Why & When Should I Care About ICD-9 vs. ICD-10 Coding?

By Sparkle Sparks & Annette Lee

Part 1: By Sparkle Sparks, PT, MPT, COS-C

Senior Associate Consultant, OASIS Answers, Inc., AHIMA Approved ICD-10 Coding Instructor

Last week, CMS confirmed through final rule publication that the implementation date for ICD-10 has officially changed to October 1, 2014. We all know that codes (currently of the ICD-9 variety) are a required part of our medical documentation. Many of us participate in one way or another in deciding which codes go where. But what do they really mean and how careful should we be in selecting them? When you consider what they’re used for the answer can be stunning.

First and foremost these numbers become part of our patients’ medical records – and they follow them for the rest of their lives. Remember, “First do no harm.” This applies to our documentation as well as our clinical interventions. None of us would intentionally harm our patients yet it seems as though some of us who choose these codes have no idea the damage that we can do when we assign codes erroneously. A classic example is assigning psychiatric codes from the mental disorders chapter based on observations reported on the OASIS or medications that we list on the 485. The rules that govern the completion of an OASIS are not the same as the coding guidelines. For the rest of Sparkle’s article, please click here.

Part 2: By Annette Lee, RN, MS, COS-C, HCS-D

Senior Associate Consultant, OASIS Answers, Inc., AHIMA Approved ICD-10 Coding Instructor

Sparkle provided us with a great baseline in why coding is important. I come from a background of working for the Medicare Intermediary- so payment is on my mind. Is coding still at the core of reimbursement? Does it really have that much impact? Short answer: ” Yes”. So much so, that the OIG addressed coding again in the March 2012 report. The report noted that in 2008, the records reviewed by the OIG found that home health agencies up-coded (i.e., billed at a level higher than warranted) about 10 percent ($278 million) of claims. This is a big concern to the government, home health providers, and all of us as taxpayers. The report went onto say that home health agencies down-coded (i.e., billed at a level lower than warranted) about 10 percent ($184 million) of claims. Can we as an industry afford to not have appropriate payment, to the tune of $184 million dollars? The short answer, “No!”

Coding has been a part of the case-mix, PPS system since its inception. It has changed (can you say HIPAA?), expanded (Refinement of 2010) and recently contracted (deletion of hypertension codes in 2012) over the years. We are still all working on getting it right, as CMS provides us with additional guidance. For the rest of Annette’s article, please click here.

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