Thursday, September 17, 2015

Reflections of a Coder Coach: Ready to Get Back to Normal

A few weeks ago, it occurred to me that my job hasn't been "normal" for the last six years.  Right around this time six years ago is when I first went to AHIMA's ICD-10 Academy and earned my status as a trainer.  Creating and presenting ICD-10 training materials came soon after that and it wasn't until recently I realized that my job hasn't been normal for the last six years.  And since I've only known my husband for four years, one could argue that he's never known me when I'm normal... er.. at least when my job is normal!

As I look around the articles and social media related to coding, a lot has changed in this industry in the six or seven years that I've put myself out there as the Coder Coach.  When I first started blogging and meeting once a month with coding students and wanna-be's, there weren't a lot of people out there looking to mentor coders.  Now, my voice is one of many as people who never heard of coding before ICD-10 jump on the bandwagon to get a piece of the action.  There have been questions about certifications - which ones to get and how to make sure ICD-10 certification requirements are met.  There have been questions about how to code things we never had to think about before - initial vs. subsequent encounters for injuries and poisonings and root operations based on procedure intent.

I have to be honest and say that in my abnormal day-to-day life as a coder over the last few years, I've had trouble finding my voice and giving advice as a coding mentor.  I no longer feel qualified to tell a coder how to break into the industry because things are so different than they were 20 years ago when I got my start and coding is something that many people are now aware of - not something that people kind of fall into anymore.  Since I fill my days adding to my own intellectual bank by researching procedures and learning how to explain them - and how to code them - I wonder what it is that new coders need right now.  And for everyone who is trying to learn coding, I just want to reach out and give them all a virtual hug because this is, in my humble opinion, about the hardest time to learn this industry.

This week I am working on something I haven't done in years.  I'm reading the Final Rule for the 2016 MS-DRG changes.  That is something I used to read and summarize every year for my clients.  And even though the codes are different and there are some new sections to read in this super long file, I had a moment of realization, a sigh of relief if you will, that this... this is normal!  After we flip the switch on October 1 and everyone starts using ICD-10 (because I have pretty much zero faith in our congressmen to accomplish any earth shattering legislation in two weeks when they're so focused on Donald Trump's run for president), I'm sure there will be a few things that don't go as planned.  But for coders, it's a time for us to return to "normal."  I miss having a general confidence in assigning codes (although this has gotten better as I train more coders!).  I miss code updates!  Oh, how I miss those code updates!  We've had frozen ICD code sets for four years!  I've been following the recommendations made to the Coordination and Maintenance Committee and I can't wait to see which changes they decide to adopt on October 1, 2016.

And maybe when the dust settles a bit and we see how many people really want to stick with coding in ICD-10, I will find my voice again as the Coder Coach.  I sincerely hope so, because I miss meeting people with a passion to learn about my passion and giving them little nuggets of wisdom to help them make a difference in this industry.

Monday, March 9, 2015

So Many Books, So Little Time - Part 3

Yes, it's true.  There are so many books and so little time, I haven't even had time to blog for the last two weeks because I had my nose in two of them.  Thank God for smartphones and long waits at the car wash, or who knows how much longer it would been before I posted again!

In my first post of this series, I gave one of my favorite quotes: "ICD is from Mars, HCPCS is from Venus."  So let's move on to Venus for a bit.  Don't worry, we'll be back to Mars, but I like to talk about the present before I talk about the future (ICD-10), so let's get on with it.  I apologize for the length of this post, but I have a lot to say today!

Three Levels of HCPCS
The Healthcare Common Procedure Coding System (HCPCS) has three different levels and just to make things more interesting, Level I is not usually called HCPCS, it's called CPT.  The Current Procedural Terminology (CPT) was developed and is maintained by the American Medical Association (AMA).

