In this issue:

• April 2006 ICD-9-CM Semi-Annual Update
• Documentation Challenges for Optimal Payment for Injections and Infusions
• Coding Operations: New & Familiar Faces

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April 2006 ICD-9-CM Semi-Annual Update

The Medicare Prescription Drug, Improvement and Modernization Act of 2003, requires the Centers for Medicare and Medicaid Services (CMS) to update the ICD-9-CM code set for both diagnoses and procedures on a semi-annual basis (October 1 and April 1). For this year, there were no code revisions to ICD-9-CM for implementation on April 1, 2006.

The ICD-9-CM Coordination and Maintenance Committee, which is responsible for revisions to ICD-9, held an open forum meeting on September 29-30, 2005 in Baltimore, to discuss code revision proposals for April 1, 2006 and October 1, 2006. No new code revisions were proposed for implementation on April 1, 2006. Several proposals were discussed for potential implementation of October 1, 2006. Summary reports concerning the meetings are available. If you would like additional information, click on the links below:

For ICD-9 Volume 1 and 2 (Diagnoses), click here.

For ICD-9 Volume 3 (Procedure), click here.

Documentation Challenges for Optimal Payment for Injections and Infusions

Charging for infusions and injections in the ED became much more challenging in 2006.  Between CPT and Medicare, and injections and infusions there are fourteen new codes that were implemented this year.  With the increased number of codes the documentation requirements also increased in complexity.  To ensure that your ED gets paid for each reimbursable infusion and injection service nurses need to be aware of and document each of the following as appropriate:

For infusions

1. Document the start time and discontinue time for each infusion-- to the minute.  This year a 15 minute piggy-back infusion (IVPB) is coded as an IV push injection; a 16 minute IVPB medication administration is coded as an infusion. The codes and payments are different for each.  For instance, Medicare pays approximately $121 for an IV infusion, but only $48 for an IV injection.
2. Notation that IV fluids or IV substances/drugs were actually infused, not just hung. Current documentation often indicates only that IV fluids were hung without indication that the fluid or substance/drug was infused. It is not uncommon to find no rate or discontinue time documented in the IV section of the ED record.
3. The volume of fluids—in ml or cc's infused.
4. The rate of the IV infusion--when an IV infusion is ordered as a “bolus,” nurses should note how long the bolus ran (e.g., 500 cc bolus NS over 20 minutes or IV decreased to 100 cc/hr after 500cc bolus).
5. Notation of the portable IV pump if one is used for an infusion.
6. Notation when 2 IV lines were started in separate sites.

For injections

1. Be as descriptive as possible when documenting the route of medication administration—“given IV” is not enough information to accurately code the service in many cases.  Different codes may be assigned for an IV push vs. an IV “piggy-back"—even when the same type of medication is administered.
2. Note the time the injection is administered and if more than a simple push, the time over which the medication is administered. Again, a 15 minute injection or IVPB is coded as an IV push injection; a 16 minute IVPB medication administration is coded as an infusion. The codes and payments are different for each.
3. When documenting two medications given IV or IM via separate syringes, but administered at approximately the same time, include documentation showing that two separate injections were administered—using the different times or locations are two ways of communicating the separate services.
4. When documenting an IM injection with two medications given via a single syringe, indicate this with the term “and.” For example:
   
   

   Demerol 50mg and Phenergan
   12.5 mg IM RVG
   and note single time of administration.

Coding Operations: New & Familiar Faces

Each year brings growth and change. As a result, we have added additional personnel to better serve your needs. This is an opportune time to introduce you to the new and reacquaint you with those that you’ve come to depend upon:

Coding Operations

New :: Steve Reinhart — Comes to LYNX with over 20 years of healthcare experience, with the last 9 years in various management positions. His undergraduate degree is in Music Therapy, which he practiced until earning his Masters Degree in Management from Cardinal Stritch College. His background includes managing Outpatient Mental Health Services, Residential Mental Health Services and a Family Physician practice in the Seattle area.

Kevin Weber — Kevin joined LYNX in March of 2005. He brings more than 6 years of Emergency Medicine/Healthcare knowledge acquired while working for the United States Navy. He currently holds an AA in Health Science Technology, and a BS in Healthcare Management and Administration from Southern Illinois University at Carbondale.

Michael Gaeta, MBA — Mike joined LYNX in February 2005. He brings with him a 10 year history of working in the medical field as a podiatric physician in hospital, military and private practice settings. After completing his MBA studies, he worked in business development for a startup e-fulfillment company.

Stacy Land —  Stacy has been with LYNX for more than three years, functioning in the role of coding operations manager and most recently as special project manager. She has past experience as a practice manager and consultant for individual medical practices, including the creation of two new clinics.

Laura Bennett, RHIT — Laura has worked at LYNX for more than 7 years, most currently in the role of coding operations manager. She has taught both coder and physician education classes, managed our QM Department and has worked with our Coding Review Services (CRS) Clients as client manager.

Sally Strand, RN — Sally has been with LYNX for 16 years, working from our regional office in Tampa, Florida. She brings a clinical background in the Emergency Department, coding expertise and a solid foundation for providing consistently outstanding service to her clients.

Gary McClanahan – Gary has been with LYNX since 2004. He has a clinical background in Emergency Medicine as a EMT/Paramedic. Gary earned an MA in Education from the University of Missouri. He brings with him nearly 30 years of both clinical and management experience.

Client Services

New :: Mark Epperson — Mark comes with over 20 years of account and relationship management experience. Most recently, he worked as a national account manager servicing a number of prestigous nationwide accounts. He also acquired experience managing a payroll team as a payroll account manager, as well as time spent on both major and nationwide accounts.  He started his business career as a territory manager in Southern and Northern California, and the Pacific Northwest.

Kathe Newell — Kathe has acquired more than 20 years of healthcare experience with both payers and providers. Her expertise includes reimbursement, information systems, quality improvement, account and client management. Her current role at LYNX leverages these skills as client manager for both coding and software clients.

Suzanne Bingham — Suzanne comes to LYNX with 25 years of healthcare experience. She began her career in healthcare as a programmer for an international pharmaceutical corporation where she designed and programmed clinical trial outcomes analysis. She has also worked for several established health information system companies as an account executive and/or client manager. She holds a bachelor’s degree in English.