coding errors related to the place of service, missing modifiers, and late submissions (each payer has its own deadline for filing claims).

Confusion over primary and secondary insurance may also contribute to kicked-back claims. Secondary payers will usually deny a claim that gets submitted without the primary payer's explanation of benefit information. You may also get denied for Medicare claims that do not include a signed Advanced Beneficiary Notice of Noncoverage, or a waiver of liability, which documents if the patient is willing to assume financial responsibility for services not covered by insurance.

Finally, Medicare and other payers frequently deny claims for services deemed "not medically necessary," either because the diagnosis does not align with the service or because it's covered only at certain frequencies. Such denials can be minimized by confirming insurance coverage and authorizations prior to each visit, says Whaley.

Some payers are more particular than others. It pays to identify those that deny reimbursement most often, so you can ensure those claims are clean the first time around. Indeed, the process of resubmitting is a drain on productivity. It costs most practices an average of $25 to $30 to resubmit a corrected claim, according to the MGMA.


By understanding the payment policies of their payers, front-desk staff can work more closely with patients to verify correct insurance information, explain the coverage policies of each plan, and submit claims accurately so the claim adjudicates correctly on the first submission, says Laura Palmer, director of professional development at the MGMA. Be knowledgeable and transparent about your policies and communicate them with your patients, she advises.


To benefit from better coding both before and after the switch to ICD-10, additional training is likely required. Perhaps the best way to help physicians improve their coding accuracy is to spend 10 minutes per month at physician meetings having them read a blinded note and coding it together with a certified coder, says Whaley. "Sometimes, physicians can also benefit from having a coder shadow and scribe the visit in addition to the physician's documentation to compare what each comes up with," she says. "You would be surprised how often a physician forgets to say, 'I reviewed the … lab results, X-rays, consultation report, etc.' It's something very simple, but, if it wasn't documented, it wasn't done." Such omissions result in undercoding, which leaves money on the table.


Consider, too, appointing a coding czar someone in-house who is trained to track and trend claims, says Rachel Mitchell, director of client services for Applied Medical Systems, a medical practice management firm in Durham, N.C. As they do for claims submissions, most payers have deadlines for resubmitting claims and filing appeals. Your coding point person should flag any claims that have not been paid as the filing deadline draws near, in case the payer never received it, or rejects it with no time left to resubmit.


In an era of shrinking reimbursement, practices must also be prepared to fight for what's rightfully theirs. It takes time and effort, but appeals often pay dividends. "Sometimes you have to go to bat when you keep getting things denied and you know it's wrong," says Whaley. "You may have to go a couple of levels up the chain of command to appeal and let the payer know they have something wrong in their system. Don't overlook the idea that the payer's system may be wrong."

Finally, Palmer adds that practices should review the list of payable diagnoses when their claim is denied for medical necessity or the service is not covered as part of the benefits. And always appeal in writing following the provider manual guidelines. "Be specific about why the claim should be paid," she says. "Submit supporting documentation. Track appeal results and timing."

If you haven't made proper coding a top priority for your practice, there's no time to lose. Indeed, successful coding is your single best defense against rising costs and shrinking reimbursement. Amid the pending conversion to ICD-10, it is also the best way to minimize disruption to your future income stream.

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Is your medical practice ready for dual coding?

Is your medical practice ready for dual coding? | EHR and Health IT Consulting |

Although medical practices cannot submit medical claims with ICD-10 codes until Oct. 1, there are a few good reasons to start using them sooner.

Those reasons support dual coding — when healthcare organizations assign ICD-10 and ICD-9 codes simultaneously to medical records.

The advantages include:

  • Medical coders can practice their ICD-10 knowledge
  • Clinical documentation deficiencies are exposed
  • Extensive internal and external testing can be done

This won't be cheap. Systems need to be designed for dual coding. And no matter what your vendor promises, dual coding is extra work. That means there will be a productivity loss. Maybe computer assisted coding (CAC) will help. Costs would be associated with:

  • Added time
  • Maintaining data collection
  • Analyzing data

Medical practices likely will need to assign extra coding resources. Extra medical coders can be hired to cover the dual coders. Healthcare providers need to do a cost-benefit analysis to determine if it's better to hire personnel or accept longer reimbursement cycles.

To get dual coding started, the Centers for Medicare and Medicaid Services (CMS) recommends answering the following questions:

  • Can the practice management system (PMS) or electronic health record (EHR) can capture ICD-9 codes and ICD-10 codes in the same patient encounter?
  • How much dual coding will be done?
    • How often?
    • How many encounters will be processed?
    • Are all diagnoses or just the top X percent of diagnoses are represented?
  • Will the ICD-10 codes be captured in the PMS or EHR system or on paper?

