Thursday, October 25, 2012

ICD-10 Claim Submission & Processing Scenarios – Pay Attention to the Boundaries

Most of us who’ve spent any amount of time in the healthcare business have come to learn – often the hard way – that cutover periods and “boundary conditions” often present unanticipated operational challenges.  The days leading up to and after October 1, 2014 will reveal which providers and payers have anticipated various claims submission and processing scenarios.

Here’s a list of some claims submission and adjudication/payment scenarios to consider:

Preadmission Services

Should ICD-9 code(s) or ICD-10 code(s) be used for preadmission services submitted on an inpatient claim when Statement From (service date) of the preadmission procedure is prior to Oct 1, 2014 but the Statement Through (discharge) Date is after Oct 1, 2014?

Services Contracted And Paid As A Unit

Should ICD-9 code(s) or ICD-10 code(s) be used for services contracted and paid as a unit? – like a month of DME Rental and Global Pre-Natal Services.

Per-Case or Per-Episode Basis

Should ICD-9 code(s) or ICD-10 code(s) be used for services contracted and paid on a per-case or per-episode basis?  Like Emergency Room Observation and services paid as an Ambulatory Patient Group (APG). 

Interim Bills

If interim bills are processed that span the compliance date, and the entire episode of care needs to be adjusted, will the portion that preceded the compliance date need to be restated in ICD-10 codes?

Anesthesia Claims

Which ICD code version should be used for anesthesia procedures that begin on 9/30/14 but end on 10/1/14?

Preauthorization and Eligibility Inquiries

If a preauthorization or eligibility enquiry is submitted on 9/30/14 for a service to be performed on 10/11/14, which service date should be used to determine the ICD code version to use?


How should you handle the scenario where one admission is prior to the 10/1/2014 compliance date followed by a readmission and discharge within 30 days, or within the same benefit period but after the 10/1/2014 implementation date?

Hopefully the above scenarios will spur some thought about preparing for the ICD-10 compliance date.  You can learn more about ICD-10 by following me - @ShimCode - on Twitter

Thursday, October 4, 2012

Few Thoughts from Final Day of 2012 AHIMA Convention in Chicago

Done! AHIMA’s 2012 Conference in Chicago – last day – none to go. Here are some #AHIMACon12 tagged tweets from the Last Day of AHIMA’s 2012 convention. I posted some Tweets from Day #1 and Day #2.
See also AHIMA articles and postsrelated to 2012 convention:

Start of Last Day
@3MHISNews: Good morning, #AHIMACon12 attendees! What are you looking forward to on day 3?

@AHIMAResources: #AHIMA Convention Exhibit Hall: A Place to Learn, Network, Have Fun:
@SmyrnaGirl: Tweeting away at #AHIMACon12? I'll be sharing tips on using social media at tradeshows in the next @DodgeComm webinar:

@aneeshchopra: Preparing for my remarks at #AHIMACon12 - if you are here, I would love to respond to your questions - so pls post 'em!


@DrZahwa: Question for Mr. Chopra, what's the role of Govt (open govt) in setting health data interoperability standards?

@ehrandhit: @ReginaHolliday @kaitbr @donfluckinger might want to start with why to tweet and it's ok to tweet.

@SunnyBeach2000: @AHIMAResources How important is it for HIM professionals to get engaged? You mentioned Public Hearings in Congress? 


@AHIMAResources: Find recaps of all the #AHIMACon12 action in AHIMA Today digital edition. Members, check yr email 4 ths wk’s Special E-Alerts & the link.

@billians: @ehrandhit: A Video Tour Around AHIMA’s Exhibit Floor   #AHIMACon12

@CMInfoSpec: Have you read the Journal of AHIMA this month? Check out the article "Exploring the Remote Release of Information" by our CEO

@ReginaHolliday: @kaitbr @donfluckinger @ehrandhit Well I told #AHIMAcon12 to invite me back next year and I would host a how to tweet session...

