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2020 ICD-10-PCS Guideline Changes: Make Room for Exceptions

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2020 ICD-10-PCS Guideline Changes: Make Room for Exceptions

 

On April, we provided an overview of the upcoming ICD Code Revisions for FY2020. In July, we covered in detail the 2020 Proposed Rule for the Inpatient Prospective Payment System (IPPS) CMS-1716-P, which was published in the Federal Register, May 3, 2019.

This years’ updates to the ICD-10-PCS Official Guidelines for Coding and Reporting include a new section, updates to an existing section, new guidance on a body part, some editorial changes and the introduction to the possibility of exceptions for special cases.  In addition, the Guideline changes also included exceptions regarding mastectomy procedures, followed by immediate reconstruction; a welcomed change.

The Exceptions:  Mastectomies Coded in All Circumstances- Immediate Replacement Included

The Introduction includes this new line regarding the guidelines: “They are intended to provide direction that is applicable in most circumstances.  However, there may be circumstances where exceptions are applied.”

  • A dilemma solved for coding professionals. The exceptions that were included in the updated guidelines involve a mastectomy followed by immediate reconstruction. It was a matter or timing that determined whether the mastectomy was coded. If a patient had a mastectomy during the current encounter and a subsequent reconstruction at a different episode, then the mastectomy was coded for the first encounter, and the reconstruction for the next one. This was different in the case of a mastectomy followed by immediate reconstruction during the same encounter.  Before 2020, following the guidelines meant that in the case of immediate replacement, the mastectomy would not be coded as it was necessary to remove the native breast first before replacing it.  The exceptions to the guidelines give coding professionals a solution to this dilemma. They also bring the guidelines in line with the advice published in the Third Quarter 2018 Coding Clinic page 13, in the article:  Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: mastectomy is coded separately, and the harvest of the DIEP graft is not reflected in a separate code.
  • Guideline B3.1b has been updated to state that Components of a procedure specified in the root operations definition or explanation as integral to that root operation are not coded separately. The exception is listed:  Exceptions: Mastectomy followed by breast reconstruction, both resection and replacement of the breast are coded separately. This contrasts the resection of the native breast before replacement to the example given in the guideline: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately. As noted in the Third Quarter 2018 Coding Clinic article, “Mastectomy with breast replacement/reconstruction and joint replacement surgery are conceptually very different. In joint replacement, the objective is to restore function by replacing the joint. For a mastectomy with reconstruction, it is important to identify that the primary objective of the surgery is to remove cancerous or potentially cancerous breast tissue, and that the reconstruction is an additional objective.”
  • The changes in guideline B3.9 also relate to these circumstances. 9 instructs that if an autograft is obtained from a different procedure site in order to complete the objective of the procedure, a separate procedure is coded.  Excision of a saphenous vein for a coronary bypass is highlighted as an example.
  • The updated guideline lists the exception to this guideline: Except when the seventh character qualifier value in the ICD-10-PCS table fully specifies the site from which the autograft was obtained.
  • Added to the saphenous vein example is the following: Replacement of breast with autologous deep inferior epigastric artery perforator (DIEP) flap, excision of the DIEP flap is not coded separately. The seventh character qualifier value Deep Inferior Epigastric Artery Perforator Flap in the Replacement table fully specifies the site of the autograft harvest. This updated guideline and example are telling us that including a code for the harvest would not add any information as the source of the graft is listed in the 7th character qualifier, and therefore the additional code is not required.

ICD-10-PCS Guideline ChangesEdits in the Guidelines

While there is no change in guideline A9 that instructs that within a PCS table, valid codes include all combinations of choices in characters 4 through 7 contained in the same row of the table; the code table used as an example has been updated to include device value Y “other device” that has been added to the 0JH code table.

