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Brilliant: Hannah Galvin Looks at ICD-10’s Five Stages of Grief

Posted on August 18, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Hannah Galvin, MD has a great article on Healthcare IT News talking about ICD-10’s five stages of grief. You can go read the article to see how she describes it, but the five stages of grief are:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

Pretty fascinating way to describe people’s response to ICD-10. I think we have people and organizations that are still at all 5 stages of grief associated with adopting ICD-10. Although, I think most people have bridged #3.

There are still many people that are in denial and that are angry about ICD-10. Although, that population is getting smaller and smaller. I don’t see many people still bargaining. We went through that stage for years, but I believe it’s over. The largest group of people are stuck in stage 4. I know very few people who aren’t depressed over ICD-10. The HIM profession is more excited about ICD-10 than anyone else, but otherwise it’s a general depression around the change. It’s hard to implement something where you’re not sure what value you’ll receive from it. I think that’s many people’s perspective.

Dr. Galvin’s final comment in the article linked above is also interesting: “Whether you’re ready or not, the transition is less than three months away – and in the end, I believe it will be worth all the grief.” Now we’re less than 2 months away. I’m still not sure it’s worth the switch or not, but it doesn’t really matter. It’s happening either way. I guess I’ve reached stage 5.

ICD-10 Training Games and Lookup

Posted on August 12, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

NueMD has recently launched what they’re calling their ICD-10 Training Lab. To be honest, I wasn’t sure what to expect when they sent it over to me. They told me it was a free ICD-10 training lab. With ICD-10 breathing down our necks, I was interested to see what they’d put together.

If you’re looking for a full scale ICD-10 training course, then this isn’t it. I asked my HIM Manager friend, Erin Head, on Twitter about the training and she replied that “It’s very basic level but a good start. Still need to know how to code. Nice mobile view.”

Erin brings up a fine point. The ICD-10 training lab is not going to teach you to code. I don’t think that was NueMD’s intent. I think their intent was to provide a tool for those who already understand coding to be able to learn some of the new ICD-10 codes. In fact, since they’ve broken it out into specialties, my guess is that they really hope this ICD-10 training lab will help doctors to get up to speed on the most common new ICD-10 codes for their specialty.

My favorite part of the ICD-10 training lab is the ICD-10 Training games:
ICD-10 Training Games
What’s better than a game to learn something? Plus, when you’re trying to memorize something, repetition is a real key to learning. Games are great at providing a fun way to get in your repetitions.

The ICD-10 training lab also includes an ICD-10 code lookup. You can tell they’ve put in quite a bit of effort to make their ICD-10 code search work quite well. Although, it’s still just an ICD-10 code search. Something that should be incorporated in most EHR systems.

Funny ICD-9 Codes Video – Putting ICD-10 Codes in Perspective

Posted on August 11, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to Jennifer Della’Zanna’s post on putting crazy ICD-10 codes in perspective, I wrote about the funny ICD-9 codes over on EMR and HIPAA. I guess ClinicSpectrum liked the post enough that the decided to create a video animation of the post. I thought it was pretty cool. Check it out:

ICD-10 is near. Are you ready?

Crazy ICD-10 Codes? Let’s Put Them In Perspective

Posted on July 16, 2015 I Written By

The following is a guest blog post by Jennifer Della’Zanna, medical writer and online instructor for Education2Go.
Jen HIM Trainer
Exhibit A: W55.21XA Bitten by a cow, initial encounter

Exhibit B: Y92.241 Hurt at the library

Exhibit C: Y93.D1 Accident while knitting or crocheting

Exhibit D: W56.22 Struck by Orca, initial encounter

These are the kinds of codes trotted out to “prove” how ridiculous moving the ICD-10 coding system is. What do we need these codes for? Everybody seems to be asking this question, from congressmen to physician bloggers to—now—regular people who have never before even known what a medical code was.

Here are a few things you should know about these codes. Some of you actually should know this already, but I’ll review for those who have been sucked into the maelstrom of ridicule swirling about the new code set.