RT @emrcomparison: And the #AHIMACon12 Winner Is …: … ICD-10 by a landslide. For those of you wondering whether “upcoding” might ju...

@IronMountain: What was the best part of AHIMA? Tweet us your thoughts using #AHIMACon12!

A Bad Idea: Telling People Not to Use Social Media

@ehrandhit: @DonFluckinger @ReginaHolliday might be because last year a session told them not to use social media.

See You Next Year!

@NUAN_Healthcare: Hard to believe #ahimacon12 is done...until next year!  Thanks for all the lessons learned re: #cac #cdi #healthit

@billians: Looking forward to seeing our #AHIMACon12 friends in our hometown of Atlanta next year for #AHIMACon13!

@AHIMAResources: Thank you for attending #AHIMACon12!  We're headed South y'all!  Save the date. #AHIAMCon13 will be held in Atlanta, GA October 26-30, 2013

@MHJConn: AHIMA 2012 is adjourned.  Former White House CTO Aneesh Chopra gave the closing keynote. Says "Auto Blue Button" is coming in 90 days
You can also check out all tweets with the #AHIMACon12 hashtag and related information offered up by the nice folks at 

Tuesday, October 2, 2012

8 Things Pediatricians (and other physicians) Need to Know about ICD-10…

This post is a quick attempt to share some important topics, considerations and ideas as to why physicians – in this case Pediatricians – need to start paying attention to how ICD-10 will impact their practices, their patients and their livelihood.  The impetus for this post came from an agenda that was pushed to me: ICD-10 seminar for Pediatricians.
I’ve culled this agenda and I’m sharing agenda session titles I think are important to pediatricians – really all physicians for that matter.  I’ve left the agenda's session titles as they are presented in the above link (See bolded items below) and I’ve shortened session descriptions. In some cases, I've added my opinion. 

To be clear, I’m not endorsing this company, the seminar or its speakers. I go to great lengths to not endorse any company on this blog. Indeed, I've come across many of these ICD-10/Coding Seminars yetthis one stands out as particularly spot on with what they purport to convey. I’m merely highlighting parts I think all you docs and office staff should be aware of.  I hope this is useful.
Coding for Your Valuable Time

…audit proof pathway to get paid for time based work - only if medically necessary and well documented.

Push your coding from 99213 to 99214 and 99215

…pediatricians may under-code for the work they do. …tools and knowledge to code ethically and optimally for the every-day E&M services.

Set Your Prices Fairly and Easily

…RBRVS dominates the payer landscape, few understand how it works or how it’s useful.

Pediatricians Do Provide Procedures…Code for Them!

… reviews procedures pediatric clinicians provide, details specific guidelines for coding and documenting these important services provided in the medical home.

Who Wants to Be A Coding Millionaire?

…I’m not sure presenting coding as a way to become a millionaire is a good idea

Modifiers That Get You Paid!

…Like I’m not sure presenting coding as a way to become a millionaire is a good idea – I’m not advocating playing with modifiers. But you need to know how to be compliant with units versus modifiers, procedure modifiers, and modifier 59.

Start Prepping for ICD-10 with Pediatric Top Changes

…You oughta damn well know the top diagnoses you’ll use for ICD-10.  And how they will impact your EMR and superbill!

EMR Use in the Pediatric Practice: The Good, The Bad, and The Ugly

…seriously?  You need to go to a coding seminar to learn about the importance of an EHR?

My Hope (and another disclaimer) 

Is that this information has been helpful to all you physicians who really need to get on top of this ICD-10 stuff straightaway. And hopefully the people putting on this seminar aren’t mad at me for my thinking they are one of the few that seem to have it going on. Remember…I am not endorsing this company…just curating content in an attempt to educate and share the wealth.

