ICD-10 Education: What is Available at No Cost to You?

on Monday, 30 June 2014. All News Items | Case Management | Documentation | Coding

For everyone that had been proactively planning for the transition from I-9 to I-10 on October 1st of this year I understand the let down and frustration. For everyone else who had as of yet started to prepare for the transition in earnest, now is the time to begin. And for everyone’s sake let’s hope that the third time is the charm and there will be no further delays.

Wherever you are at in the planning and education, I want to share what I believe are some valuable and free resources that the Centers for Medicare and Medicaid Services (CMS) has to offer.

MLN Connects™ National Provider Call

On June 4th, CMS hosted the National Provider Call – More ICD-10 Coding Basics that covered CMS Code Updates and ICD-10-CM: More Basics. CMS reminded listeners on the call that on April 1st of this year, the Protecting Access to Medicare Act of 2014 (PAMA) was enacted and delayed the adoption of I-10. An interim rule is expected in the near future to include a new compliance date for the adoption of ICD-10 codes beginning October 1, 2015. Information about the new compliance date will be posted to the ICD-10 Statute and Regulations web page.

CMS ICD-10 website Resources

During the Provider Call CMS included several resources available on their dedicated ICD-10 website. These resources contain a wealth of information for Providers, Coding and Clinical Documentation Improvement (CDI) Specialists alike.

Additional educational offerings include:

Three key clinical documentation challenges were shared during the call and include:

  • “Ensuring high-quality documentation without excessive administrative burden or levels of frustration, or encroaching on time spent on patient care,
  • Ensuring sufficient documentation to support code assignment while allowing providers to document in clinical, not coding, terms; and
  • Need good clinical documentation – not a greater volume of documentation.”

With these challenges in mind, I wanted to share with you a fairly new resource that the CMS has released called "Road to 10". This online resource was “built with the help of providers in small practices. This tool is intended to help small medical practices jumpstart their ICD-10 transition. “Road to 10” includes specialty references and gives providers the capability to build ICD-10 action plans tailored for their practice needs.”

What I have found to be especially helpful on this webpage are the Specialty References where profiles “explore common codes, primers for clinical documentation, clinical scenarios, and additional resources with each specialty.” To date there is specialty specific information for Family Practice, Pediatrics, OB/GYN, Cardiology, Orthopedics, Internal Medicine and Other Specialty. Within each Specialty specific page you will find:

  • Common Codes for Your Specialty

    This section was “derived from a study performed in late 2013 which referenced a blend of commercial, stats, and federal payer data. The study focused on codes encountered in an outpatient professional setting.”
  • The Primer for Clinical Documentation

    This is the section that I believeCoding and CDI Professionals may find most useful. Especially as you educate yourself and look for ways to educate your Physician staff. “This document introduces ICD-10 clinical documentation changes for common conditions associated with” the Specialist’s area of practice. “It highlights increased specificity and laterality requirements and provides brief descriptions of the related documentation nuances significant to” a MD’s practice. For example, within the Cardiology section there is guidance on Acute Myocardial Infarction (AMI), Hypertension, Congestive Heart Failure, Underdosing, Atherosclerotic Heart Disease with Angina Pectoris, Cardiomyopathy, Heart Valve Disease and Arrhythmias/Dysrhythmia.
EXAMPLE

Congestive Heart Failure

 
Terminology Differences & Increased Specificity
The terminology used in ICD-10 exactly matches the types of CHF. If you document “decompensated” or “exacerbation,” the CHF type will be coded as “acute on chronic.”
When documenting CHF, include the following:
1) Acuity e.g.: acute, chronic
2) Type e.g.: systolic, diastolic
ICD-10 Code Example
I50.23 Acute on chronic systolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
(Source: http://www.roadto10.org/?page_id=576)
  • Clinical Scenarios

    This section equips CDI staff with information that has the “added bonus” of providing your Physicians with information that can be used in the office setting. CMS “created sample, outpatient focused scenarios to illustrate specific ICD-10 clinical documentation considerations. These examples underscore the importance of including the proper level of detail needed to support the selection of the most appropriate ICD-10 diagnosis codes based on a patient’s circumstance.”
  • ICD-10 Training and Education Resources

    This last section provides training sources in the following three areas:
    • “Documentation training for physicians, nurse practitioners, physician assistants, and other staff who document in the patient medical record.
    • Coding training for staff members who work with codes on a regular basis.
    • Overview training for staff members engages in administrative functions.”

      Just as with the Clinical Scenarios this is a free resource that you can provide to your Physicians and his office staff as they also prepare for the transition to I-10.

I have found that the older I get the harder it is for me to make changes but the more I realize that changes are inevitable. We may not know when, but I do believe that one day we will catch up to the rest of the world and transition away from I-9. In the meantime, I encourage you to take advantage of all of the free resources available to you on the CMS website. For those interested in receiving I-10 emails from CMS you can sign up at http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD-10_Industry_Email_Updates.html.

Article by Beth Cobb

Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Services at Medical Management Plus, Inc. Beth has over twenty-three years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth monitors, interprets and communicates current and upcoming Case Management / Clinical Documentation issues as they relate to specific entities concerning Medicare. You may contact Beth at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.

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