ITEMS IN FPM ON TOPIC:
Our tour of ICD-10 continues with the minor injury codes you’re likely to use in family medicine.
In ICD-10, hypertension has a limited number of codes that, on the surface, may appear to make coding this condition relatively simple, at least compared to some of the other ICD-10 complexities. There are only nine codes for primary hypertension and five codes for secondary hypertension. However, as is often the case, the devil is in the details. For example, ICD-10 assumes a causal relationship between hypertension and chronic kidney disease, but you must document the relationship between hypertension and heart disease. Additionally, all of the hypertension codes require an additional code if the patient is a current or former tobacco user. If hypertension is secondary to another disease state, code the underlying condition as well as one of the secondary hypertension codes.
ICD-10 will go into effect on Oct. 1, 2014, for services provided on or after that date. The transition to ICD-10 will be significant and requires proper planning and preparation. First steps include obtaining a copy of the ICD-10 code book and orienting yourself to the new code set, which demands greater specificity. While there are programs available to crosswalk ICD-9 codes to ICD-10 codes, the ICD-9 codes must be specific. Practices should identify the most commonly used diagnosis codes and conduct chart reviews to determine whether current documentation will be sufficient to support ICD-10 coding. Both staff and physicians will require ICD-10 education that includes coding cases. Additionally, practices will need to work with their vendors to ensure ICD-10 preparedness, set cash aside or establish a line of credit to prepare for potential reimbursement delays, and establish new coding workflows for the transition period.
The switch from ICD-9 to ICD-10 will occur on Oct. 14, 2014. As a first step in their preparations, physicians need to understand 1) the basic changes inherent in the ICD-10 system and 2) how those changes drive the need for additional documentation details. Under ICD-10, the number of diagnosis codes increases substantially, allowing for greater specificity in coding. In turn, this requires physicians to be more specific in their documentation. Although the idea of having the number of diagnostic codes expand is unsettling, physicians can handle it. Many of the new codes are combinations of current ICD-9 codes; many additional codes simply specify right, left, or bilateral; and many other codes are for more complex conditions that are rarely seen in primary care. By learning the basics of the ICD-10 coding system, making some adjustments to their current written or dictated documentation, and ensuring that their EHR system can handle the required increased specificity of documentation, physicians can be ready when ICD-10 arrives. The article includes a two-page document that describes how to document diabetes mellitus under ICD-10.
The author, a certified professional coder, presents three sample progress notes, challenging the reader to code them appropriately and then explaining how the notes appear from the coder's point of view and what codes she believes the notes will support.
A family physician expert in malpractice risk prevention describes strategies for reducing liability exposure using lessons drawn from actual malpractice cases.
The authors introduce a documentation tool appropriate for nursing home cares. The tool was designed to help residents sift through the complexities of the nursing home resident, and the authors believe that it can be widely used with the same benefit by all practicing family physicians.
The author outlines an approach to the progress note that emphasizes including the rationale for diagnoses and treatment plans in order to make notes better reflect the physician's thought processes.
A $1.5 million study is underway to determine whether this practice is a good idea. Spoiler alert: It is.
The article, the third in a three-part series, details the section of Medicare's E/M documentation guidelines pertaining to medical decision making and explains how to comply and practice efficiently with them.