Medicare Compliance & Reimbursement

CMS recently posted the 2012 ICD-10 code update, which not only shows which codes were added, deleted, and revised this year, but also offers information on the new diagnosis coding system, which will be mandatory for all providers as of Oct. 1, 2013.

For example: In 2011, ICD-10 codes for hemorrhoids were found in the I84 category (Diseases of veins, lymphatic vessels, and lymph nodes, not elsewhere classified), which spanned from I84.0 (Thrombosed hemorrhoids) through I84.6 (Residual hemorrhoidal skin tags). Now, however, hemorrhoids are classified with "Diseases of the digestive system (K00-K945)," which is found in chapter 11 of ICD-10.

You'll find the ICD-10 codes for hemmorhoids now assigned to codes K64.0 (First degree hemorrhoids) through K64.9 (Unspecified hemorrhoids). Many other ICD-10 codes follow suit with new and revised code assignments, so you should update your list of the top 30 most common codes that you have been developing in preparation for the ICD-10 transition.

In addition, CMS has released a list of duplicate codes that show which ICD-10 descriptors are assigned to the exact same codes as an existing ICD-9 classification. For instance, if you look up the ICD-10 code for "Wilson's disease" and find that it's E83.01, you may notice that looks familiar. That's because ICD-9 code E83.01 is currently an active diagnosis code to represent a boat accident (which will eventually be coded using V90.89 under ICD-10). It is unclear whether CMS intends on replacing the ICD-10 codes that are repeated (with different meanings) under ICD-9 or whether they have simply pointed the duplicates out to make practices aware of the differences.

For more on the 2012 ICD-10 changes, visit http://www.cms.gov/ICD10/11b14_2012_ICD10CM_and_GEMs.asp.

Sometimes common sense does seem to prevail at the policy-making level.

CMS has agreed to delay two contentious demonstration projects -- the Prepayment Review and Prior Authorization for Power Mobility Devices (PMD) demonstration and the Recovery Audit Prepayment Review demonstration. CMS received many comments and suggestions regarding these demos, so it needs the time to "carefully consider" the comments, the agency says in an e-mail message to providers.

The agency didn't give a timeline for the delays. However, it will provide "at least 30 days notice" before the demonstrations begin, it says.

If you bill for a hospital in Rhode Island, you may see some additional money coming your way if you meet newly implemented quality standards. Blue Cross Blue Shield (BCBS) of Rhode Island launched a new program with local network hospitals in November called the Hospital Quality Program.

According to a press release from the payer, "the program, which uses standard, 'evidence-based' performance metrics, also realigns financial incentives so that hospitals that provide high-quality patient care receive more compensation." The goal, according to BCBS, is to "improve the quality, safety and efficiency of healthcare received by its members."

Thus far, 90 percent of the hospitals in the payer's network have agreed to participate in the program for 2011. BCBS hopes to achieve 100 percent participation by the end of next year, the press release states. The program also hopes to help moderate long-term healthcare costs through patient health improvements and hospital readmission reductions.

"Ironically, healthcare is one of the few industries today where financial incentives are linked to the volume of services provided, not the quality of those services," explained Gus Manocchia, M.D., BCBSRI's senior vice president and chief medical officer. "If you own a restaurant and you serve food that tastes bad, you're going to lose customers. If you're a car manufacturer and your car doesn't perform well in crash tests, you're going to lose customers. But the United States spends more per capita on healthcare than most other developed nations, and we aren't any healthier."