  1. You’ll notice that all those crazy code examples start with the letters V, W, X and Y. These are all “external cause codes,” found in just one of ICD-10’s 21 chapters (Chapter 20). In my version of the manual, that encompasses 76 pages. Out of 848.

    External cause codes are the only ones ever trotted out as ridiculous. Do the math. They make up 9% of the codes. They are used mainly to encode inciting factors and other details about trauma/accident situations. There are some other uses, but not many. Do most people use them in everyday coding? No. That’s not going to change with the new system. If you’re a coder who is not already using external cause coding on a day to day basis, you will likely not have to start now. Most people never look in this chapter—ever.

  2. The reason there are such funny codes is the system allows you to “build” a code using pieces, which is what makes the book so easily expandable in all the right places (which is the point of the entire code change—the external cause codes just came along for the ride). Let’s look at Exhibit A: Bitten by a cow, initial encounter:
    The first three characters of the code indicate the category. Each additional character adds some detail.W55 is the category “Contact with other mammals”The 4th character 2 indicates contact specifically a cow (although included in this code is also a bull). You can change the animal to a cat by using 0 or a horse by using 1. You get the idea, right?

    The 5th character 1 indicates that the injury is a bite. A 2 would mean the patient was struck, not bitten.

    The 6th character X is a placeholder because this code requires a 7th character extension to indicate what encounter this visit was.

    The 7th character A indicates that this was an initial encounter. You could change this to a D if the patient has returned for subsequent visits or an S if the patient ends up with another problem later that could be attributed to this original cow—or bull—bite.

  3. We can code most of those same ridiculous codes with ICD-9, although most times not quite to the same specificity. I’ll match the ones below to the exhibits we have at the top:
    Exhibit A: E906.3 Bite of other animal except arthropod

    This is what we would currently have to use for “bitten by a cow.” There is no way in the current code set to indicate whether this is an initial encounter or a follow-up encounter for this accident, however. Since the code is so vague, this code could actually also be used to mean “bitten by a platypus” or “bitten by a pink fairy armadillo,” so yes, you can still code that in ICD-9, but not as well.

    Exhibit B: E849.6 Accidents occurring in public building

    Do you consider a library a public building? I do. Yep, you can code that with ICD-9, but not as well.

    Exhibit C: E012.0 Activities involving knitting and crocheting

    This is what we call a one-to-one mapping. A specific code for this already exists in ICD-9 with exactly the same description. Next.

    Exhibit D: E906.8 Other specified injury caused by animal

    This is the code we would have to use to indicate an attack by an Orca. Again, no indication of what encounter it is, but this time there is actually no reason to even use this code because, really, what information is it giving you? The patient was injured by an animal. We have no idea what kind of injury or what animal caused it. I’m all for going to a useful code for those rare occurrences of attacks by Orcas (which, as we all know, do occur from time to time!).

The real point is not what kinds of crazy things are now able to be coded, it’s what critical things can be coded with ICD-10 that could not be coded with ICD-9. The most newsworthy one is Ebola. In ICD-9, we have to use 065.8 Other specified arthropod-borne hemorrhagic fever. In ICD-10, we have A98.4 Ebola virus disease. But there are other reasons to go to the new system. There are new concepts in ICD-10 that didn’t exist in ICD-9, like laterality. We now have the ability to indicate which side of the body an injury or other condition occurs. This inclusion is one of the biggest reasons for the book’s code expansion. Each limb and digit has its own code (but, again, it’s the changing of one number in the overall code that indicates left or right, and which digit is affected). With all the complaints about the increased documentation required for the new code set, one would hope that most physicians already document which hand or arm or leg or ear or eye or finger is affected. As I mentioned above with the seventh-character extension, there is the ability to indicate the encounter and, more importantly, to link a prior condition with a current one with the use of the S character that indicates “sequela.”

There’s much evidence that the ICD-10-CM will help make patient records more accurate and reporting of conditions more precise. This will lead to improved research abilities and a healthier worldwide population. And the ridiculing of ICD-10 codes, which I’m sure will continue long after this blog post has disappeared from your newsfeed? Well, they always say that laughter is the best medicine!