By Physicians for Physicians
What makes CPT so unique is that it is the only coding system in the HIPAA-approved code sets that is developed by physicians for physicians.  The codes you see in the CPT code book are the result of various medical and surgical societies coming together with the AMA to decide which procedures deserve their very own CPT codes.  Every year at the AMA's CPT Symposium, coders from around the country gather in Chicago to listen to these physicians present the coding updates for the coming year.  It's an expensive but valuable conference that I think every coder should experience at least once.  

CPT codes are primarily used by physicians to report procedures and services performed in every possible setting where a physician - or qualified health practitioner - may see  a patient: his office, the hospital, a clinic, a nursing home, etc. But it doesn't stop there.  CPT is also used to report hospital outpatient procedures. Of course, since there are still a lot of procedures that are performed solely as inpatient, hospital coders use a small number of CPT codes in comparison to pro-fee (physician) coders. 

Three within Three
So now that we know that CPT is one of three levels of HCPCS, let's delve a little deeper into this major code set. CPT has three categories of codes and this is still a pretty new concept for me because when I was learning, there were no categories, just CPT codes. 

Category I Codes
Category I codes are the original CPT codes they're what I like to call "grown-up" CPT codes. In order to get a grown-up CPT code, a procedure has to meet some pretty stringent criteria: 

  • The procedure must have FDA approval
  • The procedure must be commonly performed by practitioners nationwide
  • The procedure must have proven efficacy
Once these criteria are met, a five-digit numeric code is assigned to the procedure and unlike ICD (different planet, remember?), these codes do not have decimal points. The codes are arranged in sections by type of procedure or service:

  • Evaluation and Management (E/M) (codes beginning with 9)
  • Anesthesia (codes beginning with 0)
  • Surgery (codes beginning with 1-6)
  • Radiology (codes beginning with 7)
  • Pathology and Laboratory
  • Medicine (the rest of the codes beginning with 9)
The Surgery codes are divided by specialty, for example, the cardiovascular codes begin with 3 and neuro codes begin with 6. After coding for a while, you should be able to look at a CPT code and have a general idea of what it is. A common newbie mistake is to look for the E/M codes in the back of the book. After all, they begin with 9!  But remember that CPT is a coding system that was developed by physicians for physicians and since physicians use E/M codes more than any others, they are in the front of the book for quick reference. 

Here are a few examples of Category I CPT codes:

  • 99283, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity
  • 12002, Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.6cm to 7.5cm
  • 75625, Aortography, abdominal, by serialography, radiological supervision and interpretation 
Category II CPT Codes
Category II CPT codes are located behind the Category I CPT codes in the book. These are the only CPT codes that are optional. They are used by physicians for tracking performance measures. The purpose of these codes is to decrease administrative burden on providers while collecting information on the quality of patient care. Category II codes are five-digit alphanumeric codes that end in "F."  Here are some examples:

  • 1040F, DSM-5 criteria for major depressive disorder documented at the initial evaluation (MDD, MDD ADOL)1
  • 3775F, Adenoma(s) or other neoplasm detected during screening colonoscopy (SCADR)12
Category II CPT codes are implemented throughout the year and may be implemented before they actually appear in the CPT book.  Code updates can be accessed on the AMA's website

Category III CPT Codes
Category III CPT codes, or "baby codes," as I like to call them, are for emerging technologies that do not meet the criteria of a grown-up Category I CPT code. The Category III codes are found behind the Category II codes in the CPT book. For procedures that are not commonly performed, lack FDA-approval, or don't yet have proven efficacy, Category III codes are assigned. These are temporary codes for a period of 5 years. It has become common practice to see Category III codes reach Category I status with each annual update. For 2015, one of those procedures that was moved was transcatheter mitral valve repair with a prosthesis. The MitraClip uses this relatively new technology to treat mitral regurgitation and it received FDA approval in 2013. 

These are five-digit alphanumeric codes that end in "T." The codes are added throughout the year and may be implemented before they are published in the CPT book. Here are some examples of some Category III codes:

  • 0387T, Transcatheter insertion or replacement of permanent lead less pacemaker, ventricular
  • 0274T, Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic
Updates to Category III codes can also be found on the AMA's website throughout the year.  

