Posts tagged ‘jan. 1’

December 27, 2011

That 5010 transition is when?

I know that no one has forgotten that the Version 5010 transition is this coming week, but I thought I would repost some information from CMS for reference …

The Centers for Medicare & Medicaid Services (CMS) has announced an enforcement discretionary period of 90 days for Version 5010 compliance, the deadline remains January 1, 2012. Enforcement will not be exercised until April 1, 2012; however, it is important that organizations continue to complete the transition to Version 5010 as soon as possible, if they have not done so already.

Version 5010 Resources
CMS is committed to helping organizations make a smooth transition to Version 5010 and ICD-10. The CMS ICD-10 website has been updated to include a new web page dedicated to Version 5010 information and resources. CMS has also posted a new fact sheet, which discusses steps providers should be taking now to ensure a timely transition to Version 5010 by January 1, 2012.

Other materials on Version 5010 include the following fact sheets:

Additional Resources
Stay on top of deadlines and action items for Version 5010 and ICD-10 by referencing the following resources on the CMS ICD-10 website:

Keep Up to Date on Version 5010 and ICD-10.
Please visit the CMS ICD-10 website for the latest news and resources, and to download and share the implementation widget today!

November 14, 2011

Jan. 1 M0090 date is the end for case-mix hypertension

CMS has clarified that payment changes relative to the removal of the hypertension codes will be effective with M0090 dates of 1/1/2012.

“Beginning with M0090 dates of January 1, 2012, 401.1 Benign essential hypertension codes and 401.9 Unspecified essential hypertension are removed from the HH PPS case-mix system. Specifically, 401.1 and 401.9 diagnosis codes will no longer result in additional points when computing the HIPPS codes”

Providers should not change the codes they use for hypertension unless they have been coding the 401 codes in error. Changing the codes just to get points is upcoding and we certainly do not want to prove CMS correct about case mix creep. You can be sure that they will be watching for trends in hypertension coding as a result of the case mix change.

Remember hypertension with chronic kidney disease (585) or renal sclerosis (587) changes the hypertension code to the 403 category. There is a presumed relationship between CKD and HTN with HTN causing the CKD.

However, a relationship between heart disease and HTN cannot be presumed. The physician must either state (e.g., heart failure due to hypertension) or imply the relationship (e.g., hypertensive heart disease).

Even if you do not have the information to be able to change the hypertension code to some other category besides 401, do not despair! Remember that hypertension and heart disease are together in Table 4. Even if you do not earn points with the hypertension codes, think how many of your patients with 401 codes also have codes from the 414 category (coronary atherosclerosis and chronic ischemia), 410 (acute myocardial infarction) and 428 (heart failure). Those codes are case mix, too, so you will not be losing any points!

Grouper information!