A Note from the Associate Director: Quarterly Conference Call highlights new ICD-10-PCS concerns

More than 700 ACDIS members registered to participate in last week’s ACDIS Quarterly Conference Call. The calls, part of ACDIS membership benefits, features members of the Advisory Board who present on timely issues of the day and respond to participants’ pre-submitted questions.

The February 18 agenda included:

• Capturing appropriate risk adjustments for total documentation integrity
• ICD-10 unspecified codes
• Comparison of onsite versus remote CDI staffing models
• CDI reviews for risk-adjusted payment methods (outpatient CDI efforts)

A discussion around ICD-10-CM/PCS codes resulted in the greatest amount of feedback from both the Advisory Board and the general membership participants both during and after the call. One pre-submitted question asked:

“What is ACDIS’ opinion regarding the new ICD-10-PCS inclusion of arterial lines as a surgical procedure?  Some experts say it is a valid procedure, others say it is not.”

“Unfortunately in ICD-10-PCS, central lines/PICC Lines, and arterial lines do not have a default code because of the specificity of the code set,” says ACDIS Advisory Board member Anny P. Yuen, RHIA, CCS, CCDS, CDIP, director of ambulatory CDI for Enjoin.

Coders require documentation of where the line ends, along with the intent of its use, in order to select the accurate body part and device within the ICD-10-PCS tables, Yuen says.

A number of minor proceedures which may not have been considered surgical in ICD-9 are coding to surgical procedures in ICD-10-PCS, resulting in the assignment of higher paying surgical DRGs. In fact, members of the Advisory Board have encountered enough of them to warrant a larger discussion and prompted them to create a poll to determine how the CDI community has been handling these discrepancies (please take a moment to participate in the poll).

“Last week, this very topic came up at our health system and I've had conversations with our coders and coding leadership about it,” says Advisory Board member Sam Antonios, MD, FACP, FHM, CCDS, CDI and ICD-10 physician advisor at Via Christi Health in Wichita, Kansas. “ICD-10-PCS is brand new and has never been used before, so it is not surprising that things like this will pop-up. However, we live in the real world with real patients and real money. So any irregularities created by the inherent current imperfections will affect real claims.”

Although it is beyond the scope of the Advisory Board to offer definitive regulatory advice on how to code these procedures, it did acknowledge that discrepancies exist and plans to raise this issue to regulatory authorities.