Press release: Deadline for ICD-10 allows health care industry …

Deadline for ICD-10 allows health care industry ample time to prepare for change

Deadline set for October 1, 2015

The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services. The code set’s granularity will improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and provide detailed data to enhance health care delivery. Health care providers and specialty groups in the United States provided extensive input into the development of ICD-10, which includes more detailed codes for the conditions they treat and reflects advances in medicine and medical technology.

“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services (CMS). “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”

Using ICD-10, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM. Moreover, the level of detail that is provided for by ICD-10 means researchers and public health officials can better track diseases and health outcomes. ICD-10 reflects improved diagnosis of chronic illness and identifies underlying causes, complications of disease, and conditions that contribute to the complexity of a disease. Additionally, ICD-10 captures the severity and stage of diseases such as chronic kidney disease, diabetes, and asthma.

The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology and preventive services.

ICD-10 represents a significant change that impacts the entire health care community. As such, much of the industry has already invested resources toward the implementation of ICD-10. CMS has implemented a comprehensive testing approach, including end-to-end testing in 2015, to help ensure providers are ready. While many providers, including physicians, hospitals, and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and this rule ensure all providers are ready.

For additional information about ICD-10, please visit: http://www.cms.gov/ICD10

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ICD-10 delay impacts implementation of OASIS-C1 « CMS …

In a new S&C letter, “Outcome and Assessment Information Set (OASIS)-CI / International Classification of Diseases (ICD-)9 Webinar: September 3, 2014,” (Ref: S&C: 14-40-HHA), CMS notes that is has determined that the ICD-10 delay will have an impact on the Home Health Quality Reporting Program, especially the implementation of OASIS-CI. The new version of OASIS data set items was scheduled to be implemented on October 1, 2014, but five of these codes require the use of ICD-10 codes. The letter details the codes that require change.

Additional, the S&C group will be hosting a webinar, “OASIS-C1 / ICD-9” on September 3, 2014. The webinar will cover the OASIS-C1/ICD-9 data set and its implementation, the types of changes made to the data set and changes made to the OASIS-C1/ICD-9 Guidance Manual.

OASIS-C1/ICD-9 is scheduled to be implemented on January 1, 2015.

Read the S&C letter on the CMS website.

ICD-10 Dual Coding – Stay the Course – HITECH Answers : HITECH …






EdwinHartai5 Key Reasons to Keep on Schedule

By Edwin Hartai, Senior Consultant,  Hayes Management Consulting
Twitter: @HayesManagement

The delay of ICD-10 has caused healthcare providers to re-evaluate the time and costs associated with planning and implementation efforts, including those devoted to dual-coding. President Obama signed the SGR bill (H.R. 4302) on April 1, 2014, effectively delaying ICD-10 until October 1, 2015 at the earliest. Many organizations were just getting their dual coding efforts underway and others were trying to give their coders at least six months of practice to minimize the impacts on productivity following the implementation of ICD-10.

Onward and upward – Why stay on track?

Although the delay of ICD-10 may cause many providers to halt or reduce their dual coding efforts, there are five key reasons why moving forward as originally planned will help reduce risks and better prepare organizations for ICD-10. The following go well beyond getting coders comfortable with ICD-10 and addressing the learning curve:

  1. Better trained and efficient staff. More time spent dual coding will help increase efficiencies coding in ICD-10 and build coder confidence. Effectively tracking and monitoring coder accuracy and productivity while dual coding also allows for a better ability to budget for additional coding resources both initially and ongoing.
  2. Ability to identify and address documentation gaps. Dual-coding will help to provide meaningful feedback to physicians on identified gaps and weaknesses in their documentation to effectively support accurate ICD-10 code selection. Depending on the timing of physician education, this will also help assess the success of the ICD-10 training program(s) and identify coders, providers and services that may need additional training. Dual-coding may also help to better estimate the need for additional Clinical Documentation Improvement resources based on the volume of additional queries under ICD-10.
  3. Better data for financial impact analyses. Using cases that have been dually coded using actual documentation will help to provide more accurate claims for financial impact analyses. The more cases that can be dually-coded will help to achieve better sample sizes and help organizations to move beyond just their top 100 cases. Financial impact analyses that were originally completed using data that was forward mapped between ICD-9 and ICD-10 can be refined based on actual dually-coded cases for more accuracy and better identification of potential DRG shifts.
  4. Better data for reporting. Similar to item three, dually-coded data will help to make sure that reports spanning the ICD-10 implementation date are pulling information correctly and reports can be more fully tested using dually-coded data.
  5. Better data for unit, integrated, end-to-end and payer testing. Many organizations have been using forward mapped data to create test cases for ICD-10, both within and across systems. Using dually coded cases may help to better identify mapping issues, identify code translation issues within and across systems, and for interface testing. Dually-coded data can be used to create test data for payer testing based on actual cases.

Reduce risk and minimize financial exposure

Although there are costs associated with dual-coding, primarily around the resources required to code records in both ICD-9 and ICD-10, the benefits of these five key reasons may help many organizations to re-coup those expenses in the long-run by reducing risk, minimizing financial exposure and identifying and resolving issues sooner rather than later.

About the Author: Edwin has more than 23 years of health industry experience focusing on hospital and physician practice revenue cycle operations, information systems, patient access and patient accounting, performance improvement and facilities management. Edwin is now a Senior Consultant for Hayes Management Consulting, where he has recently helped to develop and deliver ICD-10 tools and methodologies to their clients. Edwin’s background includes working for a “Big Four” accounting firm, with experience leading revenue cycle assessments, redesigns and implementations as well as working on the provider-side for over 10 years in health system operations.

