Friday, February 13, 2015

Difficulty Breathing in an ICD-10 World

Like a Brick
We took the time to actually pick up and carry the “ICD-10 Book” the other day. This thing is like a brick. The book could anchor a small boat! 

Like a Brick
ICD-10 is the new version of the International Classification of Diseases. This is a system of codes used the world over to categorize physical illnesses and conditions. These alpha-numeric codes are utilized by healthcare professionals to label and document diseases, ailments and injuries for documentation purposes for medical records, tracking and in our world here in the billing office to report patient conditions for the purpose of billing and collecting reimbursement. 

Beginning today we are going to be peeking into the world of ICD-10 codes and attempt to help you understand how all this will tie back to the ambulance billing office. 

Keep in mind, as we share our thoughts there really has been nothing of substance released by Medicare, Medicaid or Commercial Insurance payers showing us what the official requirements and instructions will look like. 

So, like when you were a kid and you peeked in mom’s upstairs closet at the Christmas presents she had purchased for you, so we are “peeking” into the ICD-10 book for hints of the “presents” this system will bring to our world. 

Blanket Codes 
The thing about ICD-9, the version we now use, is that it allows for some generalities. The code sets are broad and encompass a myriad of underlying mechanisms, complications and exacerbations. 

Just looking at the sheer number of codes contained in the new version and the fact that we are adding 55,000 choices it completely makes sense that specifics are going to drive what we do in the billing office and those specifics must come from all of you in the field. 

Code Groupings 
Keep in mind that the coding is separated in groupings. 

So, for the purpose of our discussion, here today, we find a grouping that is branded “Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified- The “R” classification covers our respiratory scenario. 

The alpha classification allows for multiple coding for a single condition. 

So within the “R” general code set is the provision for the codes we cite for this difficulty breathing discussion. 

Tagged to the general code sets are number designations to append adding a drill-down into the overall condition representing secondary process or manifestation of the patient’s specific signs and symptoms including associated complications. Plus there is yet another layer of coding attachments for those situations where there are sequelae or late effects. Those indicators are meant to include residual effects of the patient’s condition following the acute phase of the illness or injury. 

Obviously, ambulance billing offices will be dealing more with those acute condition phases, but coding extensions for long-term effects won’t be out of the question to describe patients that we transport in EMS, especially for patients transport in routine, non-emergency transport scenarios. 

What’s the point 
If you can detect our struggle to boil this all down into a nice, neat “What’s the point” statement for this post, then you are picking up on our frustration about how to apply these codes to our everyday processes. 

The point is we are going to need you- the people out on the street to write documentation about your scenarios leaving no doubt about the patient’s condition. Your words must be specific. 

For example, here are just some of the codes we’ll have to work with. Think as you read over these how you’ll need to prepare your documentation to support the use of these codes. 

Coding Examples 
Dyspnea’s general code is R06.0. R06 is the blanket for “Abnormalities of Breathing” and the .0 part is the only the first level of explaining the patient’s condition. 

There’s shortness of breath (R06.02) but that doesn’t include tachypnea and is only for adult scenarios, because there are set of codes for newborns too. To further demonstrate, if your patient is exhibiting stridor, then that’s another code (R06.1) or wheezing- a different code (R06.2) or maybe hyperventilation which we see in the field a lot (R06.4). 

But just when we think we have maybe caught a glimpse of how this unfolds, the coding information points us to the entire coding classification, call them the “J” codes which is an entire section of codes to cover “Diseases of the Respiratory System.” 

These codes incorporate ailments such as the pneumonia, bronchitis and then incorporate the various drill-downs for when there are issues such as edema, allergy complications, COPD and emphysema and break out the acutes from the chronics. 

The list goes on and on. 

EMS is a team effort. Your ambulance billing office is going to need you to work together with them to make this transition. 

Upcoming we’ll dig deeper to demonstrate to all of you how you can help us jump from Version 9 to Version 10 without a glitch! 

The Ambulance Billing Services blog is brought to you by Enhanced Management Services Inc. Enhanced Management Services Inc is an all-EMS billing contractor with Fire/EMS clients from across the United States. For more information about us and what we do, please be sure to visit our company website at
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