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Since our last ICD-10-CM blog, I have successfully completed the two required AHIMA courses, attended an on-site Nashville, TN grueling three day session, and successfully wrote the final exam. I am now the proud recipient of the AHIMA Approved Instructor for ICD-10 CM/PCS and an AHIMA Coding Ambassador. This four month experience was an eye-opener to me professionally as an HIM administrator but also as a member of the health care team. Prior to initiating these studies, I had little familiarity as to how two code-based diagnostic and procedural systems would have the degree of monumental impact on the US health care industry as a whole.

From my background in Clinical Documentation Improvement Systems, I questioned which major health care leaders were engaged in the advancement of these coding systems. My research suggests that the principals were the Center for Medicare Services (CMS), National Center for Vital Statistics (NCVS) , American Hospital Association (AHA), and the American Health Information Management Association (AHIMA), all of whom have fully engaged this huge overhaul, a refit of an old and tiring code-based system which has been used for over thirty years.

Surprisingly the preliminary years, beginning in the early nineties, were spent in the design, testing, and restructuring of two new and completely unique code sets that could optimally meet the challenges of US health care practices. I suspect that these years did not go without many sleepless nights for the principals. Some say that a saving grace is that the diagnostic system, ICD-10-CM, did not require a complete overhaul since many of the coding guidelines and rules were compatible with the old ICD-9-CM diagnostic system.

As with the development of any new documentation system and more specifically where medical terminology, medical nomenclature and classification systems will affect the documentation of the medical practitioner, one key player, the American Medical Association (AMA) has rarely been mentioned. Through the evolution of DRG's in 1980-83, we recognize that not bringing the physicians into the new case mix system was a huge mistake and caused many hospital organizations to fail. We need to take heed from our past experiences if we have any chance for these coding systems to be successful from the onset. As we all know, these systems are predicated on capturing physician documentation and converting these diagnostic and procedural terms to ICD-10 alpha-numeric language.

To add insult to injury so near the implementation phase, the American Medical Association delegates, at their Annual Meeting in November, 2011, voted against the start date of October 1, 2013 for ICD-10-CM/PCS. Although they admit that their disagreement is not in the actual ICD-10-C/PCS code structures, they object to the timing, physician financial constraint and staff preparation. They questioned the efficacy of implementing systems that would require much more physician time in clarifying documentation while adding more financial woes for implementing required manual and computerized system changes into their practices.

The American Health Information Management Association has responded in full disagreement to the American Medical Association's position. They contend that the current ICD-9-CM system cannot meet the demands of the emerging knowledge and technology in American health care and can only survive through broader, more flexible systems that can keep up with the health care changes.

Who will win and who will lose in this recent dispute over classification systems and time frames? Stay tuned. 2012 will be an exciting year!

This is the first of a series of educational articles to introduce two (2) new coding and classification systems that the American Health Information Management Association (AHIMA) anticipates their implementation on October 1, 2013.  These two systems will have a major impact on how we, as diagnostic and procedural coders, will assign appropriate codes to inpatient and outpatient records.  These systems will also have long term implications for medical decision making and medical documentation practices.

These systems will be similar to those currently in use by other countries, such as Canada, Sweden, Korea, Thailand, Australia, France and Germany under the auspices of the World Health Organization (WHO); yet our systems are unique to the United States because they will encompass both major morbidity and mortality diagnoses code sets and a specific inpatient procedure code set unique for our medical and surgical care delivery systems.  Ultimately data obtained from these systems will be used nationally and internationally to report, compile, use, and compare healthcare information.

International Classification of Diseases-10th revision-Clinical Modification (ICD-10-CM) and International Classification/Procedure Coding System (ICD-10-PCS), have been in the works since 1985, yet their final code sets have yet to be published in electronic or printed media.   Delays in implementing both systems have been experienced due to many issues such as electronic transactions (EDI) and HIPAA covered entities to name a few.  Scheduled for implementation in January 2009, the systems have been pushed back by four years and are now on target for October 1, 2013.

