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Preparing Your Surgery Center for ICD-10: Part 3 (Patient Encounters)

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Lolita Jones, RHIA, CSS, independent coding and billing consultant, discusses five ways ICD-10 will affect patient surgical encounters in an ambulatory surgery center. This article is the third installation in a four-part series.

Read the first two parts of this series:
Preparing Your Surgery Center for ICD-10: Part 1
Preparing Your Surgery Center for ICD-10: Part 2

1. Update surgical preference cards. Ms. Jones says many ambulatory surgery centers use preference cards or preference card software to make sure the operating room is stocked with the appropriate supplies for a case. In many cases, surgical preference cards list the case diagnosis code, which would need to be updated to reflect ICD-10-CM diagnosis codes as surgery centers make the transition to the new system. If the surgery center uses hard copies of preference cards, the forms should be updated to reflect the change. Otherwise, the surgery center would need to contact the software vendor to make sure the code fields are updated for ICD-10. Ms. Jones recommends surgery centers update their preference cards by early 2013 to prepare for the switch.

2. Address physician education.
Physician education is one of the most important components of the transition to ICD-10, as accurate coding requires thorough physician documentation. "If the physicians don't understand the additional documentation required, the case can't be coded," Ms. Jones says. She recommends surgery centers divide up physician training by specialty rather than sending physicians to a general training session. "Don't waste time on something that doesn't apply to them," she says.

For each specialty, surgery center leadership should look through ICD-10-CM chapters and determine which chapters apply to each specialty. For example, orthopedic surgeons might focus on the musculoskeletal chapter, the injury chapter and information on external causes of injury. Here are some examples of changes to common ASC specialties through ICD-10-CM, according to Ms. Jones:

Orthopedics. Ms. Jones says one major change for orthopedics involves fracture codes. Under ICD-10-CM, fractures or dislocations being treated in the ASC must be assigned a seventh character to indicate whether the encounter is initial, subsequent or sequela. The initial fracture or injury codes would be assigned if a patient is coming to the ASC for treatment of a fracture or dislocation. The encounter does not have to be the patient's first treatment. The subsequent fracture or injury codes would be assigned if the patient is coming to the ASC for after-care or follow-up after a surgical procedure. Finally, the sequela fracture or injury codes would be assigned if the patient came to the ASC for an infection in the open fracture wound.

Ms. Jones says any open fracture will also require coding around the gustilo classification, or the depth of tissue involved in an open fracture. "A lot of surgeons use that in medical school and never use it again," she says. "In 2013, it's coming back, and it will need to be documented in the operative report."

GI/endoscopy. Under ICD-10-CM, physicians will have to indicate on the operative report whether or not a patient's anal fistulas are chronic or acute. "Right now they'll just say 'anal fistulas,' and that's it," Ms. Jones says. She says ICD-10-CM will also include more codes for colon polyps depending on the pathological morphology of the patient.

OB/GYN. If a surgery center treats a pregnant patient under ICD-10-CM, the codes will have to indicate the trimester of the pregnancy, Ms. Jones says. The patient does not necessarily have to be in the ASC for an OB/GYN procedure; even if the patient is undergoing carpal tunnel surgery, the codes are required.

3. Update adverse event reporting. Ms. Jones says surgery centers should update adverse event reporting mechanisms to make sure they reflect the move to ICD-10-CM. "Right now a number of healthcare providers report adverse outcomes to a national database," she says. "If they're using software to report adverse outcomes, such as a sponge left in a patient or a laceration or a [medication error], they need to work with vendors to make sure the ICD-9 fields are updated to reflect ICD-10 diagnosis codes." She says these changes also apply if the surgery center uses hard copies to mail in adverse outcome reports.

4. Check on state department of health reporting requirements. ASCs may be required to report information to the state department of health on a quarterly basis, Ms. Jones says. "Some data may be clinical information if it's extracted on a per-case basis," she says. "[Administrators need to ask], "What are my state reporting requirement changes going to be under ICD-10-CM? What are we capturing in the OR that we report on a quarterly basis?"  

Lolita M. Jones, RHIA, CCS, is the author of the new book "ICD-10-CM/PCS Implementation Action Plan". Visit her website at www.EzMedEd.com.

Related Articles on ICD-10:
Health IT Advisors: Would Delaying Stage 2 Help ICD-10 Transition
93% of Payors Have Chosen an Approach to ICD-10 Migration
ICD-10 Straight Talk Overview


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