A Fun Day At The Themepark

A Fun Day At The ThemeparkS13.4XXA — Sprain of ligaments of cervical spine, initial encounter (whiplash injury of cervical spine)nnY93.I1 — Activity, roller coaster ridingnnY92.831 — Amusement park as the place of occurrence of the external cause.nnR11.0 — NauseannIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2014 implementation date. Please don’t hesitate to contact us for all of your training and education needs!

How ICD-10 Will Benefit Physicians

ICD-10Physicians have reason to question the timing and value of ICD-10 as they have many competing priorities due to a multitude of concurrent regulatory, technology and industry changes. Many see ICD-10 as “salt in the wound.” However, ICD-10 offers potential value to physicians if leveraged and utilized correctly. Physicians who take decisive steps to fully integrate ICD-10 into their clinical practice stand to benefit in several ways.nnSo, yes, ICD-10 implementation is an investment in time, but it presents physicians with five benefits that have the potential to be major game-changers.n

1. Grow compensation and reimbursement.

nICD-9 codes were not originally developed with reimbursement in mind. ICD-10, however, offers a more decisive system to determine payments by offering greater detail on the quality of the care provided. In turn, government payers, insurers, hospitals, health systems, medical groups and others will use ICD-10’s granular data to determine accurate and fair physician compensation and reimbursement for goods and services.nnSome hospital systems with employed physicians have been offering compensation plans based on performance for several years. For example, Geisinger Health System in Danville, Pa., has a pay- for-performance (P4P) program that bases 40 percent of incentive payments on quality goals (Cheung- Larivee, 2012). The New York City Health and Hospitals Corporation recently announced that more than 3,500 employee physicians will receive bonus payments tied to meeting quality measures, such as lower readmission rates (Caramenico, 2013). With the arrival of ICD-10, quality incentives are in jeopardy if the physician does not document to the level needed to attain the correct and more specific code selection. This is because the code is a reflection of how severely ill that patient was, and a sub-optimal code in ICD-10 will not provide support on why a certain amount of care was needed.nncash_0Under the government’s Value-Based-Purchasing program, physicians who do not provide precise documentation (e.g., laterality, specificity, anatomic site, etc.) to support the specificity of ICD-10 will experience reduced payments. On the other hand, it is important to note that ICD-10 does not require a change in how physicians practice medicine or treat patients. Rather, it demands more accurate documentation and gives physicians more diagnostic choices to capture new data to ensure they are paid for the complex work they perform.nnAnother example is documentation and payment on new and cutting-edge procedures. New procedures are problematic for coding purposes. In both CPT and Volume 3 of ICD-9, they are often given an unlisted procedure or an unspecified code. With ICD-10-PCS (Procedure Coding System), which will be used for inpatient procedures, the codes are going to be created based on the surgeon’s documentation in the operative report. The code will be built based on the type of surgery, body system, root operation, body part, approach, device and any qualifiers that the surgeon includes in the documentation. So, for inpatient procedures, there are no limitations in code selection because ICD-10-PCS codes accurately reflect the goal, the location, and the steps of each procedure without the restrictions of procedural naming conventions and agreed-upon methodology. Often new procedure codes were not covered by government or private payers, according to an ICD-10 RAND report (Libicki & Brahmakulam, 2004). The upshot: payers may cover more procedures, reject less, pay faster and reimburse more accurately.nnClick Here To Read Moren

Online ICD-10 specialty-specific provider training modules coming soon!nContact us for more details

n

On-site, custom ICD-10 training for staff and providers – book your ICD-10 trainer now!

nSource: www.physbiztech.com; Tom Ormondroyd; July 17, 2013.

Obama Administration Delays Employer Mandate

n

delay Welter Healthcare Partners does not think this will cause any material effect on the PPACA.  It only delays one very important provision of this very complicated law.

nObama administration delays employer mandate for 1 year – July 9, 2013nnThe Affordable Care Act requires businesses with more than 50 employees to provide health insurance for their workers or face a penalty of up to $3,000 per employee. The Obama administration has delayed this requirement until January 2015, due to employers’ concerns about their ability to comply with the complexities of the requirement. While more than 90 percent of companies with at least 50 employees already offer health insurance to their workers, those individuals affected by the delay may obtain coverage through the health insurance exchanges, set to begin in 2014. Additional guidance is expected to be released this week.nnSource: www.naph.org; July 9, 2013.nn

Summer Evening Stroll

Summer Evening StrollS03.1XXA — Dislocation of septal cartilage of nose, initial encounternnW22.02XA — Walked into lamppost, initial encounternnY92.830 — Public park as the place of occurrence of the external causenn nnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2014 implementation date. Please don’t hesitate to contact us for all of your training and education needs!

Fourth of July in the Emergency Room

Fourth of July in the Emergency RoomW3.9xxA – Discharge of firework as the external cause of injury,ninitial encounternnW42.9xxA – Exposure to loud noise as the external cause of Injury, initial encounternnX04.xxA – Exposure to ignition of highly flammable material (while attempting to light the barbecue grill), initial encounternn