Staying Updated
Back in the day, it was important just to make sure that you had the most recent year's CPT book to ensure you were using valid codes. However, with the Internet, now it's also important to monitor the CPT updates and errata on a regular basis since changes are made throughout the calendar year. I find it easiest to put a reminder on my calendar the first of each month to check the AMA's website for updates to the errata, which is a list of corrected errors in the CPT code book, as well as changes in Category III codes. Since I don't use Category II codes, I forego that update, but if you are coding them, be sure to look for those updates too. 

By the way, the errata is on the list of approved materials for the AAPC exams. The year I took the CIRCC exam (Certified Interventional Radiology and Cardiology Coder), there were a lot of errors in the electrophysiology code notes and the errata was something I really needed.  Be sure to check it out!

HCPCS codes have a concept specific to HCPCS codes only: modifiers. Think of modifiers like moons that are specific to a planet (and please forget for a moment that Venus doesn't have any moons!). Modifiers apply to HCPCS codes only, not ICD-9-CM codes. They are added to HCPCS codes to provide additional information, such as a bilateral procedure or an unusual service or to indicate that a procedure was discontinued. CPT modifiers are two numeric digits that are appended to a HCPCS code with a dash (e.g., 75710-59). 

All CPT Coders are not Created Equal
The people who assign CPT codes are just as complex as the coding system. Since hospital coders code only a subset of CPT codes, they don't have the same skill set that a pro-fee coder has. Remember that hospital inpatient coders use volume 3 of ICD-9-CM to code procedures. Hospital outpatient coders assign CPT codes for procedures that are found in the outpatient setting. So while the pro-fee coder coding for the cardiologist will code everything from a clinic visit in the physician's office to an angioplasty in the hospital cardiac cath lab to a full blown coronary bypass in the hospital's OR (all using CPT, of course), the outpatient hospital coder would only use CPT to code the angioplasty. Hospitals don't follow conventional E/M rules and coronary bypass is an inpatient procedure that gets coded using ICD-9.   In addition, many of the modifiers used by hospitals are different than those used by physicians. 

These differences are one of the reasons it's so difficult to make the crossover from hospital to pro-fee coding and vice versa. I personally hate E/M coding but I know people who love it. So if you find that one area of coding is not really your cup of tea, fear not!  You may find another area very rewarding. 

I also really can't talk about CPT without bringing up a little tiny thing from the hospital side called a charge description master (CDM), or as it's more commonly called, the charge master.  It's as masterful as it sounds: a line-item listing of everything a hospital department charges for.  Each line item has a description of the charge, charge amount, and sometimes a CPT code.  One of the most difficult transitions I see in pro-fee coders crossing over to the hospital side is not understanding that the coder doesn't code everything.  There are many codes that are assigned automatically by the charge master when a charge is applied to the bill.  This is the case when the CPT code doesn't require a lot of subjective reasoning (e.g.,  lab test or x-ray).  For those procedures and services, such as operative procedures, that require subjective reasoning, a real-live coder will assign the code.  It may sound counter intuitive, but this actually increases the amount of coding-related jobs in a hospital.  The charge master analyst requires coding knowledge as he/she works with hospital departments to set up charges, research appropriate CPT codes for the procedure or service, and determine if it will be hard coded (by the charge master) or soft coded (by a person in coding).  

CPT Made (Too?) Simple
This posting really oversimplifies the CPT code set (that's right, it gets more complex!), but it's a start if you're still finding your way in the coding field.  I have a love-hate relationship with CPT because I find it both challenging (love!) but also frustrating when I hear conflicting coding advice between CMS, the AMA, and medical/surgical societies (hate!).  If you find that you love all aspects of CPT, then you can have a very lucrative career in either the pro-fee or facility coding arenas.

Stay tuned to this series...  Next up is HCPCS Level II.

