Archive for July, 2012

July 26, 2012

Winners and losers with the health care ruling

Some interesting reading …

FierceHealthcare has pulled together their winners and losers list from the recent healthcare ruling.

See the slideshow for their evaluation.

July 24, 2012

Nursing home and hospital comparison websites are revamped

CMS recently updated and redesigned Hospital Compare and Nursing Home Compare to include new tools like findings from nursing home inspections.

Both sites contain important data on how well these facilities perform on quality measures – such as the frequency of infections that develop in the hospital, how often patients have to be readmitted to the hospital, and the percentage of nursing residents who report having moderate to severe pain while staying in the nursing homes. Researchers will now be able to access the data on both of these sites through mobile ready applications.

July 13, 2012

CMS beginning to look ahead to ICD-10 assessments

CMS is really beginning to emphasize the ICD-10 transition. SHA and our CoDR services are standing by to help you with all of your ICD-10-CM needs. See the ICD-10 FAQs on our main website!

CMS recently released this reminder/information on ICD-10 assessments:

Steps to Assess How the ICD-10 Transition will Affect your Organization

Although the final rule on the proposed ICD-10 deadline change has yet to be published, it is important to continue planning for the transition to ICD-10. The switch to the new code set will affect every aspect of how your organization provides care, from registration and referrals, to software/hardware upgrades and clinical documentation.

A critical step in planning for the transition is to conduct an impact assessment of how the new code sets will affect your organization. Your impact assessment should include:

  • Documentation Changes:  You will need to consider the increased specificity of ICD-10 codes compared to ICD-9 codes, and ensure that patient encounters are documented with appropriately comprehensive clinical descriptions. You should:
  • Reimbursement Structures:  You should coordinate with payers on contract negotiations and new policies that reflect the expanded code sets, since they can affect reimbursement schedules.
    • Train staff to accommodate the substantial increase and specificity in code sets
    • Consider physician workflow and patient volume changes
    • Revise forms, documents, and encounter forms  to reflect ICD-10 codes
    • Evaluate processes for ordering and reporting lab/diagnostic services to health plans
  • Systems and Vendor Contracts: Ensure your vendors can accommodate your ICD-10 needs.  Find out how and when your vendor plans to update your existing systems. You will need to review existing and new vendor contracts and to evaluate vendor offerings and capabilities against your organization’s expectations.   Work with your vendors to draft a schedule for needed tasks.
  • Business Practices: Once you have implemented ICD-10, you will need to determine how the new codes affect your processes for referrals, authorizations/pre-certifications, patient intake, physician orders, and patient encounters.
  • Testing: Work with your vendors to determine the amount of time needed for testing and schedule accordingly.

ICD-10 will affect nearly all areas of your practice, but with a thorough impact assessment, you can keep your day-to-day activities running smoothly while you transition to ICD-10.

July 11, 2012

New diabetes report released by CDC

Diabetes Report Card 2012 is now available from the Centers for Disease Control and Prevention. It gives data on diabetes and its complications at the state and national levels. The report also looks at prediabetes awareness, diabetes outcomes, and risk factors.

To learn more about controlling health complications from diabetes and preventing type 2 diabetes, visit the CDC’s Diabetes homepage at

Learn more specifically about the report.

July 9, 2012

401.9 is still valid … just not case-mix

I recently received a query on hypertension codes. A client was saying that 401.9 and 401.0 are no longer legitimate, as of January 2012, but coding books ordered after that have these codes.

My response is below:

The coding manual is correct. The codes are valid codes. The coding guidelines have not changed on using 401.9 and 401.1. If the patient has hypertension and there is 1) no stated or implied relationship documented by the physician between the hypertension and heart failure and 2) no chronic kidney disease or renal sclerosis, then the 401 category is correct for hypertension.

Furthermore, if the 401 category is correct (as is usual), then 4th digit 9 (unspecified) is usually correct because the physician doesn’t specify benign or malignant.

What did change is the case-mix status of 401.9 and 401.1. Those two codes are no longer case mix meaning they do not earn points. But alas, do not be discouraged. Many patients who have hypertension also have CAD, chronic ischemia, heart failure or the like, and those diagnoses earn the same points that 401.9 and 401.1 used to earn.

Continue to code hypertension when it is pertinent to your POC. The codes ARE allowed. What is important is to NOT change the code you use for HTN just to get points. CMS is looking for that type of behavior.

The coding manuals were published prior to the final rule from CMS on case-mix status so all you’ll need to do to update your manual is to write “NO $” next to those two codes.


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