Can You Guess Which of These ICD-10 Codes Are Actually Real?

With the impending implementation of ICD-10 codes on October 1st, people have started to take note of all the new codes and they have found that some of them are pretty ridiculous. Going from having 13,000 billing codes under ICD-9’s coding system, which has been around since 2002, to 68,000 codes with ICD-10 will be a huge adjustment for everyone in the healthcare industry.

The new codes range from a little unbelievable to absolutely absurd, begging people on social media in healthcare to wonder “what’s the point of this new diagnostic coding system?” ICD-10 matters though and here’s why:

1. It is vital to health care reform as it will help patients achieve better quality of care, improved care access and lower costs
2. It will improve quality reporting programs like PQRS
3. It will include new procedures and references to medical breakthroughs/innovations
4. It will help researchers to have a better, more focused understanding of public health
5. It will enable physicians to be more efficiently reimbursed for the care they are providing

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With all these new codes though, how is someone to tell which codes are for real? Take our quiz to see if you can guess which of these ICD-10 codes are real and which ones are fake.

Poll Maker

Why ICD-10 Matters

Many people might be wondering why CMS is even moving forward with the implementation of ICD-10 codes, but we are here to tell you why ICD-10 matters. It’s a daunting task, getting everyone in healthcare to adopt this new set of billing codes, which is why it has been pushed back so many times before. The time has finally come however, on October 1, 2015 ICD-10 codes will be implemented and healthcare providers will have 55,000+ (no, those zeroes are not a typo) new codes to learn.

Other than the fact that the ICD-10 train is coming and we don’t have a choice but to jump onboard, let’s take a look at a few ways ICD-10 will improve the health care industry:

• It is vital to health care reform as it will help patients achieve better quality of care, improved care access and lower costs

• It will improve quality reporting programs like PQRS

• It will include new procedures and references to medical breakthroughs/innovations

• It will help researchers to have a better, more focused understanding of public health

• It will enable physicians to be more efficiently reimbursed for the care they are providing

Yes, learning all the new codes will take time. Yes, it might be a little annoying at first, but change is always a little uncomfortable. Just think, in a couple of years you won’t even remember what it was like before ICD-10. You’ll be all like, “You’re still hanging on to ICD-9 codes? Psh. Might as well be carrying around a flip phone in your cargo shorts while you listen to your Walkman.”

ICD-10 Education

Working with our partner, Universal Health Network, we’ve learned a lot about medical billing and all of the changes that are coming up.  Terms like ICD-10 and meaningful use have been floating around since this time last year, but like many others out there, we didn’t have the specifics. 

First, it is important to know what the difference is between ICD-10 and its predecessor; ICD-9.  Coders will have to go from knowing 13,000 diagnosis codes to a whopping 68,000 codes with ICD-10. If you’ve been wondering what people have been complaining about, this is it. Imagine the knowledge needed for you skill set growing to more than six times its size and trying to keep up.  Inconveniently, there are no simple conversions from ICD-9 to ICD-10.  Some codes here and there are remaining the same, unfortunately the new system is much more robust. Taking one code and breaking it down into many more specific codes now, the ICD-10 codes even look different.  Previously, codes were only 3-5 characters, while now they can have up to 7 characters.

Now, why was it necessary to make all of these changes if the system worked before?  Well, think about how fast technology has changed over the last few years. There’s literally a new iPhone every other year and people all across the world immediately adopt that new technology.  Now think about the medical advancements that are being made daily.  Every year there are newly identified medical conditions and brand new treatments and medical devices discovered.  Just to give you an idea of how desperately these changes were needed, ICD-9 had been around since 1979.

(Medical Advancements from 1979 to 2003 via: AAMC)

1979 First use of the immunosuppressant drug cyclosporine, now standard therapy for organ-transplant patients

1980s Development of coronary angioplasty

1980 First acute spinal cord injury intensive care unit

1981 First successful surgery on a fetus in utero

1981 Establishment of the first Pediatric Trauma Center

1981 First successful human combined heart/lung transplant

1981 Development of the first artificial skin made from living human cells

1981 Descriptions and reports of the nation’s first cases of AIDS

1981 Development of balloon angioplasty

1983 First performance of autologous bone marrow transplant for acute myeloid leukemia

1984 First successful pediatric heart transplant

1985 First Fetal Cardiovascular Center

1986 First hospital to initiate a lung transplantation program

1986 First use of lithotripsy to break up common duct gallstones

1988 First successful double-lung transplant

1989 First living-donor liver transplant, and in 1993, the first liver transplant from an unrelated living donor

1989 Identification of human umbilical cord blood as a suitable source for stem cell transplantation

1993 First Geriatric Research and Training Center

1993 First human gene therapy trial for cystic fibrosis

1993 First gene-therapy procedure on a newborn infant, correcting an inherited disorder of the immune system

1994 First use of functional MRI to provide rapid diagnosis of most strokes

1994 First gamete intrafallopian transfer for treatment of female infertility

1994 First human retinal cell transplant

1995 First implantable, artificial inner ear for treatment of deafness

1995 First deep brain stimulator implantation for the treatment of Parkinson’s disease

1996 Development of computer-assisted stereotactic neurosurgery

1997 First use of gene therapy in cardiac disease in humans

1997 First stem cell transplant for active lupus

1997 First retinal transplant

1997 First transplant of human fetal tissue in patient with spinal cord injury

1998 First laryngeal transplant

1999 First hand transplant

2000 First quadruple transplant of four organs—a kidney, two lungs and a heart—from a single donor

2000 First bioengineered cornea transplant

2001 First implantable replacement heart that functions without a permanent attachment to a power source

2001 Discovery of stem cells within the pancreas that can generate insulin-secreting beta cells

2002 Development of a Rapamycin-coated stent, a breakthrough in the prevention of restenosis following cardiac catheterization

