ICD 10 is scarry and ICD 11 is comming

ICD 10 came into use among the WHO member countries in 1994 and the United States completed revising ICD 10 to ICD-10-CM in 2003 and it then took more than a decade for the United States to implement ICD-10-CM i.e. in 2013. Implementation of ICD-10-CM in Oct 2013 is usually described as Y2K of medical coding, because of the huge transition that involves not only medical coding training but also transition of IT system associated with the revenue cycle management of providers and payers. This implementation will cause backlogs for several months and even after complete transition productivity will come down due to complexity of ICD-10-CM. The ICD-10-CM is so complex and extensive that crosswalk software would not produce desired results as it will throw too many options to choose from and thus requiring the coders to work more like an analyst than rather a medical coder of present day.

Now, many are asking the question that since ICD 11 is in development then why not directly implement ICD 11 instead of ICD 10. The alpha draft of ICD 11 was made online in July in 2011 and the final draft is expected to be available by 2015. Although ICD 11 will be ready by 2015, it may take at least two decades for its implementation in the United States. According to a study, ICD 10 implementation will cost around six to 14 billions dollars in a time span of three-years. This is a costly investment by the US health care industry and hence the industry will not be ready anytime soon to spend another 10-20 billions dollars for ICD 11 implementation.

Intraoperative Radiation Therapy CPT Codes

New CPT codes for intraoperative radiation therapy have been introduced and are to be used beginning 2012 . These new codes for electronic brachytherapy are as follows:

77424 IORT delivery, x-ray, single treatment session
77469 IORT management

Electronic Brachytherapy is a minimally invasive procedure and is completed in just one session. This allows the patient to resume normal life activities sooner than any other therapy present today . Other therapeutic alternatives for intraoperative radiotherapy require five to seven weeks of treatment courses.

AHIMA approves Career Step Medical Coding Course

Career Step's inpatient and outpatient medical coding and billing online courses have been approved by AHIMA. Career Step is a leading online training school for entry-level medical coding and billing professionals for years. They have gained national level repute and respect for their training methods and professionalism. They have a placement cell for the students they train and have placed students with 700 companies. Apart from medical coding and billing, Career Step also has training courses in medical transcription, pharmacy assistant, and administrative assistant.

Career Step has recently been listed among the top educational institutes in the Inc. Magazine's 5000 list of private American companies. Career Step has also won several honors and awards at the national level.

ICD 10 would bring more opportunites for coders

ICD 10 implementation is usually described as Y2K of medical coding. As Y2K brought huge opportunities for software professionals, ICD 10 would do the same for medical coding professionals. Coding is going to become much more complex and coders would be required to apply their analytical skills to choose from 100's of codes rather than just remembering a few codes.

Productivity will go down by about 23-50%. Even after complete transition, coding productivity will not reach the Pre-ICD-10 levels so hospitals will be required to hire new coders to compensate for lower productivity. It is also expected that many senior coders who are in their fifties and sixties would leave their jobs rather than learn the new system, thus creating opportunities for the new coders. Also, ICD 10 implementation will require the creation of new data analyst positions in the hospitals thus increasing the opportunities for medical coders.

Coding Depression

Here is a list of some of the common depression codes.


Depression NOS 311

Depression with Anxiety 300.4
Depression Recurrent 296.30
Depression Situational 309.0
Major Depression Nos 296.20
Depression Reactive 300.4
Manic Depression 296.80
Depression Psychotic 296.20
Neurotic Depression 300.4
Brief Depressive Reaction 309.0
Prolonged Depressive Reaction 309.1
Depression Acute 296.20

Coding Epistaxis

CPT codes for control of epistaxis are in the range 30901-30906. The physician may apply manual hand pressure to control the epistaxis, and no CPT code is assigned for this service, as it is included in E/M service. To control the epistaxis various types of nasal balloons, rocket, nasal sponge or tampoons eg. Rhino Rocket are used. The CPT codes for epistaxis control are unilateral in nature and require the use of modifiers LT or RT for unilateral services and modifier 50 for bilateral service.

CPT codes 30901 and 30903 are used for epistaxis control anterior
CPT codes 30905 and 30906 are used for epistaxis control posterior

Level II HCPCS Finger Modifiers

Many coders are confused when it comes to HCPCS finger modifiers. Here is a simple rule that can help remember the HCPCS finger modifiers. The first digit is the thumb, followed by index finger, middle finger, ring finger, and little finger or pinky.

The Thumb is the first digit of hand

Index finger is is closest to the thumb and is the the second digit of the hand.

Middle finger is the third digit of human hand.
Ring finger is the fourth digit of the hand.
Pinky finger also called as little finger fifth digit of human hand.

Here are the HCPCS finger modifiers.
F1 Left hand, second digit -Left Hand Index finger

F2 Left hand, third digit - Left hand Middle finger or forefinger.
F3 Left hand, fourth digit - Left hand Ring finger
F4 Left hand, fifth digit - left Hand Pinky finger or little finger.
F5 Right hand, thumb - Right hand Thumb
F6 Right hand, second digit - Right Hand Index finger
F7 Right hand, third digit - Right hand Middle finger or forefinger.
F8 Right hand, fourth digit - Right hand Ring finger
F9 Right hand, fifth digit - Right Hand Pinky finger or little finger
FA Left hand, thumb - Left hand thumb.