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HIPAA 5010, ICD-10 and Telemedicine

Posted by Lawrence Kerr on Mon, Feb 20, 2012 @ 12:32 PM

Did you know you might have missed a deadline? Again.

Have you heard of HIPAA 5010?  ICD-10-CM? ICD-10-PCS?

Other than being a mathematical and acronym conundrum, what does all of this have to do with taking care of patients?

Well, what do you mean by taking care of patients?  If you mean giving shots, writing prescriptions and doing surgery, not so much. But if you want to bill for your work, are trying to stay within the law, and if you are responsible for getting things done, then you probably are pretty aware.

Don't worry, CMS has extended the deadline (which you weren't aware of anyway). You now have until  April 1, 2012. Could this date be more than coincidence?  Sooner or later some degree of fluency will be needed, so here is a primer.

First, HIPAA 5010 is a modification of HIPAA 4010 under which we live now. It will include descriptors using the International Classification of Diseases, ICD-10. The suffix CM is the set of diagnostic disease codes while suffix PCS is equivalent to CPT codes. Since ICD-10 is necessary for the use of HIPAA 5010 reporting, here is a brief introduction.

ICD-10 is not 10 items  Many of us think ICD-9 is called that because there are 9 categories. The logical extension of that is ICD-10 is 10 items, but that is not the case. There are 22 chapters. Seventeen categories are listed. Mostly each chapter has one category, but sometimes a category will cross two chapters. Each category has a letter and 2 digits as the major category indicator. two other digits are placed at the end. Now!, there are 5 characters. Finally, for billing purposes, two interposed x,s (xx) further define the details. If no detail is available, then the xx must be placed instead.  

ICD-10 Code placeholder diagram

American Health Information Management Association

For example:

A pressure ulcer of the left buttock, stage 4 is coded as L89.324.
L89 is the primary 3 character (first letter, and two digits) category describing a pressure ulcer. It is further refined by either letters or digits. In this case the digits 3, 2, and 4 define buttock, left side and Stage 4.  

For billing, October 2013 this will require a place holder of x's to complete a 7 digit code if all seven characters have not been assigned.

  1. A pressure ulcer of the left buttock, Stage 4 is L89.324.  The portion L89 is the core three character description for a pressure sore. The digits 3, 2, and 4 define buttock, left and stage 4.
  2. For billing, this would be L89.324 with a subsequent 7th character as a code extension such as A,D,S for initial, subsequent and sequelae.

There are a phenomenal 114,000 codes currently listed. 

All of this said, which tells you more?  

          L89.324  ...or...   
value of picture when used to collaborate

That's the value of pictures and words!  Telemedicine using pictures and words will always communicate clinical problems more precisely and clearly. Codes have an important statistical role, and a necessary financial role, but they will never help take care of the individual patient sitting in front of a provider.

One final factoid, these codes started in 1891. They were presented at the International Statistical Institute by Jacques Bertillion. They were crafted by Dr. Bertillion to be placed on death certificates to enable the statistical analysis of causes of death.  If only he had known...

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Tags: telemedicine, HIPAA, Telemedicine and HIPAA, HIPAA 5010, ICD-10

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