Before dual coding can start, a medical practice should:

  • Upgrade systems so they are ICD-10 compliant.
  • Make sure clinical documentation can support ICD-10 coding.
  • Start ICD-10 training and education.
  • Test with healthcare vendors or payers.

Then start practicing ICD-10 coding on real cases in the medical practice. Chances are that all this time and money will be investments that payoff after Oct. 1.

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No ICD-10 Delay Included in Latest Congressional Spending Bill |

No ICD-10 Delay Included in Latest Congressional Spending Bill | | EHR and Health IT Consulting |
Lawmakers have not included an ICD-10 delay in the 2015 Congressional spending omnibus.

Rumors of another ICD-10 delay appear to be greatly exaggerated – this time, at least.  Despite calls from the Medical Society of New York to include an additional two-year delay of ICD-10 in the $1 trillion omnibus spending bill that funds most Congressional activities through the majority of 2015, the legislation did not include an additional push-back of the health information management schema before lawmakers agreed on the final form of the bill.

While the legislation is certainly not the only opportunity for Congress to scupper the new code set, it does give providers some confidence going into the holidays that ICD-10 will continue as planned on October 1, 2015.  Uncertainty about the actual implementation date has left many healthcare organizations wondering about the point of spending time, effort, and money on upgrade systems and processes to be compliant with ICD-10 requirements.  Advocates of postponing ICD-10, or scrapping it all together, have tried to feed on these worries to build momentum for their cause.

“The onerous penalties tied to these mandates add to the hysteria that is running through physicians’ offices and is generating many early retirements,” states the Medical Society of New York in a letter addressed to Rep. John Boehner in November. “If every entity in the complex medical payment pyramid does not function perfectly on October 1, 2015 then physicians’ income goes to zero which is a steep price to pay for a new imperfect coding system.”

The American Medical Association, another staunch advocate of abandoning the ICD-10 mandate, has also raised arguments about the cost of implementation and the burden on physicians to comply with the new codes in addition to several other major healthcare reform initiatives.  Boasting that the AMA has held off ICD-10 for more than ten years, Dr. Robert Wah recently made a speech decrying ICD-10’s less common codes and urging providers to join his organization in opposition to the code set.

However, after the most recent delay from 2014 to 2015 shocked ICD-10 proponents and threw the industry into turmoil, many organizations just want to get it over with.  In another letter to Rep. Boehner, this time from a coalition of hospital and health systems, ICD-10 advocates note that repeated delays have been highly disruptive, costly, and frustrating for the healthcare community.

“The delay added billions of dollars in extra costs,” state the American Hospital Association, Premier Healthcare Alliance, and a number of health systems.  “Many of our members had to quickly reconfigure systems and processes that were prepared to use ICD-10 back to ICD-9.  A further delay would only add additional costs as existing investments would be further wasted and future costs would grow.

Wrangling over the true financial impact of implementation has added to the confusion among healthcare providers, who have been chronically lagging behind recommended timelines and guidelines for testing, education, and upgrades.  “The lack of progress by providers, in particular smaller ones, remains a cause for concern as we move toward the compliance deadline,” said Jim Daley, WEDI chairman and ICD-10 Workgroup co-chair in a September letter to HHS Secretary Sylvia Burwell. “Delaying compliance efforts reduces the time available for adequate testing, increasing the chances of unanticipated impacts to production. We urge the industry to accelerate implementation efforts in order to avoid disruption on Oct. 1, 2015.”

Lawmakers have until Thursday to vote through the omnibus spending bill if they are to avoid another paralyzing governmental shutdown.  While the most recent ICD-10 delay was slipped into the SGR reform bill without much notice, it does not appear that the divisive code set will make a cameo in this latest bipartisan agreement.

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Seven ICD-10 Transition Steps Medical Coders Should Follow

Seven ICD-10 Transition Steps Medical Coders Should Follow | EHR and Health IT Consulting |

With only four months to go until October 1, healthcare providers who are behind in their implementation of the new diagnostic coding set need to follow specific ICD-10 transition steps to ensure success by the compliance deadline. From integrating new systems and upgrading technological processes to training staff on the new codes and testing the systems, providers will need to be ready by October 1 to ensure their healthcare reimbursement and revenue remains stable.

According to the Journal of AHIMA, coders especially have had difficulty moving toward the new ICD-10 codes, as the amount of responsibilities on their shoulders has risen drastically. When it comes to training and learning about the necessary ICD-10 transition steps, the funding for such activities is low and few resources are being put toward it within the healthcare industry at large, the Journal ofAHIMA reports.

