Rev Cycle Intelligence– By Jacqueline DiChiara on

“They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant.”
Lack of training for inpatient procedural coding may pose a significant challenge for the healthcare industry as 2015 comes to a close, said Teri Jorwic, ICD-10 Educator and Professor of Healthcare Informatics at the University of Illinois at Chicago, to RevCycleIntelligence.com in an exclusive interview last September.

icd-10-cm coding characters
Jorwic caught up once again with RevCycleIntelligence.com to assess what has been happening across the greater healthcare space in regard to procedural coding concerns over the past month and a half.

“The two main things I’ve heard so far have to do with either linking and LCDs [Local Coverage Determination] or NCDs [National Coverage Determination], particularly having to do with the injury codes and the seven characters,” Jorwic states.

Questions about whether or not the coverage is the same post-October 1, 2015 are common, says Jorwic, who confirms coverage policy changes are on the horizon.

“They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant,” she says.

Physical therapists, for instance, may struggle to determine differences between “initial” and “sequela,” as they often deal with a subsequent portion of injury when a patient enters regular recovery.

Another problem now popping up involves new guidelines for the often perplexing Excludes1 notes, says Jorwic.

“There is a new guideline in ICD-10-CM – the diagnoses side that says if you have an Excludes1 note, you cannot code conditions that appear in that Excludes1 notation together,” says Jorwic. “So, the classic example would be, for example, a patient that has a congenital condition, you can’t code that as ‘acquired’ as well.”

Such makes sense, she says, because coding has to be completed for either one or the other. Confusions have been heard by leading organizations and are being clarified, she says.

“We are finding that there are some Excludes1 notes that maybe should have really been Excludes2 notes. Excludes2 means it’s not covered here if you have both conditions and are coding in both,” she explains.

“Unfortunately, because we won’t have the first revision of the system, the code system itself won’t be unfrozen, so to speak, until October 1, 2016. There’s nothing that they can really do,” Jorwic says. “The CDC [Centers for Disease Control and Prevention] put out a notice that was updated October 26, originally posted on October 19, about the circumstances where Excludes1 notes are being found that don’t make sense,” she states.

CDC offers the following advice regarding the interpretation of Excludes1 notes in ICD-10-CM in relation to unrelated conditions: “If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note.”

Says Jorwic, “What they’re basically saying is you can go ahead and use the Excludes1 code in the interim until they have a chance to change that.”

“The Coalition for ICD-10 said it’s kind of all quiet on the Western Front on things in terms of how many things have been coming in and how many things have been denied. I don’t have anything personally beyond that. Maybe the other shoe’s yet to drop but it seems like things are going fairly smoothly.” Jorwic says.

As RevCycleIntelligence.com reported, both the Coalition for ICD-10 and the Centers for Medicare & Medicaid Services (CMS) released statements during the first week of October.

Said the Coalition for ICD-10, “As a result of the replacement of the obsolete ICD-9-CM with the more modern ICD-10-CM and ICD-10-PCS code sets, patients can look forward to complete, accurate, up-to-date diagnostic and procedural data necessary to achieve significant advances in the quality of care and more efficient healthcare administrative processes.”

Said CMS, “It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days.”

Questions about ICD-10 reimbursement? Physician Credentialing and Revalidation ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844 or credentialing@thefirmservices.com
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