  • Guideline B2.1a for body systems had some editorial changes, listing the complete titles of the Anatomical Regions body systems and removing the Control example, since this root operation can now be coded in in other body systems. Also added was an example: Amputation of the foot is coded to the root operation Detachment in the body system Anatomical Regions, Lower Extremities.
  • The root operation Extraction was added to B3.5 for overlapping body layers, stating that for root operations such as Excision, Extraction, Repair or Inspection performed on overlapping layers of the musculoskeletal system, the body part specifying the deepest layer is coded.
  • In guideline B4.1b for body part that addresses the prefix “peri,” guidance is given for the periosteum: A procedure site documented as involving the periosteum is coded to the corresponding bone body part.

A New Section of Guidelines, and Updates to New Technology

A completely new section with two guidelines, section D, is added for Radiation Therapy.  The new guidelines concern Brachytherapy and instruct when separate codes are needed from the Medical and Surgical section for Insertion of the brachytherapy source that remains in the body at the end of the procedure.  Also covered is the placement of a temporary applicator for brachytherapy delivery.  Review these guidelines carefully.

  • With the addition of the Radiation Therapy section, the New Technology guidelines from section X have been moved to E, with some edits and the addition of a new guideline.  The updated guidelines specify when a New Technology code may be the only code reported and when they may be additional codes reported along with codes from other sections of ICD-10-PCS.  One example given is for the use of dual filter cerebral embolic filtration, coded as X2A5312 used in conjunction with a transcatheter aortic valve replacement (TAVR); both codes are assigned.

While the updates to the 2020 guidelines are not extensive, there are important changes that warrant careful review. You can find the full document here: https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2020-ICD-10-PCS-Guidelines.pdf

Case Study: Coding Quality Improvement Plan for Healthcare Facility Acquisition of a Large Physician Group

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Case Study: Coding Quality Improvement Plan for Healthcare Facility Acquisition

 

As healthcare organizations strive for continuous efficiency and sustainability, merging and acquiring (M&A) diverse medical facilities provides organizations with new opportunities to reduce costs and generate a larger footprint in current, and even new markets. As an HIM and Coding consulting company, YES has encountered several opportunities to implement auditing, coding, and education improvement plans in these specific scenarios. This case study summary provides an analysis on the unique challenges a medical facility faces when merging with independent practices (I.E. the impact on overall medical coding quality, turnover rate, and productivity), and the solutions we have crafted to be implemented for maximum results. In addition, an included overview of the impact of these solutions presented to a facility and practiced over a 21-month period.

The solution we’ve proposed is one that can be achieved through implementing the four key objectives of our Coding Quality Improvement Plan:

– Identifying the significant pain points impacting coding quality, resulting from a

healthcare facility acquiring a large physician group

– Creating and conducting a coding quality improvement program

– Capturing comparison data & analyzing the solution’s impact on overall coding quality

– Providing recommendations for future programs and addressing similar challenges

 

Overall, the implementation of a Coding Quality Improvement Plan for a merger and acquisition scenario for a period of 21 months, yielded the following results:

ProFee coding accuracy increase at a constantly growing rate: ProFee coders increased coding accuracy by 14.33% in a 21-month period for CPT (1Q17 vs. 3Q18). For DX coding, ProFee coders increased accuracy by 16.41% in the same period. Coder turnover decreased while constantly increasing coder accuracy.

Successful transition of complex encounters to YES team while maintaining a higher accuracy rate in CPT and DX: The YES team consistently performed with a higher accuracy rate in CPT and DX in regards to the overall ProFee coding program and the physician group ProFee coders.

Coder turnover decreased while constantly increasing coder accuracy: Quality Audits are performed per ProFee coder. As the first Quality Audit results were presented in 2Q17, coder retention decreased by over 30%, which resulted in a needed shift in physician group coding personnel in order to continuously increase accuracy and achieve a 100% retention rate by 3Q18.

To conclude, this case study highlights the best approach to address these challenges: assess and develop a plan, with a holistic approach that positively impacts coding quality on an enterprise level. This approach requires an objective team with higher accuracy rates, higher level of expertise in the ProFee field, and proven experience in coder mentoring.

