Harmony Healthcare Blog

An Introduction to ICD-10

Posted by Kris Mastrangelo on Thu, Dec 04, 2014

With the upcoming transition date of October 1, 2015 from ICD-9 to ICD-10 quickly approaching, it is important to note the coding changes from ICD-9 to ICD-10.  Specific areas of this transition will impact skilled nursing facilities and the coding of both the short and long term population in the facility.

ICD-9 has been utilized for over 30 years for a number of uses in the American Healthcare system.  These uses include reimbursement, payer contracts and coverage determinations, assessment of provider performance with disease management, and monitoring utilization patterns.  It has also been utilized for providing criteria for inpatient care vs. outpatient services, tracking the severity of illness data including mortality and complications, as well as public health tracking
and reporting.

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Topics: ICD 9 Coding, MDS Coding, ICD-10, ICD-9

MDS Alert

Posted by Kris Mastrangelo on Fri, May 20, 2011

Elisa Bovee, Vice President of Operations at Harmony Healthcare was recently quoted in two articles in Eli Researches MDS Alert. 

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Topics: ICD 9 Coding

Reduce Risk of Audit With Accurate ICD-9 Coding

Posted by The Harmony Team on Thu, Apr 07, 2011

ICD-9/Diagnosis Coding:  Harmony frequently discusses the process of ICD-9 coding and the ordering of diagnoses for coding on the MDS and UB-04 during site visits. Often in the SNF setting there is a disconnect between the ICD-9 codes that are coded on the MDS, on therapy evaluations and the ICD-9 codes that are coded on the UB-04. Harmony recommends the facility evaluate this process to ensure the appropriate codes are being used on the UB-04.  

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Topics: MDS 3.0, MDS, QIS, ICD 9 Coding, Quality Indicators

ICD 9 Coding

Posted by The Harmony Team on Wed, Jun 23, 2010

ICD 9 CODING Q: Where can I find a list of commonly used PT ICD-9 codes that have been deleted as of January 1? A: ICD 9 code changes take effect October 1 of each year. CMS publishes these changes on its Website at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp Keep in mind that several Medicare contractors’ local coverage decisions (LCD), as well as Aetna’s therapy policies, contain a list of ICD 9 CM codes that support medical necessity for all outpatient therapy services. To be considered for reimbursement, at least one of the ICD 9 CM codes contained in the LCD or Aetna policy must be present on the claim form to support the medical necessity of all services provided during that billing period. If the claim submitted does not contain an ICD 9 CM code that is in the LCD or Aetna policy, the entire claim will be rejected or denied. Several other Medicare contractors’ LCDs link ICD 9 CM codes to CPT codes. For each CPT code to be considered for reimbursement, at least one of the ICD 9CM codes listed under each CPT code in the LCD must be presented on the claim form. If an individual CPT code submitted on a claim form for payment does not have an ICD 9 CM code on the claim form to support its medical necessity, the individual line item will be rejected or denied. Contact your fiscal intermediary’s provider inquiry department to obtain clarification about why it considers this specific ICD 9 code to be nonpayable for skilled therapy services.

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Topics: Medicare Coverage Criteria, ICD 9 Coding

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