2003 First successful larynx reconstruction accomplished using tissue taken from patient’s arm

The time to make changes will be up on October 1st this year and those who have not taken steps to prepare for ICD-10-PCS will be left in the dust.  This transition period is predicted to be rather turbulent for providers across the board, even 1/3 of hospitals still haven’t started their ICD-10 education.  Those who haven’t been getting ready have a couple of options at this point:

-       begin training with ready-made education programs

-       out-source your coding to a medical billing company

Having your coding managers in-house certainly has its pros, but with these changes, getting by with your current systems will prove very difficult.  When it comes to coding, the margin for error has grown and with reimbursement cuts, it is increasingly more important to be accurate.

Are you ready for October 1st?

The Rise of Health Care Compliance Programs

The Patient Protection and Affordable Care Act (PPACA) requires health care providers to enroll in a federally mandated health care plan and to adopt a health care compliance plan. Section 6401 of PPACA states that health care providers must establish a compliance program that contains certain core elements as a condition of enrollment. 

Compliance programs became popular in the early 1990’s when professionals in the health care industry were in need of a strategic and systematic way for companies to deal with misconduct and fraudulent activity.  The purpose of these compliance programs was to serve as a “mitigating factor in sentencing.”  Essentially, it set in place standards for health care providers to follow, so that when misconduct was detected, penalties and reductions by the government could be justified, providing a level playing field for all in the industry. The Office of the Inspector General (OIG) began to require compliance programs in investigations of Medicare fraud, which sparked the voluntary adoption of compliance programs by more health care providers.

The PPACA of course now requires most providers to adopt such plans by 2012, however the core elements of requirement have not yet been defined by regulation and will be different for each type of provider. Therefore, health care providers currently without compliance plans are working to draft and implement programs reflective of old guidelines. 

This is because fraud enforcement has increased and compliance plans will help to reduce or even avoid penalties for violations. The OIG’s Work Plan indicates a greater need for compliance in areas such as claims accuracy and provider training, suggesting these as areas of increased focus in future plan guidelines. Although the regulations haven’t yet defined the future core elements for compliance plans, previously issued materials help providers prepare for what’s next.

In the past, the following elements were typical of acceptable compliance programs:

 

• Establishment of written compliance policies and procedures and distribution to employees.
• Designation of a specific individual or individuals to monitor compliance like a compliance officer.
• Commitment to conducting formal training and education programs.
• Development of internal system for communication of suspected compliance violations.
• Commitment to auditing and monitoring to evaluate compliance and identify potential problematic areas.
• Maintenance of disciplinary policies, which are consistently enforced.
• Development of process for investigation of suspected violations and reporting to the government and law enforcement authorities when necessary.

These elements should likely be helpful to providers without compliance programs in place, to use in drafting plans for the future, allowing for practices to be proactive about changes.  This will allow practices, hospitals and care providers to communicate their culture and standards of ethics to their staff and patients in addition to the ability to provide a sense of transparency into the standards of practice operations.

EBook: Improved Practice Revenue with ICD-10 Changes

You are probably wondering how the right medical billing and coding strategy improve your practice’s revenue.  Today’s medical economic environment has not been kind to radiology. Both hospital-based and the independent radiologists are at risk. Hospitals and Universities do not want to contribute to radiologist’s salary support in the same fashion that they have done in the past. Reimbursement, and in many locales, volume has decreased via radiology benefit managers and controlled utilization. In many areas of the country radiologist’s compensation is decreasing, even when practice volumes may not have changed.

There are a number of steps your practice can take in order to ensure that you’re in the best place possible to improve efficiency and find improved practice revenue. In light of recent ICD-10 changes and the ever-morphing medical coding standards, it is important to manage your processes and stay on top of the newest codes, so as to save time and money.

Matthew Rifkin, MD, FACR, is one of Atlantic Health Solutions' most valuable team members due to his expertise in the field. Dr. Rifkin became a Board-Certified in Radiology in 1978 and has since been a member of the faculty for the Johns Hopkins Medical School, the University of Miami School of Medicine and the Jefferson Medical College in Philadelphia. In 1991, he was appointed Chairman of the Department of Radiology at the Albany Medical College where he reorganized the department and also was responsible for running the Medical School’s entire faculty practice (a $110,000,000.00) enterprise.

He then assumed the position of Vice-Chair of the Department of Radiology and Chief of Clinical Operations at the State University of New York at Stony Brook. In 2002, he became Chairman of Radiology at the Good Samaritan Hospital in Long Island and in 2004 incorporated the radiology services of St. Catherine Hospital, 2005 St. Charles Hospital, 2007 Mather Hospital and in 2008 four independent Imaging Centers (all in Long Island), expanding the group of Board- Certified radiologists from 10 to 48. In 2011, he joined Atlantic Health Solutions as Executive Vice-President of Physician Integration.