ProFee Coding

Selecting the right coding audit company for your organization

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Selecting the right coding audit company for your organization

 

The process of performing regular coding audits in order to evaluate the effectiveness of your organizations coding procedures has become a necessity throughout today’s healthcare industry. And with more and more companies looking beyond their own departments to outsource this task, it’s important to consider the key factors of choosing a coding audit vendor that is just the right fit. Providers and healthcare organizations that work with coding vendors are well aware of the many factors that go into selecting coding consultant companies. Ensuring the vendor is aligned to the needs and requirements of the organization and its members is top priority. But what are main items of importance to keep in mind?

Coding Audits

Experience: How long has the organization been performing in the field of medical coding consulting services? And is it one of their main areas of expertise, or just a side-service they offer. A good way to figure this is out is by doing some research. Check their company website; it usually highlights their credentials, achievements, and testimonials. The company website can prove to be a great resource to much of the information you are looking for without having to do a lot of digging. Another important question to keep in mind is if the company is experienced in working with small and large facilities. Do they handle on-site as well as remote audits? More often than not, determining how versatile a company is can lead you in the right direction towards the best possible choice. Does the coding consultant company knows how to partner with their clients? This is an important answer to seek. Providing an audit is not the same as partnering with a client to increase quality. Experienced auditing partners know the difference.

Planning & Communication: Does the healthcare coding audit vendor you are thinking about working with give you peace of mind through the way they communicate their plan for your organization? Choose a vendor that practices good communication techniques prior to a contract being signed. A good auditing partner will provide you with information and statistics from their past cases to ensure that you are making the right choice in working with them as well as show you how they stack up against the competition. Does their audit plan for your organization include periodic check-ins or education sessions? If so, you are headed in the right direction. A reputable vendor should include a “touch-base”, or what we call at YES, a coaching session in their plan to keep the client educated and informed on the processes taking place.

Performance & Follow Through: Make sure your vendor of choice will provide you with statistical findings, trend reports, and suggested paths to improvement that will not only help identify problematic patterns in your current coding and documentation, but educate you in the ways that you can improve in these areas. A good way to gauge a potential vendor’s performance is by checking their references and reviews. Would other reputable companies refer you to give them your business? How highly are they rated or reviewed? A smart way to find the answer to these questions is to look for testimonials or reviews from past projects. Be sure to keep an eye out for any trends in these reviews, where certain areas of service are repeatedly commended (or criticized). This can help you gauge if the areas that this vendor specialized in match the needs of your company.

When it comes to selecting the coding audit vendor that fits best for your company, knowledge is power. So, don’t be afraid to dive in and do the necessary research if your goal is to yield the best results for your team. Considering these key areas before making your choice can save you time, money and a lot of work in the long run.

 

End-to-end patient experience becomes top priority in today’s evolving revenue cycle

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End-to-end patient experience becomes top priority in today’s evolving revenue cycle

 

Regardless of how good the average experience of a patient has been during their time at any given healthcare system, what often determines their general memories of their experience is the financial resolution that follows after. High costs and/or a difficult payment process can tarnish a patient’s perception and greatly affect their opinion on said healthcare system as a whole. One of our own team members experienced a similar situation in which she chose not to return to one of her specialist doctors because their outpatient coder mishandled her bill, resulting in her insurance not covering the charge and her bill sitting in revision. In today’s world, you can leave a review of your experience virtually anywhere where payment is exchanged. It is because of this that health systems need to prioritize reinforcing the structure of their back end and front end financial processes to make them look, feel, and behave more like online retail or personal banking environments.

Patient Experience

“Patient payment behavior is changing the revenue cycle. Rising insurance deductibles and higher out-of-pocket medical expenses mean up to 30% of a health system’s revenue is now derived from the patient-as-payer population” (Visitpay.com, 2019). The revenue cycle of today has drastically changed from that of the past few decades and is only continuing to evolve as technology continues to advance, enabling patients to have a greater role in the process. As with many processes in the healthcare industry, revenue cycle has turned into a hybrid of the old structures and guidelines and new methodology. The way in which patients pay their bills has continued to change as well. “Rising insurance deductibles and higher out-of-pocket medical expenses mean up to 30% of a health system’s revenue is now derived from the patient-as-payer population.” (Visitpay.com, 2019).