“The budget is the paramount issue,” Anita C. Archer, CPC, Director of Regulatory and Compliance at Hayes Management Consulting, told the news source. “Providing funding for [physician practice] coders to attend training is a problem. There is a much better infrastructure on the HIM side.”

MeShawn Foster, another consultant on ICD-10 implementation, stated, “Based on what I’ve heard, some coders have had to use their own money for training and even their own paid time off to attend the training. With hospital coders, the training is available, and they don’t need to pay out of pocket. Justifying the cost of some of these conferences is hard for the physician coder.”

As the ICD-10 transition deadline comes near and providers only have four months to finish their preparation, physician practice coders are experiencing significant challenges in ensuring they can properly utilize ICD-10 codes in time, especially when it comes to their training.

Another complex challenge that physician practice coders will need to overcome is the management of the practice’s superbill, which requires patient demographics to be evaluated. Additionally, EHR templates will need to be updated as part of the key ICD-10 transition steps.

The Journal of AHIMA offered seven practical tips for providers to follow as they adhere to some common ICD-10 transition steps on their path toward the October 1 deadline. These tips are:

1) Become an expert on using the ICD-10 diagnostic codes.

2) Start at the beginning and convert only the top 20 ICD-9 codes to the new ICD-10 codes. This will prevent coders from becoming overwhelmed.

3) Set aside one to two hours for practicing dual-coding per week.

4) Network with other physician practice coders to reduce the costs of ICD-10 training.

5) Find a physician leader in larger medical practices to advocate for ICD-10 training and preparation on the coders’ behalf.

6) Offer ideas and opinions on template design along with template updating.

7) Schedule weekly meetings in order to discuss any and all ICD-10 implementation issues.

By following the seven tips above, physician practice coders will be on their way toward successfully transitioning toward the ICD-10 code set.

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3 things to know about the Cutting Costly Codes Act of 2015

3 things to know about the Cutting Costly Codes Act of 2015 | EHR and Health IT Consulting |

As far as proposed legislation goes, the latest attempt to avoid ICD-10 cuts straight to the point.

Republican Texas Rep. Ted Poe reintroduced what was formerly the Cutting Costly Codes Act of 2013 at April’s end, and after a several day delay in posting the text to, it is publicly available.

Whether the Cutting Costly Codes Act of 2015 will meet the same fate as its predecessor and essentially die on the House floor remains to be seen, but at this point industry consensus suggests its passage is a long shot.

That said, here are three things to know now.

1.) The proposed bill “prohibits the Secretary of Health and Human Services from replacing ICD-9 with ICD-10.” That’s one thing to know about the Cutting Costly Codes Act of 2014, of course, and neither ICD-10 advocates nor opponents should be particularly surprised by that intention.

2.) Unlike the Protecting Access to Medicare Act of 2014, which prevented HHS from mandating the deadline before October 1, 2105, Cutting Costly Codes aims to push ICD-10 back indefinitely. As such, no new compliance deadline is suggested.

3.) The bill also calls on The Government Accountability Office to “conduct a study to identify steps that can be taken to mitigate the disruption on healthcare providers resulting from a replacement of ICD-9.”

Whereas the first two are pretty straightforward, that last provision is likely to raise a number of eyebrows among industry observers.

What, after all, could possibly be less disruptive for replacing ICD-9 than converting to ICD-10?

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ICD-10 Documentation and Quality Reporting Changes

ICD-10 Documentation and Quality Reporting Changes | EHR and Health IT Consulting |

In the physician practice, it cannot be stressed enough that only ICD-10 will be utilized come Oct. 1, 2015. The first thing that needs to be understood is what exactly is changing in regard to the diagnosis codes in ICD-10.


ICD-10 has gone from 17 chapters to 21 chapters. While this might sound like the cause of all the additional codes, it really is not. In ICD-9, there were the V-codes and E-codes that were not classified as "chapters." That accounts for two of the four new chapters. The other two are the result of diseases of the eye and ear each being promoted out of the nervous system chapter. There are also some codes that have been reclassified into more appropriate categories based on current medical knowledge.

In contrasting the two code sets, ICD-10 has changed how injuries are classified. They are now grouped by the body site injured and then by the type of injury, whereas ICD-9 only classified injuries by type. To allow for future expansion, ICD-10 codes can be as small as the three-character category code and as information rich as a seven-character code that includes laterality, severity, and episode of care. Additionally, ICD-10 has switched over to alphanumeric versus the straight numeric ICD-9.


