Friday, April 8, 2016

ICD-10 Ushers in “New” Concepts

Good Day of Training!
Last week, in this space, we talked about the importance of training for the billing office. We made the point that the billing office is vital to the success and “health” of your EMS agency and as such training is vital not only maintaining a consistent cash flow, but more importantly to insure your EMS agency’s compliance with all EMS billing rules and regulations.

Our day for training has come and gone. This billing office enjoyed our visit from Doug Wolfberg of the National Academy of Ambulance Coding.

Training Brings Concepts to the Forefront
Deliberate training sessions not only facilitate the learning of new concepts, but also helps us all to recall once-learned, existing concepts we all tend to take for granted…and sometimes even forget.

As part of his presentation, Wolfberg reminded us all of the two “new” concepts hoisted on our backs following the October 2015 introduction of ICD-10 coding to our EMS billing world.

Two Important “New” Concepts
ICD-10 demands that the EMS provider meticulously include the existing concepts of Specificity and Laterality into our Patient Care Reports.

Remember those boring anatomy and physiology lectures? Testing where you thought you’d never get through all of the many bones, muscles, ligaments, tendons, and systems that comprise the complex nature of our human bodies.

ICD-10 demands that we use all that “stuff” that maybe you haven’t thought about in a long time but should have been using all along when documenting your incidents.

Specificity
In this ICD-10 environment, be certain that you are painting a picture in words using clear clinical documentation about the specific details of all injuries, including the anatomic location, the location of the incident and even the mechanism of injury if your scenario is trauma related in any way.

Instead of “leg injury” now you must be sure to describe in writing that your leg injury is a “possible fracture of the left distal femur just above the knee.”

Your “hemorrhage” scenario should include the estimated volume of blood loss, the color of the blood, the nature of the blood loss (oozing, spurting…) and specific steps taken to control the bleeding (direct pressure/elevation, tourniquet, etc…). Plus, include any attempts to replace the lost volume with IV fluids and/or other interventions.

What was the location of the incident? Describe the scene itself.

What was the mechanism involved in your industrial accident? Was the patient run over by a forklift and, if so what are the suspected injuries and the location of those injuries (see below)? Is there ecchymosis anywhere on the body consistent with the tire treads from the forklift or did the patient experience a puncture wound to the torso from the forks prior to being run over by the machine? If so, how deep are the wounds? What is the patient’s level of consciousness? What is the level of pain experience by the patient in his/her own words on a 1-10 severity scale?

Laterality
Location! Location! Location!

Is it the right humerus or left humerus that’s injured? Is the injury proximal, distal, medial or lateral to another reference point on the body.

Does your patient’s chest pain present mid-sternal or in the left lower rib cage? Is your patient’s abdominal pain centered in the right, left, upper or lower quadrants….or everywhere?

Is This Really “New”?
Is any of this really “new”? The answer is “NO”!

ICD-10 demands that we follow these rules, but we should have been using this level of detail in our PCRs all along.

So make like Nike and…Just do it! Your billing office will love you for it!

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 agencies across the United States. To learn more about who we are and what we do, please visit our website at www.enhancedms.com and click on the “Get Started” button on any landing page.

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