Segmentation

An answer and stand-out solution to the question of what can be done to bridge the gap between patient and provider, improving the end-to-end patient experience, is segmentation. Market segmentation in regard to the healthcare industry is a process by which medical services are designed and targeted to meet the specific needs of a particular group of customers. Utilizing this technique can help revenue cycle teams engage patients more meaningfully. It is obvious that the patient to provider ratio is staggered, meaning that you can’t engage with every patient as an individual. But in using market segmentations, health systems gain a way to address the needs of different groups of patients who exhibit similar characteristics.

Segmentation

The technique of segmenting, or breaking down a huge audience into smaller, more personalized groups is one that is used across all industries. Sales, hospitality, and retail along with numerous other “consumer-facing” industries make use of segmentation in order to personalize their approach and mold their information in a way that gives the consumer reassurance in feeling like their needs are being met, while not taking on the impossible task of reaching out to each one individually. Providing patient-tailored and consistent financial information throughout the care process is the answer to connecting with and meeting the patient’s needs and giving them peace of mind, while avoiding the confusion and stress that can result from the financial experience that follows.

Coding Audits: How they directly affect the success of your organization

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Coding Audits: How they directly affect the success of your organization

 

When considering the constantly evolving and ever-changing coding landscape of today, efficient coding audit practices have become a crucial and necessary step in what healthcare organizations must do to remain compliant and profitable. If your organization is struggling to properly and accurately evaluate its coding procedures, now is the time to take the essential step of seeking an independent entity to conduct regular coding audits. The benefits of conducting a monthly coding audit for your team can save your organization a substantial amount of work, time and money. But above all else, you will have peace of mind in knowing that your coders are maintaining high compliance standards and accuracy.

Coding Audits

Making the transition from an annual external coding audit program to an ongoing periodic review increases costs for healthcare provider organizations. Periodic and consistent audits also yield a stronger return on investment. Moreover, audits can be customized to address the organization’s specific needs—which usually vary from month to month (journal.ahima.org, 2017).

Provider burnout?

This also holds true when considering the fact that performing these audits internally can cause a sort of “provider burnout”, where the execution of these audits becomes too monotonous, leading to inaccurate results. To quote Karen Youmans, President and CEO of YES HIM Consulting, “Some providers have become too routine and complacent.” Having an outside entity to conduct facilities’ coding audits could be used in more ways than just the auditing. As Karen Youmans states, “…using the expertise of consultants to re-educate coders and give presentations to doctors on ways to improve documentation” is a great benefit that goes beyond the auditing itself, (healthdatamanagement.com, 2018). A fresh take or a fresh pair of eyes from external consultants and auditing experts can help providers pinpoint areas of concern that may have been overlooked otherwise.

Take into concern these 3 main benefits of conducting monthly coding audits:

  1. Training and Coder Development: One thing is inevitable; coding is constantly changing. It is because of this fact that it is extremely important for every member of your coding team to change and grow with it. No matter how seasoned your coders may be, continuously learning, sharpening their skills and developing new skills will ensure that your team performs at the best of their abilities.

 

  1. Consistency and Compliance: Outsourcing your coding auditing needs to an experienced 3rd party will ensure that your audits are completed consistently and accurately, without the concern of any changes that may occur internally within your organization. This also gives providers peace of mind that their audits will maintain compliance with all lawful regulations and protocols.

 

  1. CDI Improvement: Coding audits provide a detailed look at what areas your team already has a good grasp on and covers efficiently, and what areas have room for improvement. Missed cases, recording errors, and incorrect codes are all areas that can be identified and improved through the use of an external coding audit.

 

YES Spearheads Automated Education Initiatives in 2019

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YES Spearheads Automated Education Initiatives in 2019

 

In the last decade, operational and patient data have been digitized by the healthcare industry. Digitization has made immediate access to information easier and improved the efficiency of patient outcomes for healthcare professionals. Automation has revolutionized the healthcare industry, making day-to-day processes more practical and cost effective across the board. It is no surprise that automated education within the healthcare industry has quickly followed suit, making HIM education easily accessible at the hands of prospective learners. Coding guidelines change every year, resulting in an ever-growing need for coding education that results in proper documentation and payment to providers. YES aims to provide automated education services with a practical approach, utilizing the knowledge base of our team of nationally recognized educators and experienced executives.

