The following table will assist you in documenting interrogation for cardiac devices: Description ICD-9 ICD10 unspecified cardiac device. . . . . V45.00. . . . . Z95.9 Cardiac pacemaker . . . . . . . . . . . V45.01. . . . . Z95.0 automatic implantable . . . . . . . . V45.02. . . . . Z95.810 cardiac defibrillator Other specified cardiac . . . . . . . . V45.09. . . . . Z95.818 device Fitting or adjustment . . . . . . . . . . V53.31. . . . . Checking and testing Z45.010 adjustment and management Z45.018 remember that many codes in ICD-10 are combination codes requiring linking language from the provider. One example is diabetes with polyneuropathy. In ICD-10 that code is e11.42. another example is hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease or end stage kidney disease. In ICD-10 that code is I13.2. That single code in ICD-10 offers a wealth of information about the patient’s condition. steer clear of using unspecified codes in ICD-10. although they exist, the carriers are looking for more specific information related to patient care. Contact vendors that have prepared robust applications for fast and easy translation from ICD-9 to ICD-10. ensure that those applications also offer backward mapping, as there may be a few carriers that do not accept ICD-10 codes. Begin dual coding by taking one or two evaluation and management services and one or two procedural services each day and translating the codes into ICD-10. This will familiarize your coding team with the diagnosis codes. get the physicians and other nonphysician practitioners involved. ensure they have the tools to meet with success in making the transition to ICD-10. some specialties are impacted more than others. make sure any training to providers is specialty specific. Often, documentation just needs small modifications, not a major overhaul. Provide a diagnosis for every medication ordered. If a lab value is of concern, an associated diagnosis should be included in the documentation. Documentation of comorbidities will demonstrate the severity and complexity of the disorders treated in the practice. Be aware of the improvements to data analysis to come with the new code set, offering more and better opportunities for research. Trending across patients to identify successful treatments or reactions 34 HBma BIllINg • NOVemBer.DeCemBer.2014 to specific treatments will enable improvements in standard of care with an enhanced focus on evidence-based medicine. Work with providers to integrate these changes into practice now rather than waiting until October 1, 2015, or beyond. Preparation now will reduce cash flow problems, increased denials, and requests for additional information from the carriers. remember that in today’s healthcare environment, transparency is the objective. as a result, multiple agencies are responsible for reporting data about physicians. They include the federal government, which tracks reimbursement; recovery audit contractors, who are responsible for oversight and recovery; and the insurance carriers, which track information regarding credentialing and pay-for-performance objectives. Public information is available via the Internet from Healthgrades, leap Frog, and other consumer-oriented websites. ensure that this information is accurate and services are appropriately documented using the new code set. ensure your budget for 2015 includes line items for staff training, updates to computer systems, and plans to purchase an electronic ICD-9 to ICD-10 translation tool, if applicable. apply for a line of credit should payment be delayed with the implementation of ICD-10 after October 1, 2015. reassess staffing needs to determine whether additional staff are needed to ensure robust reporting of the new code set. Identify both a physician champion and an ancillary staff champion for the planning and implementation of ICD-10. give them the resources they need to meet with success and be supportive of their initiatives that will ensure the practice is ready for the transition. (It should be noted that the american medical association remains adamant about not implementing ICD-10, indicating that there are increasing administrative responsibilities placed on physician practices related to meaningful use of the electronic medical record and quality initiatives, all the while the reimbursements for physicians continue to shrink.) Finally, the best advice is to plan for the October 1, 2015, implementation date, and, should there be another delay, view that as an opportunity to enhance preparations. The improvements made in documentation will provide more robust information to support medical necessity, regardless of whether or not the new code set is implemented next year. Valerie Fernandez is the assistant director of health information management, and previously the ICD-10 quality assurance manager at the Hospital for Special Surgery in New York. She also holds a CPC and CPC-H from the American Academy of Professional Coders (AAPC). She served as president of the midtown Manhattan chapter and president for the Manhattan chapter of the AAPC.
Billing_NovDec14
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