More Thoughts about Day #2 of AHIMA’s 2012 Conference in Chicago

AHIMA’s 2012 Conference in Chicago - two days down – one day to go.  Here are some #AHIMACon12 tagged tweets from Day #2 of AHIMA’s 2012 convention that I thought were interesting and not just vendor marketing.  Yesterday I posted some Tweets from Day #1 here. See also AHIMA articles and posts related to 2012 convention
Introductory Thoughts

@Brad_Justus: Chicago At Night
@ehrandhit: Another beautiful day in Chicago at #AHIMACon12

@LarryLin: It's a beautiful morning in Chicago. [pics] #LakeFrontSunrise  

@AHIMAResources: Join leaders in healthcare, business, academia, gov & workforce development discussing the future of healthcare innovation

@Kristi_Eells: How's everyone enjoying #AHIMAcon12? Learning a lot from following the tweets,  seems like it’s all about #data this yr! #healthIT

Thoughts and Quotes from Presentations

@AHIMAResources: Pres Elect @kafrawley emphasized that HIM prof's has never been more important.

@KenOnHIT: Quotes from #AHIMAcon12 - "#EHR systems will come and go, but your data won't. It must be solid." - Scott Bennett

@Pattytsheridan: Kathleen Frawley Urges HIM professionals to believe in themselves

@KenOnHIT: Quotes from #AHIMAcon12 - "Nationally, only 40% of rejected Medicare claims are appealed" - Karen Bowden

@KenOnHIT: Quotes from #AHIMAcon12 - "Transcription isn't going away. It is simply evolving." - Randy Drawas

@Kristi_Eells: @LarryLin good point - it can be tough to sift through tweets to find 'real' content. What's been your fav part so far?

@LarryLin: "What can Pirates Teach us" about Innovation, Mr. Yu. He worked in healthcare investments before.  

@AHIMAResources: Invention does not equal innovation- Wil Yu, @HlthInnovation

@Cascadia: What value does coding add to healthcare? As we move away from fee for service will ICD10 be a dinosaur? 

@djna09: Innovation is measured by Value - Wil Yu

@DonFluckinger: Cleveland clinic: outcomes=data. Improving data=improved outcomes. That idea set off massive documentation improvement project

@DonFluckinger: Data governance among health care providers suddenly is becoming an issue. Now #EHR systems in place, the work's just starting

@LarryLin: CMS Innovation Center goals - Global Payment for dual eligible, Pioneer ACOs, Advance payment, ComprePrimary Care, BundPayment

@LjkMModal: Dr. Juergen Fritsch: keys to success for the ACO...know your population. Enable to physicians.

@LjkMModal: Engage physicians in improving documentation on front-end to drive more useful, quality records. Juergen Fritsch, PhD.

Some Thoughts about Winning & Not-winning (aka. Little Fails)

@ehrandhit: Always the best strategy for a conference. Find smart people and listen.

@ehrandhit: Big props to the #AHIMAcon12 press support people.  100 times better than last year.  Makes my job a lot easier.

@KenOnHIT: Two things noticeably absent at this years' #AHIMAcon12 - Dr. J at the Cardone booth and The Scarf King.

@LarryLin: (speaker does much better when he isn't looking down on his notes ... can engage audience better. #BestPracticePublicSpeaking )

@SmyrnaGirl: Majorly bummed there is no coat/bag check at #AHIMACon12!

Fun Thoughts

@3MHISNews: 3M caricatures are up online - check it out => Haven't gotten yours yet? Head over to booth 1000!