With countless studies detailing how staggering amounts of employees feel as though they aren’t achieving their full potential at work and could benefit from some form additional training, it is becoming more and more apparent that an organizations’ investment in continued education is extremely important (shiftelearning.com, 2016). YES aims to answer this demand with the use of our intuitive education platform of online coding courses and automated modules. These webinars can be accessed anytime, anywhere and on any device- making it practical from both the perspective of the provider looking to adopt automated education into their organization, as well as the employee or potential learner using the platform.Automated EducationAll education by YES has pre-approved CEUs with an automatically downloadable certificate available after the webinar is passed, taking the process of education-testing-recognition and streamlining it into one cohesive, user-friendly experience. All of our courses provide AHIMA and AAPC CEUs. Our Refresh with YES courses cover a wide range of ICD-10-CM, ICD-10-PCS, and CPT topics, from Spinal Procedures to Obstetrical and Newborn Diagnoses, that we cultivate directly from the feedback and needs of our clients and partners.

With automation rising to the forefront of the educational efforts of today’s top companies, the benefits of adopting these methods into your company’s curriculum also continue to grow. At YES, our goal is to provide the most fluid, easy to navigate, and content-rich platform to the user. In doing this, we aim to make the transition into automated education as smooth as possible for the client or company, while maintaining our standard of top-notch education.

Automated Education

Join YES at the 2019 FHIMA Annual Convention

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Join YES at the 2019 FHIMA Annual Convention

 

The Florida Health Information Management Association (FHIMA) is a component state association of the American Health Information Management Association (AHIMA) that supports and promotes health information management professionals by advancing best practices through education, technology, professional development, leadership, and communication. On July 28th though the 31st, FHIMA is holding their annual convention for health information management professionals at the Walt Disney World Swan and Dolphin Resort in Orlando, Florida.

FHIMA

YES is pleased to announce our attendance, and that we will be exhibiting during the conference as well. Make sure to stop by our booth (#107) and come visit members of the YES team. We are looking forward to meeting you! Just like this year’s FHIMA conference theme, we predict there will be nothing but “Smooth Sailing Ahead” as we count down to July! You can follow YES on social media for more updates from the Quad-State Annual Meeting & Exhibit!

FHIMA YES Facebook     |     YES LinkedIn

EHR: One Step Forward, Two Steps Back?

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EHR: One Step Forward, Two Steps Back?

 

Electronic health records were projected to make some pretty big waves in terms of change in the healthcare industry. In setting major goals of bringing higher quality care, making medicine safer, empowering patients and being more cost-effective, this new method had some pretty big shoes to fill. For some, these promises almost sounded too good to be true; and many would agree that it was. $36 billion dollars later and over a decade after President Obama signed a law to push the digitization of medical records, the return is much lower than expected. Instead of the promised electronic network of information, the nation’s countless EHR systems remain a vastly detached and disjointed mess. To make matters worse, the effort has tied healthcare providers to the use of a system they dislike, while funneling money to the industry that sells it.

EHR

The widespread adoption of electronic health records across the United States is one area in which these efforts succeeded. From only 9% in the year 2008, to a staggering 96% adoption rate today, it is obvious that the high hopes people had for EHR’s helped this number skyrocket over the past decade (Fortune.com, 2019). Unfortunately, what was received were non-user friendly, faulty and unintuitive systems that instead caused physicians to spend more time trying to navigate them than time spent with their patients. What turned out to be one of EHR’s biggest downfalls is the fact that these seven hundred plus vendors don’t talk to one another- meaning data cannot be transferred throughout the varying systems. This huge misstep really started becoming prevalent when countless incidents started occurring where patients lost their lives due to critical or time sensitive information (Allergy documentation, test orders, lab results) going unnoticed; highly important patient information buried in vast amounts of electronic data.

Light at the end of the tunnel?

