Archive for ‘ICD-9 Coding’

September 24, 2012

Train on ICD-9 to prepare for ICD-10

Prior to the news about the postponement of ICD-10 the most common question was, “Why should we continue with ICD-9 training when “10” is on the horizon?” The answer is simple. At the very least we still need to understand & correctly assign ICD-9 codes until 10/1/13.

I am holding ICD-9 education that also prepares you for the ICD-10 transition in Tampa, Florida; Houston, Grapevine, and Corpus Christie, Texas.

We still need training because we are mandated by regulations to only enter accurate information in our patients’ records. Erroneous coding can have horrible unintended consequences for the patient whose medical record becomes contaminated by diagnoses that they don’t have.

If you think there’s nothing new in coding, then you’re wrong! There is more scrutiny in the form of medical reviews.

Lisa will provide ICD-9 answers and food for thought for the future, as well as an extra bonus of what’s new with ICD-10-CM and how to best ready your agency for this huge change.
Learn more about my training!

September 7, 2012

Use official guidance to help with symptom coding

Symptom coding is always confusing!

Should I code abnormality of gait for example if my patient has hemiplegia? What about if she’s falling and the physician doesn’t have an explanation for the falls yet?

If you have the DecisionHealth 2012 Complete Home Health ICD-9-CM Diagnosis Coding Manual turn to p. 1039 and read the second paragraph. Some of those examples do not apply to home care but it is a good summary of when we do use symptom codes. The part about integral or not is in the general coding guidelines p.29 #6-8. That should help you think about whether you need abnormality of gait, difficulty walking or any other symptom!!

By the way, those symptom codes are not required just because you’re adding therapy to the mix. There is no separate set of rules when it comes to coding for therapy in home care!

If you don’t have that particular coding manual, it’s still in your book, because it’s official guidance! For other manuals, look at the first page of Chapter 16 (780-799) and the Official Guidelines for Coding and Reporting, Section I.B.6-8.

August 24, 2012

ICD-10 delayed one year

The Department of Health and Human Services (HHS) announced Friday the final rule that changes the implementation deadline for the transition to ICD-10-CM and ICD-10-PCS from October 1, 2013 to October 1, 2014.

The rule is scheduled to be published in the Federal Register Sept. 5.
HHS concluded that delaying ICD-10 by one year does the least to disrupt existing implementation efforts, and minimizes the costs of delay, while affording the small provider community an additional year to become compliant. In order to assist entities in being prepared to meet the new compliance date, HHS expects to increase education and outreach events and to work with industry on improvements to the overall standards implementation process.

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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June 26, 2012

Coding education in Texas!

We’re teaching in Texas in July! Come join SHA for coding education in McAllen July 9-10 and Dallas July 30-31.

Beginners: The coding book is friendly if you know how to use it!

  • PLUS: 3.75 nursing contact hours and 3 CEs toward HCS-D maintenance

Intermediate: Go over basic skills, move to PPS, case-mix, RAC targets, and complicated scenarios.

  • PLUS: 9.75 nursing contact hours and 9.75 clock hours for administrators and 10 CEs toward HCS-D maintenance