Medical Billing and Coding Healthcare Blog

The American Medical Association (AMA) has announced it intends to create new Current Procedural Terminology (CPT) codes for telehealth services.

A new AMA-sponsored workgroup — the Telehealth Services Workgroup — gathered for the first time in October. The workgroup will serve as a facilitator for proposals to expand CPT's current telehealth codes to include emerging services.

The workgroup is a committee comprised of more than 50 industry experts representing physicians, health professionals, telemedicine innovators and health insurers.

AMA President Steven J. Stack, MD, said, in a new release, "The CPT code set is the foundation upon which every participant in the medical community — physicians, hospitals, allied health professionals, payers and others — can efficiently share accurate information about medical services. Input from the Telehealth Services Workgroup will help the CPT code set reflect new technological and telehealth advancements available to mainstream clinical practice, and ensures the code set can fulfill its role as the health system's common language for reporting contemporary medical procedures."

Other responsibilities of the workgroup include developing new introductory language or modifying existing introductory language to guide coding of telehealth services and recommending solutions for the reporting of current non-telehealth services when using remote telehealth technology.

Need assistance identifying correct CPT and other codes? Check out PGM's HCPCS code lookup tool and its other medical codes lookup resources.

It's a little more than a month until the October 1 deadline for the implementation of ICD-10. While the transition to ICD-10 requires a great deal of work — and carries with it substantial risks, as we previously discussed — there are also a number of benefits of switching from ICD-9 to ICD-10.

As Sue Bowman, director of coding policy and compliance at AHIMA, writes, "... no matter the trouble, the transition is necessary, because the current coding system can't take healthcare into the future. Today's data needs are dramatically different than they were 30 years ago when ICD-9 was introduced."

Here are five of the top ICD-10 benefits.

1. Improved data quality. The granularity of ICD-10-CM and ICD-10-PCS is vastly improved over ICD-9-CM and will enable greater specificity in identifying health conditions. They also provide better data for measuring and tracking healthcare utilization and the quality of patient care. Some of the reasons are as follows:

  • The greater level of detail in the new code sets includes laterality, severity and complexity of disease conditions, which will enable more precise identification and tracking of specific illnesses and severity over time.
  • Terminology and disease classification are now consistent with new technology and current clinical practice.
  • Injuries, poisonings and external causes are much more detailed in ICD-10-CM, including the severity of injuries, and how and where injuries happened. Extensions are also used to provide additional information for many injury codes.
  • Postoperative codes are expanded and now distinguish between intraoperative and post-procedural complications.
  • There are new concepts that did not exist in ICD-9-CM, such as under-dosing, blood type, the Glasgow Coma Scale and alcohol level.

With better quality data, providers will be able to make better clinical decisions; segment patients more effectively to improve care for higher acuity patients; design more specific protocols and clinical pathways for various health conditions; improve public health reporting and help track and evaluate the risk of adverse public health events; and drive greater opportunity for research, clinical trials and epidemiological studies.

2. Positive impact on bottom line (eventually). While the transition to ICD-10 will require an initial investment — perhaps a substantial one for some organizations — it has the potential to positively impact a provider's bottom line.

According to Pam Jodock, HIMSS senior director of health business solutions, in a RevCycleIntelligence.com report, "There should be fewer claims pended for requests for medical records because the ICD-10 code will provide the information not included in ICD-9 codes today. Hopefully over the course of time, we’ll see a streamlining of claims payment and providers will see a reduction in the number of claims that get pended or rejected at first pass."

She continues, "Providers can only control a small portion of outcome with their patients. There are other things — comorbidities, lifestyle choices and adherence to medication protocol — that will impact outcome. The more of that type of information that providers are able to capture, the better able they’ll be able to account for those factors when negotiating appropriate reimbursement levels."

Other financial benefits include providing objective data for peer comparison and utilization benchmarking, and the use of ICD-10 may reduce audit risk exposure by encouraging the use of diagnosis codes with a greater degree of specificity as supported by the clinical documentation

3. Organization-wide improvements. Once an organization is comfortable with using ICD-10, there should be opportunities to bring about changes that will positively impact the entire organization. Through enhancing the definition of patient conditions, ICD-10 will provide improved matching of professional resources and care teams and increasing communications between providers. It should afford more targeted capital investments to meet an organization's needs through better specificity of patient conditions.

Finally, ICD-10 should support a transition to risk-sharing models through the use of more precise data for patients and populations.

4. Increased professional insights. ICD-10's increased specificity should provide greater insight into a number of areas. It is expected to indirectly lead to more accurate and less fraudulent coding, and the Centers for Medicare & Medicaid Services has stated ICD-10 should aid in the prevention and detection of healthcare fraud and abuse.

ICD-10 is also expected to provides clear objective data for credentialing and privileges; improves specificity of measures for quality and efficiency reporting; and provide more specific data to support physician advocacy of health and public health policy.

5. Easier comparison of mortality and morbidity data. The U.S. currently the only industrialized nation still utilizing ICD-9-CM codes for morbidity data (though we have already transitioned to ICD-10 for mortality) This severely limits direct comparison of U.S. morbidity diagnosis data to U.S. state and national mortality data, and limits international disease comparability.

When the U.S. transitions to ICD-10 code sets for morbidity and procedures, it will enable more direct comparability of U.S. morbidity data with U.S. mortality data, and it will also allow comparison of U.S. morbidity data with international morbidity data.

Need help preparing for ICD-10? Then check out PGM Billing's ICD-10 Codes Lookup Tool and ICD-10 Code Conversion Tool, then contact PGM to learn how they can help your organization leading up to and following the transition to ICD-10.

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