Grouping of the new diagnostic classification system has changed drastically. Unlike ICD-9-CM where body systems designed chapter disease groupings, the new ICD-10-CM will now categorize their code sets according to the following: 1)communicable diseases; 2)general diseases affecting the entire body; 3)local diseases arranged by body site; 4)developmental diseases; 5)injuries; and 6)external causes of illness.   Therefore, as we start this journey together we must recognize that another paradigm shift in our technical coding knowledge will evolve.  Let us embrace these new systems and learn how our impact will assist in improving disease management and health care delivery for future generations.

In the next part of the series, we will be discussing the formatting of both the tabular and alphabetical index of the diagnostic and procedural classification systems.

The two top physician concerns in general surgery patients post-operatively have been about pulmonary emboli (PE) and myocardial infarction (MI) with therapeutic measures for each of these potential conditions.   Interestingly, a recent study by Laurie Barclay, MD, from Methodist Hospital Research Institute of Houston, Texas reported that sepsis and septic shock are more likely to occur post-operatively. 

The study compared incidence, mortality, and risk factors for sepsis and septic shock with those for PE and MI in a patient population of 363,897 general surgery patients included from the 2005-2007  National Surgical Quality Improvement Program (NSQIP) data set.   Sepsis occurred in 2.3% of patients, septic  shock in 1.6% of patients while pulmonary embolism occurred 0.3%, and myocardial infarction in 0.2% .  The greatest proportion of patients were 60 years of age or greater in the septic shock group (70.3%) compared with 40.2% of those with no sepsis and 51.7% of those with sepsis alone.

Comparatively speaking, patients entering the hospital for emergency surgery had a higher incidence of sepsis (4.5% versus 2.0% in the elective admit population).  Risk of sepsis and septic shock were 6-fold higher in patients with other comorbid conditions and they had increased risks of mortality.

The study conclusions, based on record review of 363,897 patients, demonstrated that sepsis needed to be screened more acutely by general surgeons in order to prevent sepsis-associated morbidity and mortality in the their inpatient populations.


1.  Sepsis in General Surgery

The 2005-2007 National Surgical Quality Improvement Program Perspective

Laura J. Moore, MD; Frederick A. Moore, MD; S. Rob Todd, MD; Stephen L. Jones, MD; Krista L. Turner, MD; Barbara L. Bass, MD

Arch Surg. 2010;145(7):695-700.

2Archives of Surgery,  Vol. 145, No. 7, July 2010

Sepsis in General Surgery: The 2005-2007 National Surgical Quality Improvement Program Perspective

Remote medical coding and remote cancer registry have become very popular over the past decade in the HIM industry.  On a daily basis, our company receives inquiries for remote coding and remote CTR positions.  While there are many well-qualified professionals in the field, it should be noted that accurate coding and cancer registry abstracting are just the first of many ingredients that comprise a high level of customer service for our clients.  Familiarity with various computer systems and Information Technology security will certainly set you apart from your competitors while applying for remote positions.  Below is a brief checklist of some additional skills that we search for when evaluating remote HIM professionals:

       1.  Level of familiarity with HIPAA Privacy and Security Regulations and state-specific privacy

            and security laws and regulations.

       2.  Level of computer proficiency

       3.  Appropriate computer hardware (modern PC and secure, high-speed internet connection)

       4.  Level of familiarity with various hospital EMR and abstracting systems

       5.  Ability to professionally communicate with IT personnel and hospital IT help desk support

       6.  Time management skills

Please note that the above is by no means intended to serve as an all-inclusive list.  In order to provide our clients with the highest quality work product while maintaining optimum production levels, we are always searching for candidates with the above-mentioned skills.  If your department is seeking to engage an HIM Outsourcing firm for remote coding or remote oncology data management, be sure to inquire about the company's remote staff.  for example:

Does the company have an in-house IT Department?

How does the company screen its remote employee candidates?

What other in-house measures are in place to ensure the highest level of client satisfaction?

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