About Jennifer Della’Zanna
Jennifer Della’Zanna, MFA, CHDS, CPC, CGSC, CEHRS has worked in the allied health care industry for 20 years. Currently, she writes and edits courses and study guides on medical coding and the use of technology in health care, as well as feature articles for online and print publications.  You can find her at www.facebook.com/HIMTrainer and on Twitter @HIMTrainer.

Can We Now Officially Say that ICD-10 Is Going to Happen?

Posted on July 15, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

With the announcement that came a little over a week ago about CMS and AMA working together on ICD-10, does that mean that we can officially say that ICD-10 is going to happen? The ICD-10 Watch blog has a good summary of what CMS committed to do in the announcement:

  • CMS is creating an ICD-10 Ombudsman to deal with healthcare providers’ ICD-10 problems. More on how this will work later.
  • Without using the words “safe harbor” or “grace period,” CMS promises that Medicare will not deny any medical claims “based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.”
  • Quality reporting programs such as Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) will suspend penalties that may result because of lack of specificity.
  • There will be advance payments available if the Medicare system has problems.

The second and fourth items have gotten all the buzz. Most have interpreted that the second one means that CMS won’t deny ICD-10 claims that weren’t done correctly. That’s an overstatement, but it does decrease the number of denied claims that will occur with the switch to ICD-10. The fourth item listed above was a major concern that I raised, but it applied to all payers and not just CMS. So, it’s nice that CMS has addressed the cash flow challenges that slow claims processing of ICD-10 claims will cause, but that still leaves all the other payers.

With the “peace treaty” signed between AMA and CMS, can we finally say that ICD-10 will not be delayed again? One person suggested to me that it just leaves the AHA as a possible opponent that could stop it. However, I also heard it suggested that they weren’t looking for a delay.

While usually avoiding trying to predict the unpredictable Washington, I’m going to say that we can safely assume that ICD-10 will not be delayed again. We might see an overture or two still that tries to delay it, but if I were putting my money down in Vegas I’d put it all on No ICD-10 Delay in 2015. Are you putting your organization’s “bet” in the same place?

Industry Tries To Steamroll Physician Complaints About EMR Impact On Patient Face Time

Posted on June 9, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Some doctors — and a goodly number of consumers, too — argue that the use of EMRs inevitably impairs the relationship between doctors and patients. After all, it’s just common sense that forcing a doctor to glue herself to the keyboard during an encounter undercuts that doctor’s ability to assess the patient, critics say.

Of course, EMR vendors don’t necessarily agree. And some researchers don’t share that view either. But having reviewed some comments by a firm studying physician EMR use, and the argument an EMR vendor made that screen-itis doesn’t worry docs, it seems to me that the “lack of face time” complaint remains an important one.

Consider how some analysts are approaching the issue. While admitting that one-third to one-half of the time doctors spend with patients is spent using an EMR, and that physicians have been complaining about this extensively over the past several years, doctors are at least using these systems more efficiently, reports James Avallone, Director of Physician Research, who spoke with EHRIntelligence.com.

What’s important is that doctors are getting adjusted to using EMRs, Avallone suggests:

Whether [time spent with EMRs] is too much or too little, it’s difficult for us to say from our perspective…It’s certainly something that physicians are getting used to as it becomes more ingrained in their day-to-day behaviors. They’ve had more time to streamline workflow and that’s something that we’re seeing in terms of how these devices are being used at the point of care.

Another attempt to minimize the impact of EMRs on patient encounters comes from ambulatory EMR vendor NueMD. In a recent blog post, the editor quoted a study suggesting that other issues were far more important to doctors:

According to a 2013 study published in Health Affairs, only 25.8 percent of physicians reported that EHRs were threatening the doctor-patient relationship. Administrative burdens like the ICD-10 transition and HIPAA compliance regulations, on the other hand, were noted by more than 41 percent of those surveyed.

