AMA Bookstore News, April 10, 2012

Whether you are new, just learning or have a more advanced knowledge of the ICD-10 coding system, ICD-10-CM Mappings is an essential reference for you and your office. The higher degree of specificity in the ICD-10 code sets will require more documentation and coding precision.

ICD-10 contains new concepts that are not present in ICD-9-CM and because there is not a one-to-one match between code sets, it is important that you plan in advance. By mapping the most frequently used ICD-9-CM codes for your practice or facility to their corresponding ICD-10-CM codes, you can identify areas needing increased documentation and evaluate how additional specificity could impact your revenue. This allows you to focus your training to meet the needs of your practice or facility.

Let the AMA help you prepare. Start now with ICD-10-CM Mappings or explore the entire line of ICD-10 preparation materials.

Are you up to speed on version 5010 electronic administrative transactions? While the deadline to comply with the HIPAA version 5010 was Jan. 1, the agency announced a second extension of the enforcement date, which is now July 1. Physicians who continue to experience difficulties with claims processing should complete a complaint form so the AMA can help resolve these issues and alert CMS to ongoing problems.

Those wanting to learn more about version 5010 or HIPAA and HITECH in general should turn these AMA titles authored by Carolyn Hartley and Edward Jones III: EHR Implementation: A Step-by-Step Guide for the Medical Practice, HIPAA Plain and Simple, and Policies and Procedures for the Electronic Medical Practice.

More information can also be found at www.ama-assn.org/go/5010.

Invest in AMA HIPAA School and avoid the millions in fines that companies like Blue Cross Blue Shield of Tennessee (BCBST) are facing. In March, BCBST agreed to pay the US Department of Health and Human Services (HHS) $1.5 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. BCBST also agreed to a corrective action plan to address gaps in its HIPAA compliance program. The enforcement action is the first resulting from a breach report required by the Health Information Technology for Economic and Clinical Health (HITECH) Act Breach Notification Rule.

The investigation followed a notice submitted by BCBST to HHS reporting that 57 unencrypted computer hard drives were stolen from a leased facility in Tennessee. The drives contained the protected health information (PHI) of over 1 million individuals, including member names, social security numbers, diagnosis codes, dates of birth, and health plan identification numbers. OCR’s investigation indicated BCBST failed to implement appropriate administrative safeguards to adequately protect information remaining at the leased facility by not performing the required security evaluation in response to operational changes. In addition, the investigation showed a failure to implement appropriate physical safeguards by not having adequate facility access controls; both of these safeguards are required by the HIPAA Security Rule.

“This settlement sends an important message that OCR expects health plans and health care providers to have in place a carefully designed, delivered, and monitored HIPAA compliance program,” said OCR Director Leon Rodriguez. “The HITECH Breach Notification Rule is an important enforcement tool and OCR will continue to vigorously protect patients’ right to private and secure health information.”

In addition to the $1,500,000 settlement, the agreement requires BCBST to review, revise, and maintain its Privacy and Security policies and procedures, to conduct regular and robust trainings for all BCBST employees covering employee responsibilities under HIPAA, and to perform monitor reviews to ensure BCBST compliance with the corrective action plan.
You can avoid such a potential risk by ensuring you properly understand HIPAA and HITECH with AMA HIPAA School. This online, three-course program satisfies HIPAA workforce training requirements and covers such topics as an overview of securing patient health information, HIPAA privacy compliance and HIPAA security compliance. Each course takes approximately two hours to complete.

Also check out AMA’s HIPAA and HIT Best Practices Package for two informative titles on the subject of HIPAA and HITECH.

The ICD-9-CM disease classification for Alzheimer’s differs from the classification for ICD-10-CM, as does the disease index.

In ICD-9-CM, there is only one code for Alzheimer’s disease, 331.0. Additional codes for dementia with (294.11) or without (294.10) behavioral disturbance are coded in addition. In ICD-10-CM, Alzheimer’s disease is further classified as being early onset (G30.0), late onset (G30.1), other specified (G30.8), and unspecified (G30.9). Codes for delirium (F05), and dementia with (F02.81) or without (F02.80) behavioral disturbance are also coded in addition.

Similarly, in the ICD-10-CM alphabetic index, the code for Alzheimer’s disease is found under the entry ‘Disease , Alzheimer’s’. In ICD-9-CM, the coder must look under the term ‘Alzheimer’s’ to find the code.

Advanced Anatomy and Physiology for ICD-10-CM/PCS and other ICD-10 preparation titles can help you understand and prepare for these and other coding changes.

Question: What code would I use to report the Button Transurethral Resection Prostate (TURP) procedure?

Answer: Code 52601, Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included), describes the Button TURP procedure.

Want more coding Q&A? Subscribe to CPT® Assistant Newsletter today!

Question: Are electrocardiograms (ECGs) an inherent component of elective cardioversion?

Answer: Any electrocardiogram (ECG) performed prior to or during cardioversion is included in code 92960, Cardioversion, elective, electrical conversion of arrhythmia; external. However, if a post-cardioversion ECG is medically necessary and documentation supports this additional study, then the appropriate 12-lead ECG CPT code should be reported with Modifier 59, Distinct Procedural Service, appended. In certain cases a post-cardioversion ECG is performed to diagnose unexpected arrhythmias after cardioversion or to define ST wave changes. Medical record documentation should reflect this eventuality.

Q&A from January 2012 CPT® Assistant.

“Very informative—it took the scary out of ICD-10!” —Glenda McMaster

“Every private practice needs to address the ICD-10 conversion. This is a great workshop for getting started and should be attended by office managers, practice administrators, and managing physicians, not just coders and billers.” —Julia M. Pillsbury, DO

“Well worth the investment!” —John Link, MBA, CPC

Register today.

Only 13 days remain to register for the first of this year's ICD-10-CM workshops hosted by the AMA. Multiple workshops will occur throughout the country this year with the first three being held at the AMA headquarters in Chicago. The workshops focus on developing the skills needed to properly code for ICD-10-CM. A brief overview of implementation strategies will also be presented.

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