Pulmonology Coding Alert

Keeping handy a list of most frequent diseases will greatly improve your response-time efficiency.

There is no turning back now, as the ICD-10 implementation date approaches within a few months. Your pulmonology practice too needs to gear up now from the current ICD-9 codes and give serious attention to learning the new system. Don’t wait. Take action now by implementing our experts’ strategies.

Pay Attention to the Following 5 Tasks

Your first step toward organizing your ICD-10 implementation is to form a competent management team and a comprehensive project plan.

“The lack of project management can have a huge financial impact on an organization,” asserts Bonnie Cassidy, senior director of HIM innovation at Nuance Communications, Burlington, Vermont. A good idea would be to conduct a thorough assessment of all departments affected by ICD-10 before budgeting for infrastructure changes. Also track the financial impact by using metrics.

It is essential to know how ICD-10-CM is different from ICD-9-CM (including familiarity with the maps between them). While outpatient coders may not be required to learn ICD-10-PCS (which will be implemented in inpatient settings), it is critical that they apply knowledge of anatomy, physiology, and clinical disease processes to support correct coding assignment for diagnoses in ICD-10-CM.

Once your team is in place, they’ll need to focus on five top areas:

• Assess and improve physician documentation in order to provide the specificity and detail mandated by the new code set.
• Understand the structure, organization, and unique features of ICD-10-CM, the ICD-10 final rule and its implications for your coders.
• Learn about the General Equivalence Mappings (GEMs) between ICD-9-CM and ICD-10-CM.
• Use assessment tools to identify areas of strength and weakness in the biomedical sciences (e.g., anatomy and pathophysiology).
• Review and refresh knowledge of biomedical concepts as needed based on the assessment results.

Test Your System – Then Test Again

“Testing, testing, and more testing is key!” states Sally Beahan, HIM Director at the University of Washington Medical Center. Payers also need to make infrastructural changes to ensure that the reimbursement process is smooth.

“Development of a thorough testing strategy and partnerships with payers around testing are crucial and have proven to be challenging,” Beahan says. All the areas, including clinical areas, revenue cycle, IT, data and reporting, human resources, etc., will all feel the impact of this transition.

Continue Your Focus on More Frequent Diseases

Trainings should focus on the most frequent disease processes your staff come upon daily, such as diabetes or heart failure. Coding managers can select specific clinical disease processes to begin targeted training for outpatient coders.

For example, training on the fundamentals of coding asthma and chronic obstructive pulmonary disease (COPD) in ICD-10-CM may include:

• Differentiating between external and internal causative agents of COPD
• J44 – Other chronic obstructive pulmonary disease

                J44.0 – Chronic obstructive pulmonary disease with acute lower respiratory infection
                J44.1 – Chronic obstructive pulmonary disease with (acute) exacerbation
                J44.9 – Chronic obstructive pulmonary disease, unspecified

•  J45.2 – Mild intermittent asthma
  

                J45.20 – Mild intermittent asthma, uncomplicated
                J45.21 – Mild intermittent asthma with (acute) exacerbation
                J45.29 – Mild intermittent asthma with status asthmaticus

• J45.3 – Mild persistent asthma

                J45.30 – Mild persistent asthma, uncomplicated
                J45.31 – Mild persistent asthma with (acute) exacerbation
                J45.32 – Mild persistent asthma with status asthmaticus

• J45.4 – Moderate persistent asthma

                J45.40 – Moderate persistent asthma, uncomplicated
                J45.41 – Moderate persistent asthma with (acute) exacerbation
                J45.42 – Moderate persistent asthma with status asthmaticus

• Recognizing the characteristics of ICD-10-CM codes for this condition
• Applying the official ICD-10-CM coding guidelines for accurate coding of asthma and/or COPD.

Final thought: “Note that many organizations including the AMA and AHIMA offer ICD-10-CM and ICD-10-PCS training to supplement in-house efforts,” says Sarah Goodman, MBA, CHCAF, CPC-H, CCP, FCS, president of the consulting firm SLG, Inc., in Raleigh, N.C. “There’s help available, you just have to ask for it.”