In May, we expect to see the release of the International Classification of Diseases, 11th Edition, for Mortality and Morbidity Statistics (ICD-11-MMS) by the World Health Organization. Work will then begin in the U.S. to adapt it for our clinical use as ICD-11-CM. Hopefully, with the benefit of foresight and lessons learned from the past, we will not reenact the pain we all had with the ICD-10-CM/PCS implementation.
If ICD-10-CM/PCS is used to its full potential, it will provide greater detail and a more accurate depiction of patient severity. This level of detail is expected to provide more information about the relationship between a provider’s performance and the patient’s condition.
CMS’ policy in the 2018 OPPS final rule to cut reimbursement for drugs purchased through the 340B drug discount program by nearly 30%, accounting for the decrease from average sales price plus 6% to minus 22.5%, is getting a lot of attention from the provider community—and with good reason.
Coding experts take a look at changes to ICD-10-PCS, including guideline updates, the addition of “other devices” characters, and new tables added for root operation Replacement.
Most physicians are familiar with the MIPS quality models: These are the Physician Quality Reporting System (PQRS) measures that we’ve been reporting for years with the old Medicare value-based purchasing program. What we don’t know much about are the new cost efficiency models in MIPS, which are based solely on hospital and physician ICD-10-CM/CPT claims data rather than a clinical abstraction of our medical records.
Documentation and coding based on time requires knowledge about the general principles of E/M documentation, common sets of codes used to bill for E/M services, and E/M services providers.