Documentation has been touted as one of the biggest challenges with ICD-10, which is understandable considering the need for more specificity in order to obtain the most accurate code to describe the patient's condition. The more precise the description of a patient's condition, the more detailed the code choice can be. This leads to better data for outcomes reporting, research, and public health statistics, just to name a few benefits. The goal of documentation improvement is not to increase the amount a provider charts on a patient. The goal is to give an accurate depiction of the symptoms that lead to diagnosis, and the treatment course chosen to most effectively care for the patient. When looking at the groups of quality measures in the Physician Quality Reporting System (PQRS), ICD-10 offers the physician a greater number of combination codes to more succinctly report the more common etiologic and manifestation relationships.


In ICD-10, there was a significant change in the diabetes mellitus codes. In ICD-9, there was only the 250 category. With ICD-10, there are five categories, but the most significant change is the combination codes that were created. As mentioned earlier, there have been a number of additional codes added to ICD-10, and diabetes is one of the places where that occurred. These added combination codes actually reduce the number of codes to report. Rather than using two codes to describe a single condition, the diabetes combination codes describe both the etiology (diabetes) and the manifestation (such as, glaucoma) all in one code. A perfect example of this is type 2 diabetic retinopathy with macular degeneration. In ICD-9, it would have taken three codes to capture every detail of this condition. In ICD-10, it only takes one code. So if there is type 2 diabetic retinopathy with macular degeneration, then there is also a type 1 diabetic retinopathy with macular degeneration. Sufficed to say, the same would be true for each of the other three categories of diabetes mellitus. It is for this reason that, when looking in the 2015 PQRS Measures Group Specifications Manual, there is going to be a longer list of possible codes the diabetes group. The number of reportable diabetes codes for Jan. 1, 2015, through Sept. 30, 2015, is 54. Beginning Oct. 1, 2015, there are a total of 92 reportable diabetes codes. Again, these codes provide more granularity, and therefore improved data.

While some providers may be alarmed at the increased availability of these more definitive code descriptions, there is a change with ICD-10 many will be pleased about. No longer will they be inundated with queries asking if the diabetes is controlled or uncontrolled. This classification is removed from ICD-10. However, if the terms "inadequately controlled," "out of control," or "poorly controlled" are used in documentation, coders will be guided by the ICD-10 index to use the type of diabetes with hyperglycemia.


Another reportable diagnosis in the PQRS Measures Group is asthma. While the number of reportable diagnoses for asthma has also increased when comparing ICD-9 to ICD-10, the number of codes is significantly lower. There is only an increase of four additional codes in the list of reportable asthma diagnoses. This change is attributable to the addition of terms that more appropriately reflect the current clinical classification of asthma. The terms that have been added are "mild intermittent," "mild persistent," "moderate persistent," and "severe persistent." Providers that see a high number of asthma patients should be aware of these classifications and utilize an appropriate source to make consistent diagnosis and treatment decisions based on the chosen source.


On Dec. 10, 2014, a joint presentation was done by CMS and the American Health Information Management Association (AHIMA). The following list was provided as documentation focus areas:

• Disease type

• Disease acuity

• Disease stage

• Site specificity

• Laterality

• Missing combination code detail

• Changes in timeframes associated with familiar codes

By reviewing the 2015 PQRS Measures Group Specifications Manual and focusing on this list of areas for documentation improvement, any physician practice can improve not only their documentation, but also demonstrate improved quality of care by providing a clear picture of the patient throughout the care continuum.

Now that some of the groundwork has been laid, it is time to build on the foundation of strong documentation. Every ounce of clarity noted in the provider documentation builds a complete picture of the patient's health, history, treatment, and quality care. Additional steps for preparation are easily accomplished when these building blocks are in place.

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While US Focuses on ICD-10 Transition, WHO Prepares ICD-11

While US Focuses on ICD-10 Transition, WHO Prepares ICD-11 | EHR and Health IT Consulting |

The ICD-10 transition is inevitable, as the current ICD-9 coding system is very out of date. The ICD-9 coding set was implemented in the 1970s and contains information that is incompatible with current medical practice, according to a fact sheet from the Centers for Medicare & Medicaid Services (CMS).

Many other nations around the world have already made the switch to ICD-10 coding. The ICD-10 transition will bring more opportunity for code expansion and enabling physicians to provide accurate diagnoses.

Since so many players in the medical industry use the International Classification of Diseases (ICD) including physicians, nurses, health IT professionals, billers, coders, and insurers, moving forward to the most accurate set available today is essential.

