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May 2010
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My question concerns a scenario I came across in one of the coding books I’m practicing with. The case involved a delivery and had codes ending with fifth digits of 1 and 2 (antepartum and postpartum conditions, delivered). The answer in the book for this particular case had the following diagnoses listed: 667.02, 648.21, 285.1, 646.62, 670.02, 647.61, 054.9, 646.11, 664.31, 663.31, and V27.0.

I was taught to list codes ending with fifth digit 1 before any ending with fifth digit 2. Would you say that the book’s answer is incorrect? First, let me explain that I’m not confused about when to use fifth digit 1 or 2 for the different diagnoses in this case. My confusion lies with whether or not a code ending with the fifth digit of 2 can be used as the principal diagnosis when there are accompanying diagnoses ending with 1. One explanation I’ve been given concerning a code ending with 2 could be used as the principal diagnosis would be if the patient had a perfectly normal delivery with no antepartum complications but had a postpartum complication during the hospital stay for the delivery. In this situation, there would just be the code ending with 2 and the V27 code along with any procedures. Unfortunately, this example does not describe the scenario I’ve written about.

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Other News

New York Network Links to Six EDs
The Rochester Regional Health Information Organization has gained six more hospitals, according to the Rochester Business Journal.

Washington Hospital’s New System Goes Online
The Wenatchee World details the debut of Central Washington Hospital’s new computerized records system.

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Editor’s E-Note

The prospect of change can be frightening. However, it can also present great opportunity to those who embrace it and are willing to exploit its advantages.

Case in point is the pending arrival of ICD-10 code sets, a transition that brings with it numerous possibilities to improve the healthcare process, according to this month’s E-News Exclusive.

— Lee DeOrio, editor

E-News Exclusive

Choosing Integration Over Compliance: ICD-10 and the Advantages of System Overhaul
By David MacLeod, PhD, FHIMMS, CISSP

Following the coup-d’état of her husband, Peter III of Russia, Catherine the Great inherited control of a massive empire. But instead of running the country as her husband had, she expanded it even further, improved administration, and modernized it to fit more Western ideas. When asked about the changing times, Catherine said, “A great wind is blowing, and that gives you either imagination or a headache.”

This story illustrates the choice payers face today. Although migrating to ICD-10 codes is likely to give most health plans a headache, it also should spur great imagination for realigning business goals, creating enterprisewide change, and transforming healthcare in this country.

Payers are at a critical crossroads with their ICD-10 planning and migrations. In an effort to meet the January 1, 2011, testing deadline for implementing the ANSI 5010 Version X12 format, many payers have postponed their ICD-10 planning. Of those who are working on both in parallel, many are utilizing only the general equivalence mapping, a tool that cannot provide one-to-one correlations between today’s ICD-9 and tomorrow’s ICD-10 codes.

Both strategies are short-sighted, in effect eliminating the ability to leverage ICD-10 codes to drive more robust care management and provider contracting programs. Because ICD-10 will change the entire business model—affecting benefit plans, adjudication rules, care management programs, pharmacy programs, and even provider contracts—payers that make short-term changes today may miss the opportunity to dramatically improve business and operational functions. In the long term, they may face a delayed and more costly second effort to integrate ICD-10 codes into their systems—in effect, doing the work of ICD-10 migration twice.

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