Monday, February 16, 2015

So Many Books, So Little Time- Part 2

ICD-9-CM Has Procedure Codes?
In part two of my blog series about coding systems, I'd like to present ICD-9-CM, Volume 3. If you've taken classes that are preparing you to take the CPC exam, it might be news to you that ICD-9-CM has three volumes. Or procedure codes. So that's it: volume 3 of ICD-9-CM is procedure codes. 

Hospitals Use It
In part one of this series, I mentioned that HIPAA defines which code sets are used for each health care setting. Volume 3 ICD-9-CM codes are only mandated for hospital inpatient claims. They are a major factor in the determining DRG assignments, which drive hospital inpatient payments. 

Some hospitals also assign ICD-9-CM volume 3 codes for hospital outpatients as well. This is solely for data collection purposes but the codes get "scrubbed" off the outpatient bill and don't go to the insurance company. ICD-9-CM codes may be used to analyze volume of a particular type of procedure performed either as inpatient or outpatient. For example, most appendectomies are performed as outpatients, but if there are complications, a patient may need to be admitted as an inpatient. Hospitals often pull procedure volume for physician credentialing or planning purposes (e.g., to determine if a new specialty unit or more operating rooms are needed).  As a coding manager, which was a long time ago, I wrote reports that pulled data based solely on ICD-9 codes. We didn't use CPT codes to pull data at all at that time. 

Why You May Have Never Heard of It
If you've never heard of volume 3 codes in school, then it's likely that you are taking a coding course for physician coding and billing. Physicians don't use volume 3 of ICD-9. But as mentioned above, hospital coders are using it and if a hospital requires its coders to assign ICD-9 codes on outpatients, they are coding procedures using both ICD-9 and CPT procedure codes. That isn't as complex as it sounds because most hospitals use encoder software that has a crosswalk between the two code sets. Unfortunately, any time you try to map from one code set to another, there can be errors. If they were easily translatable, we wouldn't need two code sets!

Here's another critical tip: if you are buying ICD-9-CM code books, it can be super confusing because there are various publishers and lots of code books with different-yet-similar titles.  If you purchase an ICD-9-CM code book for physicians, it will have only volumes 1 and 2.  If you buy ICD-9-CM for hospitals, you get all three volumes, or the complete ICD-9-CM code set.

What the Codes Look Like
The code format of volume 3 ICD-9-CM codes is different from other code sets with two numeric digits followed by a decimal point and then one or two more numeric digits. The code category ranges are 00-99. It's the most straightforward of all of the HIPAA code sets. 

Some examples of volume 3 codes are:

  • 47.0, Appendectomy
  • 36.97, Insertion of drug-eluting coronary artery stent(s)

Commentary on ICD-9 Volume 3 and Argument for ICD-10
If you weren't trained on ICD-9-CM procedure codes, let me tell you, you aren't missing much. It is the least robust of all of the coding systems. There just simply aren't enough three to four-digit codes to keep up with rapidly evolving healthcare technology. We have run out of available codes. This is my biggest argument for ICD-10 implementation. I hate to say that we can live without a diagnosis code update, but in comparison to procedures, the need isn't as great. We absolutely need a new procedural coding system for ICD in order to keep up with emerging technologies. Plus - and this drives the OCD coder in me crazy - there are hernia repair codes in the eye procedure chapter because it's the only chapter with available codes!  

If you were trained in CPT first and have to learn ICD-9 volume 3 codes, you may find it very difficult, but only because you are trying to find codes as specific as CPT. You will be disappointed because ICD-9 codes aren't that specific. While there are appendectomy codes in CPT for open and laparoscopic approaches, ICD-9 appendectomy codes don't differentiate between open and scope procedures. 

