As the AzHIMA Coding Roundtable Coordinator, I had the great opportunity to listen to the 87th Annual AHIMA’s Clinical Coding Meeting live streamed in the comfort of my own home on Saturday, 9/26 and Sunday, 9/27 that was approved and purchased by AzHIMA Board of Directors. Coding Roundtable Coordinators are encouraged and supported by AzHIMA as a CSA of AHIMA to attend education and training; such as the 2-day Annual Clinical Coding meeting and Leadership Symposium. This enables the CRT Coordinator to use knowledge gained during these national events to carry out the coding roundtable process and better serve the membership. I consider it an honor and privilege to serve AzHIMA and all the coding and clinical documentation specialists in the great state of Arizona. I am looking toward to this pivotal year as we enter into the world of ICD-10-CM and PCS together.
There was a total of 26 one hour presentations presented for 2 days with a total listening time of 10 hours. On Saturday there was a choice of 3 tracks 1) Inpatient Coding 2) CDI 3) Management. On Sunday, the 3 tracks were 1) Other patient settings 2) Physician Practice 3) Payment Methodologies.
I was glad to see that Saturday’s Track were the same 3 areas of focus that AzHIMA’s Coding Roundtable Strategic Planning Committee had decided on for the 2015-2016 year, so I felt we were on the right track with AHIMA goals.
I am going to provide some highlights of the 2 days of presentations that I thought was good information to share with you in the limited amount of space I have in this article. The quality of speakers and subject matter experts were enormous starting out with Sue Bowman, RHIA, CCS, FAHIMA, Director of Coding Policy and Compliance with AHIMA telling us about the New Technology Section X in ICD-10-PCS which included 14 new X codes, effective 10/1/15. Some of the new technology procedures were Introduction of Ceftazidime, Orbital Atherectomy, Intraoperative Knee Replacement Sensor and Drug-Coated Balloon Angioplasty for peripheral vessels.
Nellie Leon-Chisen, RHIA, Director of Coding and Classification at AHA spoke about AHA ICD-10-CM and PCS Coding Clinic Highlights stated how ICD-9 Coding Clinic is used now will remain in ICD-10 unless something has changed in ICD-10 guidelines. It can still be used with the some caveats giving clinical clues. She said that regarding documentation issues, if nothing new in iCD-10 the same ICD-9 advice would stand. She went over the use of the 7th character and how and when it applied to LTC and Rehabs. Rehabs will be hit hard on the DRG shifts due to sequencing changes. It will no longer use Admission for PDx but coding the reason for admission sequencing late effect codes first.
Marie Mendeman, Director of CPT Coding spoke on CPT Policy Updates. They are celebrating 50 years from 1966 to 2016. CPT has 10,000 codes, 140 new codes, 134 revised coded and 91 deleted codes with a total of 365 edits this year. The biggest changes are in prolonged timed services. There are 2 new codes for removal of impacted cerumen by lavage 69209 and by instrumentation 69210. If there is no cerumen impaction these codes cannot be reported. Another area of change is with vaccinations. ACIP and CDC got together to establish most current terminology to use. There are new codes for Community Based High Risk Diabetes Prevention- 16 weekly sessions-0403T. Two new IVUS add-on codes, 14 new CPT codes in the Percutaneous Biliary Section, a new Category III for a Leadless Pacemaker 0387T – 0391T and an add- on code for Echo myocardial strain imaging test 0399T.
Lou Ann Wiederman, Vice President AHIMA spoke about the Future of Coding and industry changes for coders. She encouraged coders to look at how far we have come. ICD-9 started in the 1900’s primarily coding for mortality. Then in 1977 diagnosis codes were added and in 1983 DRG’s came into effect. She stated that 63% of CEO’s are worried about coder skills and roles that will demonstrate more analytical data information with increased clinical knowledge with resurgence of CDI efforts. She encouraged hospitals to grow their own coder education programs and doing more in the area of CDIP. In 2016 AHIMA is starting an on-line educational system called Viab-Pro with real case records with pathway to correct answers. AHIMA will still be providing Advanced ICD10 training at a higher level of learning. AHIMA just introduced a new program called Code Check that can be purchased for a certain number of questions to get quick answers.
Dr. Ginger Boyle, MD, CCS CCS-P, CDIP, Physician Advisor spoke about her experiences in residency training and trying to change patterns across the gamut. She spoke about teaching physicians to update old problem list for those chronic conditions.
There was a presentation on Achieving Optimal Coding Performance by creating 3 successful cohorts and a Coding Academy. They worked with HR and local colleges to select resident coder trainees. The hospital treated them like a full employee with benefits and had them sign a loyalty agreement. They had 3 Phases to the training.
Dr. Robert Stein with DRG Review spoke about different types of Pneumonia, what documentation and Antibiotic treatment to look for, Acute Hypoxic, Hypercapnia Respiratory Failure and Sepsis.
Victoria Weinert, Compliance Director and ICD-10 Trainer for Oxford HIM did a creative case sampling of cases with a game teaching method of “Am I done yet” helping the audience to recognize and how to apply ICD-10 PCS guidelines to understand when and why it is necessary to add additional procedures or not.
Wendy Deaton, RHIT, CCS, CCS-P, ICD-10 Services Manager for Lexicode spoke on IPPS-MS DRG’s and showed those deleted and new CC’s and MCC’s. She shared some new CC’s to focus CDI efforts are nicotine withdrawal, mild malnutrition, persistent atrial fibrillation, abscess of skin – ICD-10 separated out cellulitis from abscess She spoke about the major areas in PCS that will cause a DRG shift as those being in the body part, drainage, approach, qualifier and Obstetrics sections.
A presentation on capturing HCC’s. CMS HCC model is to promote fair payments to Medicare Advantage plans that reward efficiencies and encourages high quality care for the chronically ill. Risk Adjustment Factor is similar to Ambulatory CMI. Also, 75% of HCC’s are similar to CC/MCC’s. Slate is wiped cleaned every January so it is important not to miss current chronic conditions.
Providence Hospital – Southwest Region and Nuance presented what and how they developed an Outpatient CDI program and that CDI was called the differentiator. They reviewed 76% of members and in first year and yielded $178,000 by improving office notes by getting further specificity of chronic conditions that changed HCC. Engaged Leadership, Education of Coders, CDI and providers. The CDI’s rounded in clinics once a month and focused and nurtured camaraderie with physicians.
Kristen Bates from University of Cleveland and Susan Belley from 3M spoke on ICD-10 Coding Compliance, Creating Confident Coders by identifying common issues, designing a coding validation process to meet organizational objectives, reviewed compliance and audit techniques. They gave incentive bonuses to their employees who completed all their modules. They identified issues during this journey where they realized they needed to create clear guidelines for coding consistency, PCS was the biggest issue, needed better process in communicating with coders.
The last speaker was Margie Luke speaking on the Australian Experience from the Past, Now and into the Future providing background information on AN-DRG’s. Australia transitioned into ICD-10 in a two year implementation period. In 2000, she found an AHIMA article written in 2000 called Ten Down Under – ICD-10 on the horizon for the US. That was 15 years ago. In Australia, the procedure coding structure is 5 digits with 2 digit extension; ex: Esopagoscopy 41816-03.
Margie’s Final Words were–
The sky is NOT going to fall down, Keep Calm and Code On.
2016 Annual Conference is being held in Baltimore, MD
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