EMR Effectiveness
(Last Updated On: February 2, 2017)

Beginning October 1, 2014, medical billing companies will need to implement the new ICD-10-CM and ICD-10-PCS for diagnosis coding and inpatient hospital coding regarding specified procedures. According to guidelines, all entities covered by HIPPA are required to make the appropriate changes to their medical billing methods.

Structure of the ICD-10 code follows these categories:

  • Characters 1, 2 and 3–the disease category
  • Character 4–the disease’s etiology
  • Character 5–description of affected body part
  • Character 6–severity of the disease, disorder or illness
  • Character 7–place for code extensions for the purpose of increasing specificity

Testing of the ICD-10 software should be conducted in addition to training administrators, physicians and staff members in areas concentrating on the development of new guidelines and practice policies (such as converting the most commonly applied ICD-9 codes into their ICD-10 equivalents) and facilitating updates to forms and other paperwork.

Nephrological practices will experience significant procedural coding changes this year. These include changes to office services, consultation, outpatient services, diagnostic radiology and kidney dialysis. In particular, CMS (Centers for Medicare and Medicaid Services) proposed updates to Medicare payment rates and policies regarding ESRD (End-Stage Renal Disease) facilities that are paid according to the ESRD PPS (Prospective Payment System). This recommended suggestion by CMS is intended to enhance incentives for better standards of care and results for ESRD patients by improving the QIP (Quality Incentive Program). Consequently, dialysis facilities may experience payments that are affected by QIP performance scored during a suggested calender year performance period in 2013.

Additional payment changes for outpatient dialysis treatments are expected to rise by 2.5. According to CMS, Medicare paymentsto nearly 6000 End-Stage Renal Disease facilities in 2013 should total an estimated $8.8 billion. After the entirety of policy changes are implemented and fully active, ESRD facilities will see a 3.1 percent increase to payments received.

Moreover, CMS is also recommending that ESRD establishments collect information regarding four different reporting measures that accurately capture data and provides statistical material concerning how well the ESRD facility is:

  • Managing a patient’s anemia, a common problem associated with hemodialysis
  • Reporting infection issues to the CDC’s National Healthcare Safety Network
  • Monitoring a patient’s calcium and phosphorous levels
  • Providing patients with surveys concerning their experience at the facility

The ICD-10 will also contain changes to renal tumor diagnosis codes in 2013. Previously, the ICD-9 had medical billers using one of two codes for descriptions of neoplasms. However, starting in October of this year, there will be six codes explaining the type and condition of a renal tumor. Some of the new codes will include C64.1 (malignant neoplasm of right kidney, except renal pelvis) and C65.1 (malignant neoplasm of right renal pelvis).

By Jordan Glogau