@3MHISNews: In the Windy City and not sure what to see at #AHIMACon12? Our cheat sheet's got you covered.  #healthIT

@ehrandhit: Good times with @brad_Justus at #ahimacon12

Side Note: I gotta believe one of these guys left without their wallet or watch – just not sure which one. :)  

Closing Thoughts

@ReginaHolliday: "Under one tent" a painting for #AHIMAcon12

@ReginaHolliday: "The Launch" the final painting for #AHIMAcon12  

@AHIMAResources: This is the most exciting time in our professional history- @kafrawley

@IronMountain: One more day of #AHIMACon12, but there's still time to make the most of the city! Check out Your Insider's Guide:  

Check back tomorrow for More Deep Thoughts on Day 3

You can also check out the #AHIMACon12 hashtag and related information offered up by the nice folks at SymplurSee their page on #AHIMACon12


Monday, October 1, 2012

5 Thoughts about Day #1 of AHIMA’s 2012 Conference in Chicago

The 84th AHIMA Convention & Exhibit started yesterday in my birthplace and home for the first 35 years of my life.  I attended in spirit via communications with friends and social media.  Here are some #AHIMACon12 tagged tweets from the first day that I think share some of the spirit of Day #1 of AHIMA’s 2012 convention.
Opening Thoughts

@MichellePaster: Enjoyed the opening night at #AHIMACon12! Excited to see what the sessions and exhibit bring today!

@HITExchange: The Annual Convention Opens w. Call For Improved Health Info Governance to Unify Standards for #EHR:

@Brad_Justus: An Interview With AHIMA's CEO Gives Convention Highlights  

@SmyrnaGirl: Really impressed with @AHIMAResources' use of social media at conference. Pic:  

Some Useful Business Thoughts

@Daymarck: Audit records to determine if documentation supports level of detail required says Joan Usher
@SmyrnaGirl: Providers face too many conflicting deadlines - they really need to prioritize so #ICD10 gets done properly - @DeloitteHealth

@SmyrnaGirl: Providers, don't let 10/1/2014 give you false sense of security - you'll need every minute for training/testing/transitioning
@SmyrnaGirl: Metrics/analytics seem key to helping providers see the relation between accurate coding and accurate reimbursement

@ceckenrodt: ICD10 prep: Run data report to identify top ICD9 codes used in MD practice now. Lots of NOS or NEC codes? Fill gaps now!
Some Thoughts about Privacy…Shhh!!!

@LarryLin: "Take care of people, take care of equipment, pay attention to detail, have balance". General R's philosophy.

@LarryLin: General Rubinstein's summary slide at  

@DonFluckinger: when #HIPAA omnibus rule comes out, patients who report providers potentially can share in monetary awards

@DonFluckinger: mobile device security lags far behind in health care. #ONC privacy officer: "Not right."

@LarryLin: Joy Pritts- disproportionate breaches are about mobile devices

@DrZahwa: Excellent presentation from @ONC_HealthIT at the planting the idea that privacy & security must be leadership driven everywhere.

@LarryLin: Joy Pritts - adding privacy/security audit outcomes to staff's performance evaluation.

@ReginaHolliday: I have now passed 6 booths focused on Data privacy and not one on data sharing. 

Some Minor #Fails

 @ReginaHolliday: Asked the folks about blue button in VA booth and they had trouble recalling it #fail

 @LarryLin: Someone can help the bass drummer with a music counting lesson.  ;-D Oddities at #MiniFail

Some Thoughts on Eats, Excitement & Entertainment

@bridgefront: @billians: @billians: Beautiful sunrise here in Chicago! Bodes well for a great day. Pic:  

@Brad_Justus: (@ The Original Pancake House) [pic]:  

@abbadox: Are there restaurants you HAVE to visit while you're in town? <= Gino's East for Pan Pizza

@PrecyseTweets: The servers at our party last night wore these buttons to promote the signature drink, ICD Potion 10. #ICD10.
@Y'all: Remember what Bill Swerski always told Chicago Super Fans: Be sure ta chew dose porkchops before ya swallow 'em. ( one tweeted this...I'm just tellin' ya it's good for you'se)

More Thoughts Tomorrow – Tuesday, October 2, 2012

Check back tomorrow for info on Day 2.  You can also check out the #AHIMACon12 hashtag and related information offered up by the nice folks at

See the following for detailed info on #AHIMACon12: