ICD-10-CM

Just saw the March AHIMA article – not sure if it should read ICD-10 or ICD-11. With ICD-11 due in a few years, I would favor the move from “9″ to “11″. Start now, finish strong.

SMART phone

I was the fortunate recipient of a holiday “Smart” phone (aka iPhone). The future is now. Makes your old cell seem kind of silly. There are more smart phones on the horizon (aside from iPhone) like the Neo1973. Anyway, the iPhone gets my gmail, I can IM (who needs text), surf the net and it has lots of room for music, pics, videos and pods. I’ll have to keep reading the manual to see what other goodies are available. Apple is about to release the iPhone SDK, so there should be lots of new iPhone applications on the horizon. I’m tempted to use this hack to make the iPhone more like a PC, but don’t want to risk ending up with a brick. Since this is a tech theme, try out “Remember the Milk” for your daily agenda needs. I like it and it’s well suited to gmail. It’s free and easy.

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AUDs

A recent Addiction article suggests that alcohol abuse (AA) and alcohol dependence (AD) are not separate and distinct entities but part of the same family called Alcohol Use Disorders (AUDs). The DSM-IV and ICD-10 classifications use information from the 1976 formulation known as Alcohol Dependence Syndrome (ADS).A look at the MS-DRG CC analysis for alcohol dependence (30391) and alcohol abuse (30500) shows that both diagnoses should have been assigned as a CC. Once again, I wonder why the panel chose to remove these as comorbidities. The future classification of AUDs should make it easier for coders, removing the problem of deciding between code assignment for alcohol abuse vs. alcohol dependence.

30391 UNSPECIFIED ALCOHOL DEPENDENCE, CONTINUOUS USE

C1 8,243 1.143
C2 31,320 2.138
C3 9,700 3.069

30500 ALCOHOL ABUSE UNSPECIFIED USE

C1 16,907 0.982
C2 61,090 2.059
C3 17,185 3.002

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RSV Riddle

Today’s MMWR includes a status report on respiratory syncytial virus (RSV) activity in the US.

RSV infection primarily manifests as bronchiolitis or pneumonia and results in approximately 75,000 to 125,000 hospitalizations in the United States each year (1).

Back in 1996, RSV was added as a specific code (0796). Since there are very few cases of RSV in MedPAR data, the panel chose to assign it as a non-CC. The CMS “CC Analysis” clearly shows that RSV should be a CC, even with the low volume of cases.

0796 RESPIRATORY SYNCYTIAL VIRUS (RSV)

Cnt1 = 18
C1=1.615

Cnt2=91
C2= 2.773

Cnt3=32
C3=3.284

I don’t understand how they can make this decision knowing that the MS-DRGs would be adopted by non-Medicare payers.

Fortunately, the combination code of RSV pneumonia (4801) is assigned as a MCC in MS-DRGs while acute RSV bronchiolitis (46611) is a CC.

In the AP grouper (V23), none of the codes for RSV are CCs or MCCs.

Go figure.

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TiddlyWiki

OK, this is a little off topic but too good not to miss. TiddlyWiki is a handy tool that opens your eyes to the power of wikis and clever development. Just download the html file and get started. It’s that simple. You won’t regret it.

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WHO ICD Update and Revision Platform

Thanks to SoCalcoder you can see why we’re again very behind the times here in the US. The World Health Organization has an ICD update and revision platform (wiki-like) where you can help to shape the future of the classification. Sign up and add some content to the process. This link describes the obvious advantages of opening participation to interested parties. I hope that the NCHS or CMS has similar plans for ICD-1[01]-CM. This would be a welcome change from the current and antiquated biannual process.

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ICD-10 Future – What do you think?

CMS stated in FY08 IPPS final rule it will continue to assess the adoption of ICD-10 in the future.

•Will ICD-10 really help the quality outcome for patients?
•Will ICD-10 help reduce costs?
•Is the adoption of MS-DRGs, expanded quality measures for reporting and continued P4P initiatives enough to sustain Medicare IPPS?
•If ICD-10 is adopted, who will retire first? Will there be any coders left?

