Wellington, FL — (SBWIRE) — 03/12/2013 — Many of HSMN’s clients thought that they could rely on the Encoder to crosswalk ICD-9-CM procedure codes to ICD-10-PCS. The newsflash is that the Encoder, no matter which product is used, cannot convert the ICD-9-CM procedure code to the ICD-10-PCS. HSMN has just announced that its Start Team (ICD-10) will assist hospitals and physician practice management with complex procedure coding under ICD-10-PCS.
The explanation is a simple as it is complex: each ICD-10-PCS is unique; they are not selected from a book but rather they are built by coders based upon the clinicians clinical documentation, the coder’s understanding of the construct of the ICD-10-PCS and the coder’s ability to apply the ICD-10-PCS rules.
It should be noted that while many hospital coders have been sent for training, their scores even when they are high cannot compensate for the lack of experience in ICD-9-CM coding and working closely with clinicians, to gain a deep understanding of what procedures the physicians are doing in the OR. HSMN has developed a methodology called ICD-9-CM “Deconstruction” and ICD-10-PCS “Reconstruction” based upon the clinical documentation in the clinical record.
The program serves to work with the physicians and help train coders at the same time. The program begins with “Deconstructing” real cases some active and others not. It then presents the case back to the medical staff so that they can see differences between what they think they have performed and what the documentation says.
The HSMN team coder working closely with the hospital/practice coders reconstructs the case in ICD-10-PCS to show the coders the gaps in the documentation and the art of building the “Procedure Code”. These methodologies are presented at Grand Rounds with each clinical service. The Case is represented to them in a diagnostic mode. From that point, HSMN helps to sort out those on the medical staff who can be teachers for other members.
HSMN’s methodology involves learning about all of the procedures done by a particular service and rounding with the service members at all levels. HSMN has successfully used these methods to improve revenue based upon solid clinical documentation and critical thinking by the coders.
About Health Systems Management
Health Systems Management Network is a leading hospital, physician practice and health services management consulting firm. They had completed complex medical billing and coding engagements as well as provided revenue cycle management, healthcare financial management analysis, Epic Systems Workflow, Ambulatory Care Billing and APC’s along with other physician practice management projects for healthcare providers.
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