Can you believe we now have been using the ICD-10 code set here in the United States for four months?
I often receive technical questions from my colleagues and peers about ICD-10 coding – yes, even before implementation, and certainly after. Even with years of experience and skill, however, we just can’t know (nor should we be expected to know) all the answers to all the coding questions off the top of our heads. So when I’m asked where to go to get an answer or to get coding clarification, I have some specific resources I like to recommend and some steps I can suggest for you to consider and possibly put into practice.
Let’s first think about having a structure or some steps in place for where and who to go to initially within a department or organization to address coding questions from your staff. Within your department or organization there should be an established “coding question process” (written in a policy) or written steps that provide direction for the coding professional on where to go when these situations arise.
Coding professionals first should check the industry-standard coding references and resources, and then they should go to their supervisor or manager to vet the question with them. Then, depending on the department or organization policy or practice and/or outcome, the question may be written and submitted to an external source for guidance. Keeping track of these questions, when they were submitted, when they are answered, and when the answers were disseminated to your coding staff also should be a part of your internal coding question processes or workflow. This provides historical evidence of your coding clarification and could prove to be very useful at a future date – and when coding audits or reviews are performed.
Now let’s take a closer look at seeking coding clarification on the individual level. Each coding professional always should be sure to check the official ICD-10-CM and PCS Official Coding and Reporting Guidelines,first and foremost. These guidelines are a must-have for any coding professional in any healthcare setting, whether a hospital or physician office, etc. You can find these guidelines in your ICD-10 coding book, through your encoder/software, or on the Internet. To download a free PDF file of the guidelines go online to https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-ICD-10-CM-Guidelines.pdf
For the hospital inpatient setting, the ICD-10-PCS guidelines are the go-to document to check first for inpatient procedure coding guidance and/or clarification. To download a free PDF file of the ICD-10-PCS guidelines, go online to https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-Official-ICD-10-PCS-Coding-Guidelines-.pdf.
Both the ICD-10-CM and PCS official guidelines have been approved by the National Center for Health Statistics, the Centers for Medicare & Medicaid Services (CMS), the American Health Information Management Association (AHIMA), and the American Hospital Association (AHA), referred to as the four “cooperating parties.”
These guidelines are considered to be “official,” but always keep in mind that the ICD-10 coding instructions and conventions take precedence over the guidelines. In addition, adherence to these guidelines when assigning ICD-10-CM diagnosis codes or ICD-10-PCS codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (tabular list and alphabetic index) have been adopted under HIPAA for all healthcare settings.
The next coding resource that is very valuable to have isthe American Hospital Association (AHA) Coding Clinic® on ICD-10-CM/PCS. This is a paid subscription publication from the American Hospital Association. The contents and coding guidance are approved by the four cooperating parties mentioned above. The AHA central office is the official U.S. clearinghouse on medical coding for the proper use of the ICD-10-CM/PCS systems.
A bonus to having the quarterly Coding Clinic on ICD-10-CM/PCS subscription is that there is a knowledge quiz in each publication; after passing, the reader receives continuing education units for credentialed coding professionals and health information management (HIM) professionals. I also like for management to have quarterly discussions of the most recent issue of Coding Clinic with their coding staffs. This open dialogue can bring about great perspective and consensus on the guidance among your staff.
In addition to purchasing and receiving the AHA Coding Clinic quarterly, you also can submit coding questions online at no cost. This may be something to consider; to do so, simply go online to www.codingclinicadvisor.com and follow the instructions posted there.
Just this past September, AHIMA announced a new service for fielding coding questions called CodeCheck™.This service allows for coding questions to be submitted online to the AHIMA coding experts, who provide a response back via email. There is a fee for this service, which includes single submitted questions and an annual submission for a number of questions; another option is individual purchasing or a packaged purchase of questions/answers for an organization. It should be noted that this service includes more than ICD-10 coding questions. The subscriber or purchaser can submit questions on HCPCS and/or CPT as well. All answers are based on sound coding guidelines released from both the AHA Coding Clinic® and AMA CPT Assistant®. The response time for this AHIMA coding service is rated as very good, usually within 48 hours (Monday-Friday).
The Centers for Medicare & Medicaid Services (CMS) alsohas a website set up to publish frequently asked questions about ICD-10. Although not a true coding question clearinghouse, it does have some good information for the healthcare industry.
One section titled “Coding” includes the following FAQs:
From the Centers for Disease Control and Prevention: Interpretation of Excludes1 notes in ICD-10-CM when the conditions are unrelated to one another. (Posted Oct. 16, 2015)
What qualifier do I use for ICD-10 diagnosis codes on electronic claims? (Posted Oct. 16, 2015)
How do I access the ICD-10 code set? (Posted Sept. 10, 2015)
Another section at this site is the claims processing and billing guidance. Here’s a sample of some of these FAQs:
Does CMS require updated physician (or non-physician practitioner) orders for lab, radiology services, or any other services after ICD-10 implementation? (Posted Sept. 29, 2015)
What are the “established time limits” to process claims? (Posted Sept. 22, 2015)
Currently the guidance document only applies to services paid under the Medicare FFS Part B physician fee schedule. Will the guidance be expanded to other provider/claim types? (Posted Sept. 22, 2015)
Do the ICD-10 audit and quality program flexibilities extend to Medicare FFS prior authorization requests? (Posted Sept. 22, 2015)
I hope you found this information useful to you and your coding staff. If you don’t have a set process in place for addressing coding questions or for coding clarification, this is the time to develop one.
Also, if you don’t have AHA Coding Clinic on ICD-10-CM/PCS subscription, this is a good time to include it in your budget. In addition, read through the AHA Coding Clinic and discuss it with your coding staff.
There are always going to be coding questions for which we need to check resources to find answers. However, having a standard set of resources and references in place and a set process can make the challenges easier to handle.
About the Author
Gloryanne is a coding and HIM professional with 35 years of experience.