Any thoughts?

Welcome to the Party Pal

Great blog insight on health care IT, the EHR and Bill Gates. Note the reference to “medical records”. I can’t help but think about the problems I have navigating some healthcare EHRs for coding evaluation. It’s not pretty.

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Pulmonary Hypertension

There’s a revised clinical classification for pulmonary hypertension (Venice 2003) that separates the causes of the disease into those affected by the pulmonary arterial tree, the pulmonary venous system and because of alterations in lung structure or function. I’ve forwarded the info for inclusion in the Spring C&M agenda, so we can hopefully see changes by Oct ‘08.I’ve always suspected that the administrative data associated with 4160 and 4168 was inconsistent and unreliable. After reading this SCCM article, I’m convinced that some of the new pulmonary hypterension codes will be distributed among all SOI levels (major CC, cc and non-cc). It’s pretty obvious that these codes need to be updated. Also it looks like the I-10 codes were just copied from I-9, so maybe we do need to wait for I-11. At any rate, treating pulmonary hypertension is a difficult management decision in the critical care unit.

ICD-10-CM

I27 Other pulmonary heart diseases
I27.0 Primary pulmonary hypertension
Pulmonary (artery) hypertension (idiopathic)(primary)
I27.1 Kyphoscoliotic heart disease
I27.8 Other specified pulmonary heart diseases
I27.9 Pulmonary heart disease, unspecified
Chronic cardiopulmonary disease
Cor pulmonale (chronic) NOS

ICD-9-CM

416 Chronic pulmonary heart disease
416.0 Primary pulmonary hypertension
Idiopathic pulmonary arteriosclerosis
Pulmonary hypertension (essential) (idiopathic) (primary)
416.1 Kyphoscoliotic heart disease
416.8 Other chronic pulmonary heart diseases
Pulmonary hypertension, secondary
416.9 Chronic pulmonary heart disease, unspecified
Chronic cardiopulmonary disease
Cor pulmonale (chronic) NOS

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MRCs Trump MCCs

The MS-DRG grouper includes a category for “Major Related Conditions” (MRC) associated with AIDS/HIV (see MDC 25 logic). There are 676 ICD-9-CM diagnosis codes that qualify as MRCs, code range 0031-486. The MRCs trump the MCCs, so an AIDS inpatient treated for community acquired pneumonia, (e.g., secondary diagnosis 486) does not group to MS-DRG 974, HIV with Major Related Condition with MCC. Instead, it groups to MS-DRG 976, HIV with Major Related Condition without CC/MCC.Not included as MRCs are conditions like AIDS dementia (042 + 2941x). Read the final paragraph from this article on the HIV Dementia scale, and I think you would agree that this condition should be an MRC. It also makes me wonder why there is no grouper logic for cases with mulitple MRCs. Some of these admissions are for very sick AIDS patients, e.g., those who are non-adherent to HAART or present with multiple opportunistic infections (OI).

So what happens to our Medicare patient admitted for HIV dementia without an MRC?

The case gets assigned to MS-DRG 977, HIV With or Without Other Related Condition. This doesn’t seem right. Even if this patient is treated for acute renal failure, the case will be grouped to MS-DRG 977. Here’s an example:

PDX= 042 with secondary diagnoses = 5849, 27651, 29411; MS-DRG = 977.

Here are the MS-DRGs and relative weights for AIDS/HIV:

969 HIV w extensive O.R. procedure w MCC 5.1395
970 HIV w extensive O.R. procedure w/o MCC 3.6849
974 HIV w major related condition w MCC 2.1382
975 HIV w major related condition w CC 1.5918
976 HIV w major related condition w/o CC/MCC 1.3357
977 HIV w or w/o other related condition 1.0387

I think that CMS should revisit the MRC list, grouping logic and unique severity of illness that is associated with AIDS/HIV.

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