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Coders and Billers Gather for Day 2 of the HEALTHCON Regional Conference

Those attending the first day of AAPC’s Charleston regional conference hit the ground running, and day two was no different. The day began with an early networking breakfast and a barrage of sightseeing pictures from beautiful South Carolina on the chat wall. It was clear from all the comments and questions posted that the outstanding […]

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AAPC Knowledge Center

HEALTHCON Regional Prepares coders and billers for the Future of Healthcare

Education, networking, and good times drew hundreds of medical billers, coders, auditors, and other healthcare business professionals to an AAPC regional conference today. The three-day conference, Oct. 4-6, convened in Charleston, South Carolina, but this is a hybrid event, allowing in-person or virtual attendance. Attendees from all parts of the country signed into the AAPC […]

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AAPC Knowledge Center

Don’t forget the billers

Ready for ICD-10?

Ensure your facility’s training is on track

 

Editor’s note: Karen Fabrizio, RHIA CHTS-CP CPRA, recently presented "ICD-10 Coding and Documentation for Long-Term Care," a 90-minute webinar hosted by HCPro.

Fabrizio is an AHIMA Approved ICD-10-CM/PCS trainer and a medical record administrator and HIPAA privacy and security officer at Van Duyn Home and Hospital, a 513-bed SNF in Syracuse, New York. During the webcast, she identified common documentation pitfalls and reviewed ways that SNFs can prepare their documentation and policies for the transition to ICD-10 on October 1, 2015.

Fabrizio recently shared her suggestions for how to get ready for ICD-10 with Billing Alert for Long-Term Care. Recordings of the webcast can be purchased on CD at http://hcmarketplace.com/coding-and-documentation-for-longterm-care.

 

Q: What did you want SNFs to take away from your webcast?

A: My underlying objective was to really identify how important documentation is for accurate and thorough coding and to identify areas that facilities can take a look at across all disciplines.

The identification of a diagnosis is a physician’s responsibility; however, when you get some of the specificity sometimes from different disciplines, a physician may not pick up on the dominate side or the non-dominate side for a stroke, but a physical therapist or an occupational therapist definitely will be focused on that. So it’s looking at documentation on an interdisciplinary standpoint.

So far I’ve highlighted 10 diagnoses that are pretty common. I talk about the pitfalls of bad documentation and things to consider for providing good documentation.

The second takeaway is: I feel very strongly that facilities need to have a coding policy so that if you have multiple people coding or multiple people interpreting codes, they all come up with the same interpretation.

For instance, there is a code for history of falls. It’s important for the facility to determine when they are going to use it. You certainly don’t want to use history of falls for someone who has only fallen once and broken his or her leg. But if someone has fallen frequently, whether or not there is injury, that’s a code that is going to be important for facilities to consider how they are going to use it.

Unfortunately, the whole coding system is new, so there are not a lot of guidelines in terms of you need to have fallen three times in six months to be able to use that code. I think we’ll start to see that develop, but that doesn’t mean a facility can’t make that interpretation now.

For example, in my facility that I worked at previously, we had an interpretation that if someone had fallen three times within six months, we would code that as a history of falls, and if someone had fallen once previously with a significant injury, we would use that code as well.

So, my plan is to identify areas that we should seriously think about how we’re coding it and when we should consider using a specific code.

 

Q: What should SNFs be doing now to plan for this transition and improve their documentation? Should they begin training staff now?

A: There is mixed thoughts about the training. I think the training should be done soon and I think someone in the facility should be in the process of starting that in-depth training. But if you don’t use it you lose it; it’s a corny phrase, but you don’t want to learn how to do ICD-10 and then not do anything with it.

So I think the facilities should identify a group of people to be part of their stakeholder task force. They need to have their implementation and transition team and have at least one individual become comfortable with the classification system, and that person can go back and lead discussions?not necessarily be the chief decision maker?but lead discussions to say chapter-by-chapter, how are we going to address the endocrine? How are we going to address the neurological system? Do we want to use external cause codes? I think you need someone with that knowledge. It’s unfortunate though, because I don’t know if a lot of facilities really have the resources to do that.

 

Q: Can you walk our readers through a couple of examples of coding issues that facilities might run into?

A: Sure. So a doctor commonly says that a patient has diabetes. If he doesn’t identify type one or type two diabetes, the coding guidelines say we have to assume that it’s type two. The problem you run into is that type one diabetes is generally maintained on insulin and affects other systems. So if we don’t have good documentation by applying the rules, I would have to code diabetes as type two diabetes, and that might not represent the patient at all.

The other spinoff of that is we really need to identify whether a person is maintained on insulin and whether it’s to control a type one or type two diabetes, or if it’s a short-term use just to bring things back around. When a person is coming in from home and we have our intake people writing down his or her list of meds, and they add insulin, and I see a person that is type two diabetes and on insulin, I have to ask whether or not that is just a short time use of insulin to supplement their diabetes or if this person really does have type one diabetes.

In long-term care it does not directly impact our reimbursement because we are reimbursed by the RUGs. However, with the nation moving toward quality improvement surveys and Medicare making sure skilled services are appropriate and medically necessary, our coding that we do in long-term care is greatly affected by the coding they do in acute care prior, and can affect our discharges to a home health service.

 

Q: What are facilities still unprepared for regarding the transition to ICD-10?

A: I don’t think a lot of facilities are aware of how long it’s going to take to do the coding. We’ve jumped to one more code that requires us to be more specific and I have heard that a patient record could take up to twice as long to code under ICD-10, just because it is more specific and you’re learning a new system. For example, I know in ICD-9 UTI is 599.0. In ICD-10 I know it starts with an "N" and maybe has a "39," but then it’s getting into all the specifics. Part of it is that transition of it, but you’re getting into more specificity.

I think historically, long-term care facilities have utilized generic codes and maybe have used cheat sheets to be able to quickly assign codes, and that’s going to be very difficult to do with ICD-10.

 

Q: Anything else that facilities should be thinking about?

A: The other big thing is that this really needs to be multidisciplinary. Very few facilities have the resources of an educated or credentialed health information manager, but they are fortunate to have individuals with other backgrounds who may be comfortable with coding. But you have to include everyone in this process.

 

Don’t forget the billers

Most ICD-10 training is focused on coding, but don’t forget to train your billing staff, says Maureen McCarthy, president of Celtic Consulting in Goshen, Connecticut, and vice president of clinical reimbursement for National HealthCare Associates based in Lynbrook, New York.

Billers need to understand how changes introduced by ICD-10 codes will affect their work, McCarthy says. They should be comfortable with what codes will look like under the ICD-10 system as well as any software changes related to ICD-10.

CMS has announced that MACs will host an ICD-10 testing week from March 3?7, allowing providers to submit test claims. MACs are expected to provide more information through their websites and listservs.

McCarthy recommends that billers take advantage of the testing week to prepare for the official ICD-10 implementation on October 1. She also recommends that billers check their state and national professional organizations for ICD-10 training.

"There’s a lot of information out there for clinicians, but there’s not a lot for billers," McCarthy says. "The earlier billers can get their claims tested with their new software systems, the better off they’ll be."

HCPro.com – Billing Alert for Long-Term Care

Scary Good Advice for Medical Coders and Billers

October 1 is a scary time for medical coders. There are fourth quarter updates to HCPCS Level II codes and code editors. Payment system and fee schedules are updated. And ICD-10-CM code changes go into effect. What’s a coder to do? Whatever you do, don’t hide under your bed. Jason’s under there (just a little Friday […]

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