It’s certainly true that doctors worry about HIPAA and ICD-10 compliance, and that they could threaten the patient relationship, but only to the extent that they affect the practice overall. Meanwhile, if one in four respondents to the Health Affairs study said that EMRs were a threat to patient relationships, that should be taken quite seriously.

Of course, both of the entities quoted in this story are entitled to their perspective. And yes, there are clearly benefits to physician use of EMRs, especially once they become adjusted to the interface and workflow.

But if this quick sample of opinions is any indication, the healthcare industry as a whole seems to be blowing past physicians’ (and patients’) well-grounded concerns about the role EMR documentation plays in patient visits.

Someday, a new form factor for EMRs will arise — maybe augmented or virtual reality encounters, for example — which will alleviate the eyes-on-the-screen problem. Until then, I’d submit, it’s best to tackle the issue head on, not brush it off.

ICD-10 Survey Results: ICD-10 Business Areas of Concern

Posted on June 4, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Pretty regularly, NueMD does a survey of medical practices that produces some great insights into the small practice world. This year they decided to survey medical practices about ICD-10. They’ve posted the ICD-10 survey results for those interested in really diving into the detailed survey results. They had a total of 1000 responses from primarily small and medium-sized medical practices. That sample size always gives me a little more trust in the survey.

As I looked through their ICD-10 survey results, this is the chart that really stood out to me:
ICD-10 Business Areas of Concern
The thing that attracted me to this chart first is that it highlights a number of areas where a medical practice might be concerned when it comes to ICD-10 readiness. Are you doing the right ICD-10 training and education? Have you done payer testing? Have you budgeted in any software upgrade costs that may be required to meet ICD-10? How about claims processing? Are you ready? Will you be ready by the ICD-10 deadline? These are all good questions that every organization should be asking themselves as we move towards Oct 1 (ICD-10 implementation date for those following along at home).

The second reason I love this chart is that it shows you where organizations are most concerned. I was not surprised to see that many are really afraid of how claims processing is going to go during the transition to ICD-10. What are you and your organization doing to prepare for this? It’s going to be a really big deal for many organizations and could cause them massive cash flow issues if things go bad.

The second highest was Training and Education. This is an extremely challenging one for small practices in particular. Plus, the timing is hard as well. If you train them too early, they’ll forget it come Oct 1st. If you wait to long to do the ICD-10 training, then you might not have time to train everyone that needs to be ready. I’ve seen most organizations training earlier and then doing short refresher courses or content as they get closer.

I’m planning to do another ICD-10 post soon to talk about predictions on whether ICD-10 will go forward or not. So, watch for that in the future. However, I think organizations that aren’t acting as if it’s going forward are playing a game of Russian roulette. They’re certainly braver than I’d be if I were running a healthcare organization.

Survey: ICD-10 Business Areas of Concern

Posted on April 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Each year, NueMD does a survey of providers around ICD-10. 2015 was no exception. You can see the full results of their ICD-10 survey here. They had over 1000 respondents to the survey with the majority of them coming from small practices and 43% of them coming from patient care (DO, MD, DC, NP, RN, etc).

You should take a minute to check out the full results, but this chart from the survey results really caught my eye:

ICD-10 Business Areas of Concern for Doctors

Regardless of whether you’re interested in the results or not, the list of possible areas of concern is worth considering for your organization: Training/Education, Payer Testing, Software Upgrade Cost, Claims Processing, and Compliance Timelines/Deadlines. Are any of these areas a cause for concern with your practice when it comes to ICD-10? My guess is that it has many of you concerned about the switch to ICD-10.

I was glad to see that claims processing was the biggest concern. It should be a concern for doctors and you better prepare for it to be an issue. If you don’t, it’s very likely that you could run into a cash flow issue for your practice.

All signs seem to be pointing towards no more ICD-10 delays. Although, I did hear someone tell me that Congress had 15 (at least somewhere in that range) more opportunities to slip in language to delay ICD-10 again. That’s not likely comforting for healthcare organizations out there. However, I think at this point, organizations need to assume that it’s coming and prepare accordingly. Not doing so could have some dire circumstances come October.

