How Many Characters Are In A Code In Icd-10-Pcs Decoding ICD-10-CM for Hospices

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Decoding ICD-10-CM for Hospices

The transition to the new ICD-10 coding concepts on October 1, 2015 will be a major overhaul for the hospice community, especially given the large portion of diagnosis-driven reimbursement. ICD-10-CM for hospice providers is the replacement coding system for the obsolete ICD-9 system that has been in use for over 30 years now. ICD-9 is outdated, has no room for new codes in many areas, and is incompatible with modern medical practice.

Here are some simple tips to help understand the new system:

  • The first three numbers identify the category

  • The first digit is alphabetic-always

  • The second and third numbers are numeric

  • The fourth through sixth positions deal with clinical details—etiology, severity, and anatomic sites.

  • A seventh character is sometimes required to describe encounter characteristics

  • ICD-10 allows the use of combination codes, which is useful for coding more than one diagnosis or complication.

  • Combination coding reduces the number of codes for particular patients while providing clear and concise codes to describe a patient.

  • The use of alpha coding is allowed in ICD-10. Alpha codes allow consistency throughout coding as qualifiers for body parts, procedures, systems and more!

Hospice and Home Health Care Codes

After October 1, 2015 all codes submitted to CMS must use ICD-10 coding or they will be rejected. Coding and billing professionals must understand these concepts and how to apply them to claims to avoid denials.

Here’s what they should do:

  • Identify which of their current and existing processes need to migrate to ICD-10-CM, for example electronic health records, clinical documentation, reporting protocols, billing, contracts and vendors.

  • Find out if their contracts with providers need an update, this includes payment and payment schedules. Every revenue segment for home health and hospice care is affected by the ICD-10 transition.

  • Prepare and plan for disruptions in the billing process due to ICD-10.

  • Call their IT vendor to find out when and if an ICD-10 upgrade is scheduled.

  • Learn about the common ICD-10 codes your agency is likely to use. Test them for billing and reporting accuracy. A competent electronic health record (EHR) is essential to the process.

  • An integrated EHR can address the challenges of the ICD-10 transition for hospice and home health providers.

  • Software designed specifically for their needs should automate the unique process from the start of data collection, to every aspect of the care process.

  • Educate and train their staff for this big change. For example, providers should consider how to transition their most common ICD-9 hospice diagnostic codes to ICD-10.

  • Hospice providers should renew their testing efforts to ensure their systems can support ICD-10.

ICD-10 code set will bring a truckload of new codes and new coding procedures. Hospice providers must prepare in advance to take the pulse of this transition.

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