Who Needs to Learn it?
If you're planning to take a certification exam, here are the certifications that have traditionally tested on volume 3 ICD-9-CM codes, but keep an eye on test details for the testing switch over to ICD-10:

  • CCA (Certified Coding Associate) from AHIMA
  • CCS (Certified Coding Specialist) from AHIMA
  • CIC (Certified Inpatient Coder) from AAPC (new)

The COC (Certified Outpatient Coder), formerly called the CPC-H (Certified Professional Coder Hospital-based) does not focus at all on ICD-9 volume 3 codes. It does focus on hospital-related CPT codes and, of course ICD-9 diagnosis codes because we all use that. 

The bottom line on volume 3 codes, in my opinion, is that it is a coding system with a limited shelf life that isn't worth learning at this point in the game if we really move forward with ICD-10-CM/PCS in October (or unless you are planning to take one of the above-mentioned certification exams before ICD-10 is implemented).  There are enough existing coders to focus on the ICD-9 back work that will be involved after ICD-10 implementation and since this code set is only required for hospitals, it affects a pretty small population of coders overall.  But hey, at least you now know what it is and can have an intelligent conversation about it. 

Next up: Level I of HCPCS (AKA CPT)...

Wednesday, February 11, 2015

So Many Books, So Little Time - Part 1

What's Your Idea of a Best Seller?
Every once in a while I page through a magazine taking keen interest in the best seller and "must read" book lists that everyone is talking about.  I usually tear out the pages for books that are interesting so I can download them later.  And then I rarely read them.  Or it takes me literally months to finish a book.  I love to read, but frankly, after a day of reading code books, and spending a lot of time writing, I just don't have the eye or mental energy to crack a book for fun.

My idea of a best seller is a string of code books that I use every day.  Don't worry though, I find other ways to have fun that have nothing to do with coding!

The last time I moved, I had lots of friends helping me lug boxes and it didn't take long for them to zone in on the heaviest ones: they were labeled "code books."  I have code books for various coding systems going back several years and yes, they are heavy.  And it's hard to explain to the layman why I need so many books in such an electronic age.  I've found it can also be challenging to explain the different code sets to novice coders.  But alas, I am going to give it a try in a series of blog posts because you may not be exposed to all coding systems in coding school, but depending on the setting you work in, you may find you have to become familiar with something new.

I Don't Hate Encoders
Let's get one thing out of the way first, though.  I have no issues with computers or encoders.  In fact, I use a computer for almost everything and, like so many people, I am pretty addicted to my iPhone and iPad.  But as a coding trainer, I learned by the book and I teach by the book and will always default to the book when I have a question.  Encoders are only useful when the user understands the logic behind the program and that logic is based on the book.

ICD is from Mars, HCPCS is from Venus
In healthcare, we deal with two major planets of coding systems: the International Classification of Diseases (ICD) and the Health Care Common Procedure Coding System (HCPCS).  And as if that wasn't enough, those coding systems are divided into further classifications with different uses. Coding for a physician practice?  Then you'd better brush up on different parts of the coding spectrum than what you'd see in a hospital. Coding outpatient services for a hospital? Then you need to know something different than what you would need to know if you were coding hospital inpatient services.  Want to know how to code everything?  Then it's time to become familiar with your new best seller list.  This post will start with the basic coding system that everyone uses.

ICD-9-CM Volumes 1 and 2: Everyone Does it 
You probably aren't surprised to hear that the government determines which codes we use in the U.S.  But you may be surprised to hear that the law that defines those coding systems is a little law called HIPAA. Yes, the same law that addresses privacy and security of medical information also tells us which codes we must use to report healthcare services.  This is why some code books boldly state on the cover that they support HIPAA compliance.  In order to make health information portable and comparable,the Healthcare Portability and Accountability Act of 1996 (HIPAA) makes sure we're all speaking a common language, expressed in codes, before we exchange data electronically. The privacy and security provisions are simply byproducts of making sure health care data can be shared electronically. 

Every health care case, regardless of provider and setting, has one code set in common: ICD diagnosis codes. This coding system was developed by who?  That's right - it was developed by WHO: the World Health Organization. Here in the U.S. we currently use an adaptation of WHO's ICD, which is currently the ninth version. We call the U.S. version a clinical modification. And thus, we have ICD-9-CM: the International Classification of Diseases, 9th Revision, Clinical Modification.

ICD-9-CM has three volumes. The first two volumes include the diagnosis codes.  This includes the tabular (Volume 1) and index (Volume 2). I'll address volume 3 in part 2 of this series. Bottom line here: every HIPAA-covered entity, which includes hospitals and physicians (and excludes workers' compensation and car insurers) utilizes ICD-9-CM codes to report diagnoses on a claim.

ICD-9-CM codes have 3-5 digits with a decimal point after the first three digits. All codes are numeric except for V codes, which start with a V and then have two numeric digits and may have up to two more digits after the decimal point; and E codes, which start with an E and have three numeric digits and may have an additional digit after a decimal point. E and V codes are actually "supplementary" codes that are not included in the main part of the ICD-9-CM volumes 1 and 2 code set.

Here are some examples of ICD-9-CM codes:

  • 486, Pneumonia, organism unspecified
  • 401.9, Essential hypertension, unspecified
  • 250.00, Diabetes mellitus without mention of complication, Type II or unspecified type, not stated as uncontrolled
Examples of supplementary codes:
  • V08, Asymptomatic HIV infection status
  • V27.0, Outcome of delivery, single liveborn
  • V76.51, Screening for malignant neoplasm of colon
  • E961, Assault by corrosive or caustic substance, except poisoning
  • E885.3, Fall from skis
Regardless of who you plan to code for, you will be using ICD-9-CM diagnosis codes for billing.  As such, this is likely the first coding system you learn.  

You may notice in my picture that my most recent ICD-9-CM code book is from 2012.  That's because that was the last year that we had updates to the coding system.  ICD-9-CM is under a permanent code freeze as we optimistically await ICD-10 implementation.  Don't worry, I will address ICD-10 in future posts.  For now, you are safe using an ICD-9-CM code book from 2012 or newer, but I wouldn't waste money on a new book if (heaven forbid), ICD-10-CM is not implemented this year.  ICD-9-CM remains forever frozen and is no longer being maintained.  If you want to bone up on ICD-9-CM coding guidelines, they are printed in the front of your code book.  Or you can do what I do and download the PDF document so you can easily search the document for something specific.  Here is a link to the last version of the ICD-9-CM Official Guidelines for Coding and Reporting.  

Next up: ICD-9-CM Volume 3...

Tuesday, December 23, 2014

All I Want for Christmas is Fewer RAC Denials

This December, coders across the country got the ultimate Christmas present: a bill passed the House and Senate without the addition of language that would further delay ICD-10 implementation.  As we breathe a sigh of relief and get ready for a worry-free Christmas (at least as far as coding is concerned), we aren't fully exhaling until the end of March when the SGR bill comes up again for a vote.

But how many people are aware that there is another type of legislation at work that could cut down on the number of RAC denials we get?  Sounds almost too good to be true, doesn't it?  While the legislation is real, it's in very draft form right now.  Unfortunately, from where I sit, it also seems to be flying very low under the radar among my peers and I think it deserves some attention.

First of all, if you are not yet familiar with RACs, those are the Recovery Audit Contractors hired by Medicare to recoup improper payments to hospitals and physicians and return that money - with penalties - to the Medicare program.  The idea is great - run all the claims data through proprietary software and analyze it to see what looks weird.  This can be anything from improperly coded claims to admitting a patient to the hospital for a short stay rather than treating them as an outpatient.  Side note: contrary to what a lot of Medicare patients are told, hospitals do not get paid more for outpatient claims; they actually get paid less.  Medicare patients pay more out of pocket for hospital outpatient services and in most cases, hospitals get paid less than if patients were inpatient.  But if hospitals admit patients who could be treated as outpatients for short stays, they can have to pay the money back plus RAC penalties.

There are two types of RAC audits: automated and complex.  Automated reviews can be identified just by looking at data without reviewing the medical record.  Complex reviews require review of the medical record (e.g., for coding errors).  But the RACs don't have the final say; there is a rather lengthy appeals process that providers can - and should - take advantage of because several RAC denials have been overturned.  The problem is, there are about eight levels of appeals that end with the administrative law judge and currently there is a backlog of appeals at the administrative law judge level.

Enter the Hospital Improvements for Payment (HIP) act of 2014 (don't you just love that so many healthcare laws start with "hip?!").  This is a draft proposal aimed at reducing RAC audit backlogs by creating a new Hospital Prospective Payment System (HPPS) for Medicare short stays (less than 3 days length of stay), including observation services.  In short, it calls for the following;
  • Creation of the new HPPS by the year 2020
  • Creation of an alternate reimbursement system for short stays from fiscal year 2016 to fiscal year 2019 as data is gathered for the 2020 system
  • Elimination of RAC reviews for short hospital stays until HPPS is implemented
By now, there may be a lot of people jumping up and down with joy, but of course there is a catch.  The proposal calls for dual submission of claims by hospitals in fiscal year 2016 in order to establish payments.  This means that hospitals would have to submit both ICD-10-PCS and CPT codes for short hospital stays for 2016.  Yes, the proposal assumes that we will be coding ICD-10-PCS in fiscal year 2016, which incidentally, begins on October 1, 2015.  The proposal would also implement an ICD-10-PCS to CPT crosswalk.  If the dual coding of claims didn't make you nervous, the crosswalk should.  I've never met a crosswalk I trusted.  Let's face it, if one coding system easily crosswalked to another, then we wouldn't need two different coding systems, would we?  I can see lots of operational challenges starting with the productivity dive that would surely occur and ending with training challenges since it's getting harder to find inpatient coders who code CPT and many facilities have decided not to train their outpatient coders in ICD-10-PCS.

Read All About It
This is just a small snipit of what HIP is about, but I encourage you to read up on it yourself, starting with information from the House Committee on Ways and Means and checking out the industry commentary to see where you stand.  Here are some links you should check out:
Let Your Voice be Heard
For more information from the House Ways and Means Committee, including information on submitting comments, click here.  This proposal has the potential to rock the world of hospital reimbursement (again) and has some definite pros and cons.  While it's still only a draft and is not a done deal, it's time to take the opportunity to let our voices be heard and submit comments.

Friday, December 19, 2014

I don't want to live in a world where Ebola is sold out at the Giant Microbe store - and there's no code for it

There is a super cute little toy shop in Coeur d'Alene, ID called Shenanigan's Toy Emporium that sells vintage toys and other unique items.  When traveling there on business, we usually make a stop in to shop from their wall of amazing salt water taffy and check out their selection of toys that don't come with a power button.  You know, the kind of toys we had prior to the Atari and Game Boy era!

Shenanigan's also has a great display of giant microbes - small plush renderings of everything from the common cold to diarrhea.  I am still marveling at how they could create a plush toy out of liquid stool!  I'm sure it's just the geeky coder in me (and my colleagues), but we decided to buy a few and put them out during our training sessions along with our baskets of Play Dough, pipe cleaners, and candy (we like to have FUN in our training sessions!).  Needless to say, they were a big hit with our clients and we noticed on one of the tags that there was a website where we could order more.  By now your interest is surely piqued, so be sure to check out the online Giant Microbes store.

You're probably thinking what I'm thinking right about now, which is, wouldn't these giant microbes make great white elephant gifts for Christmas?  My thoughts immediately went to what would be appropriate for my family's white elephant gift exchange.  Don't worry, my family has a great sense of humor - there's still a copy of Pamela Anderson's novel (yes, she wrote one) complete with the "naughty" pages clipped together courtesy of my grandmother who was sheltering her daughter from the filthy parts.  And what better gift for someone in 2014 than the Ebola virus?  There's just one problem.