This article was originally published in Hayes’ Healthcare Blog and is republished here with permission.




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Category: Health Information Exchange (HIE), Health Information Technology


Medical Claims Review Nurse Job – Yoh Jobs

Medical Claims Review Nurse needed for a contract opportunity with Yoh’s client located in Sacramento, CA.

Top Skills You Should Possess:

    - Utilization Management experience
    - Knowledge of CPT and ICD-9 coding

What You’ll Be Doing:

    - Provide timely medical review of claims and claims appeals related to CPT, HCPCS and/or ICD-9 coding, to ensure accuracy of modifiers, place of service and/or date of service and to make processing recommendations per established medical and/or coding criteria/conventions
    - Perform retroactive review of claims requiring medical review, edits, and medical necessity submitted with and/or without prior authorization
    - Verify and identify that claims and authorizations are reviewed for medical and coding appropriateness pre- and post-payment
    - Review, refer and manage possible CCS cases

What You Need to Bring to the Table:

    - Current California RN or LVN license
    - Three (3) years recent utilization management or quality management experience in a clinical setting
    - Strong knowledge / understanding of CPT, HCPCS and ICD-9 coding required
    - Strong knowledge / understanding of RBRVS-based and Medi-Cal fee schedules or payment systems required
    - Understanding of the National Correct Coding Initiative and CPT coding rules / standards
    - In-depth knowledge of AB-1455, regulations and procedures governing Medi-Cal and other state sponsored programs
    - Direct experience in utilization management and/or quality management is required

Bonus Points! Otherwise Known As Preferred Qualifications:

    - Masters Degree in Nursing or a related field preferred
    - Working familiarity with the basic principles of contract law, risk management and health care economics

What are you waiting for? Apply Now!

Recruiter: Jennifer Andersen

Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK. Find out more here!

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

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Ref: 1036705

SFSF: REN

Coding Specialist – Classified Ad

Responsibilities include accurately assigning diagnoses and procedure codes to patient records using ICD-9-CM, CPT-4, and other appropriate coding classification systems; maintains billing turn-around time at established levels.

* Perform regular auditing of provider coding throughout the practice, communicate findings and provide support to provider and manager directly with follow up recommendations to the Compliance Officer and the Board, perform follow up audits as necessary.

* Communicate effectively with physicians and staff regarding correct coding and documentation principles.
* Provide coding and documentation education, updates and training (group and one-on-one) to providers and Patient Account Reps, other staff as needed.
* Design tools to assist providers in appropriate coding and documentation.
* Provide coding training specifically oriented to providers new to the practice.
* Monitor professional publications, payor publications, and websites to remain up to date on coding changes relevant to the practice and communicate as necessary.
* Monitor payer and CMS websites for coding changes and reimbursement alerts.

* High school graduate or equivalent required, Associates Degree preferred.
* Must have at least Certified Professional Coder Certification (CPC) or Certified Coding Specialist – Physician – based Certification (CCS-P).
* Must have at least 2 years experience in assigning CPT and ICD-9 codes to clinical documentation.
* Ability to understand and interpret clinical documentation and understand the department billing processes at a detailed level.
* Excellent organizatonal, communication and customer service skills required.
* Ability to multi-task.
* Extensive knowledge of ICD 9 CM and CPT coding.
* Orthopaedic experience is preferred.

*Date:* 2014-01-31

*Country:* US

*State:* GA

*City:* Atlanta

*Postal Code:* 30342

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Icd-9 Code For 'easy Bruising'? | Detox Houston

If you are wondering which ICD-9 code to use for ‘easy bruising’, just read on and find out:

Easy bruising is a symptom of another condition rather than a standalone diagnosis. As such, the ICD-9 code depends on whether or not the internist identified a cause. So if a cause is identified, then code for the specific disease. However, if no cause is pinpointed, then code for the symptoms.

For easy bruising with no identifiable cause, use 782.7 (Spontaneous ecchymoses). An individual may be suffering from other diseases that predispose him to develop bruises even with minimal trauma (like a light rap on the hands), which otherwise will not happen to normal people; therefore, resulting in ‘easy bruising. For patients suffering from these conditions, bruises seem to spontaneously appear without any identifiable reason.

An ecchymosis is a bruise which is larger than 1 cm. A bruise less than 1 cm however not less than 3 mm is called a purpura. A bruise less than 3 mm is called a petechiae. Code 782.7 also applies to petechia but not purpura, which has several other codes (287.0-287.9) depending on the etiology.

Bruises resulting from trauma can take place owing to a variety of factors including falls, accidents, and post-surgeries. In general, use codes 920-924 (Contusion with Intact Skin Surface) for bruises secondary to trauma. For instance, for a soccer player who was seen by an intern for bruises in the heel, use 924.20 (Contusion of lower limb and of other and unspecified sites; ankle and foot, not including toe[s]; foot [which is inclusive of the heel]). Remember, for a soccer player who was seen by an interim for bruises in the heel, use 924.20 (Contusion of lower limb and of other and unspecified sites; ankle and foot, not including toe[s]; foot [which is inclusive of the heel]). Remember that as per ICD-9 codes, these codes exclude contusions that are incidental to specific categories of injuries such as crushing injury (925- 929.9), dislocation (830.0-839.9), fracture (800.0-829.1), internal injury (860.0-869.1), intracranial injury (850.0-854.1), nerve injury (950.0-957.9), and open wound (870.0-897.7).


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