Friday, June 12, 2015

ICD-10- How Will It Change EMS Documentation?

Part II
Welcome to Part II of our two-part series! Last week we talked about the overall changes that ICD-10 will usher in come October 1st and we focused on the detail and specifics needed in Patient Care Reports in order to provide enough information for your billing office to choose the correct Version 10 diagnosis code.
Focus on the Details
This week we look at another important area, location.

Location
Remember those words lateral, medial, distal, proximal…all that stuff that you hoped once you learned you wouldn’t necessarily need to remember. Well, think again.

ICD-10 is very much about describing the location of illness and injury.

Where in the Version 9 code set we currently use, the codes are more blanket than specific in nature. Version 10 will force us to identify location. These codes carry a left, right, top, bottom and a relational aspect to them that Version 9 did not.

That means when you document an injury, let’s use a leg injury as an example, your billing office is going to need to know the pinpoint location of that injury. So long documentation that is general…
“Arrived on scene to find a male patient that had fallen from his bicycle and appeared to have a fractured leg.”
Welcome revised documentation such as…
“Arrived on scene to find a male patient that had fallen from his bicycle while traveling on the berm of a highway that has a 55 mph speed limit and appears to have a possible fracture of the left tib/fib area of the lower extremity. The patient denied any loss of consciousness and stated that his right leg became entangled in the spokes of the front wheel of the bicycle when a passing car forced him into loose gravel on the side of the roadway. Patient presented with angulation at the point of the suspected injury site and there was noted bruising with crepitus noted upon palpation. The patient was in a severe amount of pain that he noted was a 9 on a 1-10 severity scale.”
Of course, a description of a treatment course would follow along with notes about how the patient was moved and transported.

We think you get the picture.

Mechanism
Notice in the sample documentation above we talk about mechanism and weave the “how it happened” into the written narrative. That was no accident.

ICD-9 really did not include the need to be specific about mechanism and really only took into account the injury or illness itself. Version 10 changes all of that.

In the example above the use of the accident involving a pedal cycle (traffic) code V71.5 (as opposed to the accident pedal cycle non-traffic code) along with the injury codes for the fractures to the tibia and fibula (M96.67) would be appropriate.

Not so simple…
Many of the coding sets are not so simple.

Let’s consider vomiting. Vomiting is something we encounter a lot in EMS.

So, there’s vomiting with…nausea, asphyxia, including blood, due to nervousness plus codes for projectile vomiting. There is a group of these codes for what is labeled “cyclical” and includes due to migraine headaches or that are psychogenic in nature.

Then there are the external injury causes codes.

The Accident to or due to section includes… riding an animal, being a bare foot water skier, being in a cable car not on rails or then there’s the accident caused by a coal car or logging car.

One of our favorites is the separate code for injury to a parachutist.

Let’s say you’re a pedestrian and are injured. There’s a code to cover if you were a pedestrian on foot and the if you fell due to ice or snow or maybe while on a pedestrian conveyance or possibly on roller skates or on a skate board.

Were you injured in an ambulance vehicle? ICD-10 has it covered with a code all of its own!

Remember there are 68,000 of these codes and, as you can see, all the bases are seemingly covered but your billing office will be unable to choose the most appropriate code unless you, as the EMS provider on the scene, describe the scene and the contributing scenario in distinct detail.

The Ambulance Billing Services blog is brought to you as an educational tool by Enhanced Management Services, Inc. Enhanced Management Services, Inc. is an all-EMS, third-party billing contractor serving Fire/EMS clients across the United States. To contact us, visit our website at www.enhancedms.com and click on the “Get Started” button located on any landing page.
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