The Department of Health and Human Services (HHS) announced on Friday a proposed regulation to replace the ICD-9-CM code sets now used to report healthcare diagnoses and inpatient procedures with the more advanced ICD-10-CM code set currently used in other nations. Under the proposal, implementation will take place October 1, 2011.
A separate proposal would adopt the X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as healthcare claims. According to HHS, adoption of Version 5010 is essential to use ICD-10-CM.
Nearly 30 years old, ICD-9-CM will run out of possible code combinations by next year. The present code set includes 17,000 codes, while ICD-10-CM includes more than 155,000 possible code combinations. This greater number of combinations allows ICD-10-CM to expand and keep up with new diagnoses and inpatient procedures. According to a statement on the American Health Information Management Association Web site, the United States is virtually the last industrialized country to adopt ICD-10-CM.
According to the HHS announcement, the United States would adopt ICD-10-CM for diagnosis coding and ICD-10-PCS for inpatient hospital procedure coding. The new codes would replace the ICD-9-CM volumes 1 and 2 for diagnosis coding and volume 3 for procedure codes.
Gloryanne Bryant, BS, RHIA, RHIT, CCS, senior director of coding and health information management (HIM) compliance for Catholic Healthcare West in San Francisco, says having a proposed implementation date will be helpful in preparing for the transition and develop a timeline. "I’m very excited and elated that it has come to this," she says.
The HHS announcement first surprised DeAnne W. Bloomquist, RHIT, CCS, a coding and compliance consultant and the president of Mid-Continent Coding, Inc., in Overland Park, KS. However there was reason to think something was coming, she says, because of hints that had appeared in CMS publications and the Federal Register for several months preceding the HHS announcement.
Sheri Poe Bernard, CPC, CPC-H, CPC-P, vice president of clinical coding content at the American Academy of Professional Coders in Salt Lake City, suggests that many HIM professionals may be concerned that the three-year preparation time frame the proposed regulation specifies is not enough. "We expect there to be a public outcry regarding the short timetable established in the proposed rule," she says. "We hope that the government will listen to the concerns of physicians, payers, and facilities that understand the complexity of ICD-10 implementation and request more time to effect a cohesive transition." Bernard, who has traveled extensively lecturing on ICD-10-CM, is herself concerned by the widespread lack of preparation she has encountered.
Bloomquist thinks the three-year transition is "a done deal" upon CMS adoption, but admits it will be interesting to see the character and effect of the comments.
It is very important to understand that the transition doesn’t affect coding alone, says Bernard. It involves physician reporting, billing, information technology, and revenue management, to name just a few, she adds.
All sources agree that ICD-10-CM represents an excellent opportunity for the HIM profession to recruit and train a new generation of coders and to bring the nation’s present coding profession on board with the change. Bernard says that as the best authorities on the topic, coders have a chance to become heroes in their facilities by guiding the transition as its influences changes in many other departments.
The comment period for the ICD-10-CM code sets proposed rule and updated transaction standards proposed rule ends on October 21.
A lawsuit testing the constitutionality of Illinois' medical malpractice reforms is expected to come before the state's Supreme Court this fall. State Sen. Bill Haine was one of the leaders in a long bipartisan effort to draft the legislation, which was approved after dozens of doctors retired or relocated due to spiraling malpractice insurance premiums. The state law shaped by Haine and other legislators was enacted in 2005. It limits medical malpractice awards for noneconomic damages such as pain and suffering to $500,000 for doctors and $1 million for hospitals. The law does not, however, limit compensation for economic damages, such as the cost of medical care and lost wages.
Blue Cross and Blue Shield of North Carolina wrongfully allowed policyholders to be charged higher rates for medical services after they received their maximum benefits, according to a lawsuit that recently won class action status. The court ruling in the nearly 3-year-old suit paves the way for thousands of policyholders to seek claims against Blue Cross and Blue Shield of North Carolina, say attorneys. The lawsuit accuses Blue Cross of breach of contract, breach of good faith, and unfair and deceptive trade practices.
In 2007, New Orleans and Louisiana leaders pulled together a plan to commandeer land in a historic but struggling neighborhood on the edge of the Central Business District and offer it to the federal government as a place to build a veterans hospital. But the people who stand to be displaced have pressed the U.S. Department of Veterans Affairs to consider other locations that would not require the demolition of traditional shotgun houses and other historic landmarks. Two senior VA officials have now reiterated the agency's preference for building in downtown New Orleans, where veterans would benefit from proximity to the planned Louisiana State University teaching hospital and the city's two medical schools, which would regularly send faculty and residents to help treat the VA's patients.
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A review of state and federal records shows that dozens of Iowa healthcare workers have been disciplined by their employers for snooping through the medical records of HIV-positive men, pregnant teenagers, victims of domestic violence, and emergency-room patients. Not one of them, however, has been prosecuted for violating the Health Insurance Portability and Accountability Act. In the five years since the law was enacted, 38,000 Americans have complained of HIPAA violations to the federal Office for Civil Rights. More than half of those complaints nationally have been disposed of with no investigation, and until last year no one nationally ever was prosecuted for violating HIPAA.