Great ICD-10 Image and Poll

Posted on March 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw this great graphic on Twitter today which made me laugh:

I have friends in DC with AHIMA trying to make the case to their representatives in Congress that they shouldn’t delay ICD-10. Word on the street is that as of now (subject to change as we saw last year), the SGR fix bill doesn’t contain an ICD-10 delay. Of course, the real challenge with ICD-10 now is the uncertainty of it all.

I thought it might be interesting to see what the readers of EMR and EHR predict for ICD-10. So, here’s a simple ICD-10 poll about whether ICD-10 will be delayed or not.

5 Features to Look for in a Medical Billing Company

Posted on March 4, 2015 I Written By

The following is a guest blog post by Harold R Gibson, Chief Financial Officer at M-Scribe Technologies, LLC.
Harold Gibson
A full-service medical billing company does more than code and file medical insurance claims. While that may still make up the bulk of a company’s output, a good medical billing company should offer additional services to help a practice achieve both profitability and compliance goals. Look for the following main features in a medical billing company:

  1. With the transition from ICD-9 to the new ICD-10 coding system in place, a billing company’s coding, billing and other EHR staff should be trained and experienced to ensure optimum accuracy – the foundation of compliance, and therefore improved timely payment. Since many practices have less time or budget for training billing staff in all aspects of the newer, more complex coding system, it falls to the medical claims processing service to fill in any gaps in the EHR process. A company which carefully monitors the EHR content entered will improve the accuracy of the codes and therefore ensure better compliance and payment as well as lessen the chances of an audit. Duplicate claims, payments included in a previously-billed service or procedure already adjudicated and non-covered charges are some of the most common reasons for claim denials. Make sure your practice doesn’t make these billing mistakes by letting a professional medical billing services company handle the workload.
  1. Accurate medical documentation is critical to having claims paid on time, with no rejection due to errors or incomplete filings. This is especially true of Medicare claims, whereby a Certificate of Medical Necessity and other required documentation must be correct and current to merit payment without multiple resubmissions. The right medical billing services company should use  technology and experience when entering only claim-relevant content data, correct procedure (CPT) and diagnosis codes (ICD-9 and ICD-10). These should then be entered into the EHR charts, providing convenience, increased efficiency and cost reduction.
  1. Specialty-specific billing services are available to group practices and clinics as well as individual physicians. Whether your practice uses billings systems such as eClinicalWorks, Greenway, Kareo, NextGen or other popular systems, the right service should be able to help. Whether your practice specializes in Surgical, Dermatology, Nephrology, Orthopedic, Radiology or anything else this should not be a problem for your billing provider. As a bonus, full-service billing companies can provide other services to you, including patient scheduling, verification of eligibility, performing patient demographics, coding and claims submission.
  1. Pre-RAC audit-related support: Complying with the complexities of Medicare and Medicaid regulations can be challenging even for an experienced billing staff in many practices – even more so for smaller or solo practitioners, who often have just one or two staffers handing billing as well as other duties. On the other hand, offering pre-audit support can be tricky for smaller, less experienced billing companies.  An experienced medical billing company can help with preparing a pre-audit checklist to supply requested audit information.
  1. Training webinars for billing and coding staff are another service designed to reduce the chance of errors caused by unfamiliarity with the new coding system as well as keeping abreast of regulatory and other changes. Offered free of charge, these webinars explore the history of ICDs, a comparison of ICD-9 and ICD-10, coding guidelines and formats as well as a step-by-step plan for implementation. These webinars can help solve the dilemma of not enough time or money to send busy staff to expensive, days-long ICD-10 training classes.

If you are looking for a medical billing company, it is important to choose a company that houses the above five features and remember to look for a company that will help with profitability and compliance goals.

About Harold R Gibson
Harold R Gibson is the Chief Financial Officer at M-Scribe Technologies, LLC, an accomplished healthcare professional with extensive experience in the medical billing and coding industry. You can find him on Twitter @mscribetech. He is interested to get your feedback/suggestions. Please email him at H.Gibson@m-scribe.com.