The promise of electronic health records transforming the very way the healthcare industry works, was an immensely optimistic one. With the black cloud that has been formed over the past decade hanging over the concept of EHR, is there any hope for the future of electronic health records?

The answer is yes.

EHR

With advances in technology continuously growing and showing no signs of slowing down in the near future, researchers are looking towards four main concepts to pick up where EHR left off.

FHIR: Pronounced “fire”, FHIR is an open API that allows for more fluid health data exchange. As health IT and electronic health records continued to be plagued by translations problems, FHIR emerged in 2014 as a draft standard for trial use to enable health IT developers to more quickly and easily build applications for EHRs and to exchange and retrieve data faster from applications.

Voice Recognition: Most of our smartphones, PC’s, wearables and even our cars already have it- it only makes sense to utilize this ever-evolving technology staple in order to allow doctors to dictate speech instead of physically documenting their notation.

Mobile: Major HER vendors have already introduced mobile solutions that provide physicians with the ability to chart and record on portable touch screen devices and tablets.

Human Scribes: Technically not a new advancement, scribing, a method of recording that dates back thousands of years, is becoming more and more popular among doctors who are having personal assistants shadow them while taking notes- lightening their workload.

Value-Based Care: Trends and Challenges in Revenue Cycle Management

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Value-Based Care: Trends and Challenges in Revenue Cycle Management

The effectiveness of value-based care models is measured based on how this type of reimbursement can improve the quality of a patient’s overall health. Reducing hospital readmissions and improvement in preventive care are good examples of critical factors to assess the effectiveness of these models. U.S. legislation is clearly moving towards the adoption of value-based care models; in 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) put into place multiple quality programs under the new merit based incentive payments system (MIPS). The Health & Human Services Department (HHS) established the objective to convert 30% of Medicare charges into value-added payment models by the end of 2016. By 2018, the Agency’s objective was to make a transition to 50 percent of conventional payments.

Future Trends

Revenue Cycle Management (RCM) systems will eventually assist the industry in transitioning from fee-for-service to value-based reimbursement. The analytics of many of these RCM systems enable payers and providers to look at their patient population in more detail, such as the number of chronic disorders in their patients, allowing payors and providers to monitor claims data and identify potential abnormalities.

Revenue cycle managers are betting on data analytics to try to improve every phase in the revenue cycle process, in order to eventually obtain more cash flow from each phase. Information is being consolidated and evaluated to drive business process changes across the revenue cycle process, from scheduling appointments to claims denials. RCM systems will in due course, streamline routine processes such as claims processing and payer denials prevention.

Future Challenges

Challenge One: Lack of integration

Revenue cycle managers work with historical data from differing financial and clinical information systems. However, many hospitals and health systems have not been integrated to this level. The number of disparate information systems can continue to increase when hospitals merge and purchase physician practices and other healthcare entities. The incorporation of data from external sources can also contribute to the challenges of standardization. Large-scale analytics is still a considerable challenge, resulting in a lack of an all-inclusive view of a patient’s record.

Challenge two: Lack of preventive education

Many reimbursement problems arise from human errors, such as incorrect coding, missing items on a patient’s account, and problems with insurance eligibility. Health organizations that proactively promote appropriate coding techniques, comprehensive chart documentation, and financial policy reinforcement, have consistently reduced turnover and medical errors, which results in a reduced amount of denied claims.

Value Based Care

 

Challenge three: Lack of visibility and control on claim submission-denial process

Following up on a claim throughout its lifetime is another major challenge for healthcare revenue management. Healthcare professionals should closely monitor claims processes to identify errors. Revenue may be lost unless providers can identify where problems arise and quickly resolve mistakes. Providers can usually receive automated alerts or have a dedicated data analysis resource to produce custom and automated reporting, with the objective of identifying why payers deny claims for certain methods or codes routinely.

 

The Changing Seasons Bring the Beginning of ICD Code Revisions

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The Changing Seasons Bring the Beginning of ICD Code Revisions

Depending on your location, the spring season brings warmer temperature, green grass or maybe even hurricanes.  But wherever you are, spring brings the first sign of new ICD codes that will be implemented in the fall.