Sold out.

Apparently I am not the only person who thinks that Ebola would make a great Christmas gift.  It's a sign of recent headlines that this virus, which is actually kind of cute in plush form, is unavailable.  What's even more worrisome given that this was the year Ebola came to the US, is that we don't have an ICD-9-CM code to report it.  Here's the best we can do in ICD-9:

  • 065.8, Other specified arthropod-borne hemorrhagic fever
  • 078.89, Other specified diseases due to virus

What about ICD-10-CM?  How about this?

  • A98.4, Ebola virus disease

YESSSSSS!  Way more specific!

In previous years as we've prepped for ICD-10 implementation, the opponents have given a laundry list of extensive and admittedly ridiculous (yet fun!) ICD-10 codes that begged the question, why do we really need this?  And this year, Ebola was delivered to our health system and we have nonspecific codes to report it.  But in ICD-10, we have a very specific code.  Hmm.  Perhaps this ICD-10 thing really could help with reporting and impact patient care.  Just a thought.

So Santa, if I can't have Ebola for Christmas this year, could I please have ICD-10 so that I can code it for those people who did get it?

Author's Note: I am not affiliated with Shenanigan's Toy Emporium or in any way. I am just a really big fan!

Thursday, December 18, 2014

Diversity - and Flexibility - is Key

I've been pretty quiet lately around the blogosphere and some may even think I've disappeared.  And for about a year, up until about October, I really had disappeared a bit to plan and live through my wedding.  After a couple months of an identity crisis, I'll announce here that Coder Coach Kristi Stanton has disappeared and the new Coder Coach is now Kristi Pollard.  The new last name will take a couple of decades to get used to, but I am hopeful that if I'm quoted in the future, it won't be as the first actress to play Buffy the Vampire Slayer. True story.

For the last couple of months I've been waiting for inspiration to strike so I could once again become passionate about the blog.  I've been observing.  Don't get me wrong, with all the legislation and talk about more ICD-10 delays, I've also been writing my congressmen, participating in Twitter rallies (follow me at @codercoach), and making posts on Facebook, but I've spent more time just watching.  Watching the industry.  Watching my colleagues.  Watching hopeful coding professionals trying to break their way in.  And this is what I've deduced: if you want to make it in the coding field, you've got to diversify.

It didn't take long after the ICD-10 delay was announced in March to see the fallout.  Some of our clients stayed the course while others postponed some training.  There have been very few canceled trainings all together for ICD-10. A couple of months ago, I dusted off a couple of our CPT training manuals that hadn't been updated in awhile to get them ready to train in 2015.  It was comforting to fall back into something that still required the skill of a senior consultant that was a sure thing.  Of course, I hope for a future with ICD-10 and will continue to advocate for it, but there's always CPT as well.

Here is my message to the coding students and aspiring coders.  Coding is not steady and it's not comfortable.  Even without ICD-10, annual updates to the coding industry can rock your world (case in point all the new lower GI endoscopy CPT codes for 2015).  This field has a tendency to attract detail-oriented people who like to organize everything in pretty and neat little black and white buckets.  As coders, we don't like gray areas.  Well, as a coder, be ready for gray, purple, and yellow polka-dotted areas.  You need to be flexible.  You need to be ready when the House throws language into a bill at midnight the night before a vote that will impact your daily work.  And you need a backup plan just in case.

I feel a bit like a financial adviser as I tell you you need to diversify.  DI.  VER.  SI.  FY.  Don't put all your coding eggs in one basket.  As someone who has coded in ICD-9-CM, ICD-10-CM/PCS, CPT, and HCPCS, I understand what I'm asking you to do.  It's not easy.  They all have different rules and methodologies.  I understand that I'm asking you for a lifetime of education.  But the payoff for doing the work is immeasurable.  And the more you have exposure to, the more marketable you are as a coder.