Clearly, transitioning effectively to the new coding set is a necessity, which is why CMS offers a variety of resources to ensure a successful ICD-10 integration across the healthcare industry. The Road to 10 website, for example, provides a customized plan for physician practices to adopt the coding set and new technologies that are relevant to their needs.

Whether a hospital or clinic specializes in pediatric care, OB-GYN, cardiology, or internal medicine, the Road to 10 online resource offers tailored ICD-10 transition strategies for any and all medical facilities.

Additionally, CMS provided this flyer to educate providers, payers, and vendors on the ICD-10 transition. Vendors, especially, will need to work with healthcare providers to install and implement equipment that meets the requirements of the new coding set.

Since many other countries have already adopted ICD-10 coding, the World Health Organization (WHO) states that the release date for the next updated coding set, ICD-11, will be in 2017. WHO also offers ICD-10 training tools for providers and payers to become more educated in time for the October 1 deadline.

WHO reports that the ICD is being further advanced and developed through the next phase of ICD-11 in order to maintain the progress in medical care and among physicians. Due to the increasing capabilities of EHRs and health IT systems, the ICD-11 coding set will also be a useful addition.

The organization also states that entities will be able to access the ICD-11 coding set in multiple languages. Signs, symptoms, and definitions of disease will be reported “in a structured way” so as to improve accuracy.

ICD-11 will also be tailored for the transition to health IT systems and information networks. WHO also invites coding experts and other stakeholders to comment on the new ICD-11 developments through an online platform.

While the US healthcare system is still preparing to move forward with the ICD-10 transition, the WHO encourages experts across the globe to comment on and propose better classifications for ICD-11.

“The input from multiple parties will increase consistency, comparability and utility of the classification,” the WHO stated. “This shared process will lead to a global consensus on how diseases and health-related problems are defined and recorded.”

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Hoping for ICD-11 is “Waiting for Godot,” ICD-10 Coalition Says

Hoping for ICD-11 is “Waiting for Godot,” ICD-10 Coalition Says | EHR and Health IT Consulting |

Clinging on to the current outdated ICD-9 code system until ICD-11 is ready for use at some unspecified point in the future is akin to the endless idle loitering of Vladimir and Estragon in Samuel Beckett’s classic play Waiting for Godot, says the Coalition for ICD-10 in a new opinion piece.  After waiting more than twenty years for the implementation of ICD-10, the healthcare industry simply cannot afford another two or three decades for the newest code set to be finalized and ready for use.

“Based on the World Health Organization’s (WHO) current timeline, ICD-11 is expected to be finalized and released in 2017,” the commentary explains. “For the US, however, that date is the beginning, not the end.  As with every WHO version of the ICD codes, ICD-11 would need to be adapted to meet the detailed payment policy, quality assessment and other regulatory requirements of US stakeholders.”  The country could be waiting until 2041 for the entire pre-implementation process to be completed, the Coalition adds.

Meanwhile, the healthcare industry will be forced to continue to use a significantly outdated code set that cannot account for many emerging health threats or new advances in technologies, diagnoses, and procedures.  That’s just fine with representatives from the American Medical Association (AMA), whose House of Delegates voted to reject an internal report noting that implementing the changes inherent in ICD-10 would provide an important foundation for the eventual adoption of ICD-11.  The report concluded that skipping ICD-10 all together was “not recommended” as a viable course of action, yet the AMA continues its resistance to the ICD-10 codes – and the Coalition continues to fight back against their reticence.

“The US simply cannot wait decades to replace ICD-9, a code set that was developed nearly 40 years ago,” the Coalition states. “US healthcare data is deteriorating while at the same time demand is increasing for high-quality data to support healthcare initiatives such as the Meaningful Use EHR Incentive Program, value-based purchasing, and other initiatives aimed at improving quality and patient safety and decreasing costs.”

The AMA argues that the expense of ICD-10 implementation is overwhelming for smaller physicians struggling keep their doors open, pinning the costs at anywhere from $50,000 to $225,000 for a small provider.  Despite contradictions from AHIMA, the cost of the switch has been a major selling point for opponents.

However, after two one-year delays, the tide seems to be turning in support of ICD-10.  Not only is the Coalition growing, but Congress has stepped in to enforce the idea of a 2015 due date.  Will the wait for Godot be over in October?  The Coalition would certainly like to see an end to the “unending barrage of excuses” and continual delays.

“Waiting for ICD-11 is simply not a viable option,” the blog post concludes. “The absurdity of the endless waiting in Waiting for Godot culminates in frustration: “Let us not waste our time in idle discourse! Let us do something, while we have the chance!” Yes, the wait needs to be over. It’s time to stop wasting time. It’s time to get ICD-10 implemented.”

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