We first see the changes in the Proposed Rule for the Inpatient Prospective Payment System, published in the Federal Register, in April. Part of this Rule is the list of code changes for both ICD-10-CM diagnosis and ICD-10-PCS procedure codes. As with all Proposed Rules, there is an assigned period for comments from the public. The Final Rule is published in the summer, these include the final code changes.

ICD Code Revisions

All changes are effective on October 1st; the first day of the federal government’s fiscal year- this year is FY 2020.  The official addenda for the ICD-10-CM and ICD-10-PCS code sets that include details of all the Tabular and Index changes are also released in the summer, as are any updates to the Official Coding Guidelines for both systems. Coding professionals learn about the new codes and guidelines in time for fall implementation on October 1st.

Though we are just seeing these changes in the spring and know that we must learn about them and be ready to implement on October 1st, we may wonder, where did these come from?  And how might we influence the changes ourselves?  All code changes begin at a federal meeting that we are all invited to attend, free of charge.  Attendants can also watch and listen in live while the meeting is taking place, recordings of the meetings can be also found on YouTube.

What is this meeting that starts a code change?  It is the Coordination and Maintenance Committee (C&M). Code revisions, including additions and even deletions are introduced at the C&M Committee meetings.  Held in September and March, in Baltimore, Maryland, these are public meetings co-chaired by the Center for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).  Anyone can attend and participate in these meetings, and advance registration is required.  Proposals are introduced, with rationale and recommendations for how the code set should be changed, these suggestions come from various sources; professionals in the field, questions that have been submitted to Coding Clinic and internal review within CMS and NCHS.

The committee meets for two days and generally the procedure proposals for ICD-10-PCS are presented on the first day, with the ICD-10-CM diagnosis proposals on the second day. The meetings feature live presentations, often from the persons or organizations that are proposing the change. These can be fascinating presentations chock full of clinical information and for the PCS proposals, information on the newest technology and procedures being performed. There is discussion on the need for the new code, current coding practice and proposals for changes to the codes.  Members of the audience can ask questions of the clinical presenters or CMS and NCHS staff during the meeting, phone lines are open to accept questions from those watching the sessions online.  Participants and other interested parties are encouraged to submit comments for consideration in writing to the NCHS for diagnosis codes and CMS for procedure code updates. No official decisions are made at this meeting, the final decisions on code changes are made by NCHS and CMS.

The Coordination and Maintenance Committee Meeting – March 2019

The most recent C&M meeting was on March 5-6, 2019.  Comments on topics covered in these meetings are due by April 5, 2019. During the procedure session, several topics were discussed, see the agenda packet for more information here.

ICD-10 Code Revisions

A Great Example of how These Meetings work:

One of the topics was the use of a flow diverter stent to treat unruptured intracranial aneurysms.  Unlike a traditional stent that holds vessels open, this mesh-like stent is inserted across the neck of aneurysm to divert blood away. As time goes by the flow diverter device causes thrombosis within the aneurysm and tissue scaffolding across the neck of the aneurysm itself. This device eliminates the need for coiling of the aneurysm and has been found to be an effective stand-alone procedure.  Since the objective of the procedure is to partially close the lumen of the tubular body part, the Restriction root operation is used.  One of the proposals included adding a new device value to the 03V table for Restriction of the upper arteries.  Commenters and CMS indicated that they approved of this proposal.  The final decision will be made by CMS on the potential new device value and the timing of any change.

In the diagnosis portion of the meeting, several proposals were discussed, see the agenda for more information: https://www.cdc.gov/nchs/data/icd/Topic-packet-March-2019-Part-1.pdf, https://www.cdc.gov/nchs/data/icd/Topic-packet-March-2019-Part-2.pdf.

This is just a sample of the discussions from the March 2019 C&M meeting.  We will not know until the Proposed rule, whether these proposals or those from earlier C&M meetings will officially become code changes for FY 2020.  What we do know, is that almost any code change gets its start at the C&M meeting. And as the seasons change, so do our ICD codes.

YES HIM Consulting, Inc. Largo, Fl.
Office: (727) 531-3839       Fax: (727) 240-4592