Southeast Texas Medical Associates, LLP James L. Holly, M.D. Southeast Texas Medical Associates, LLP

EPM Tools - General principles about ICD-9 Codes and HCC/RxHCC Codes
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ICD-9 Codes were created for billing purposes. That means that insurance companies and particularly Medicare did not care whether a patient had hypermagnesemia or hypomagnesemia; they just cared whether there was a legitimate reason for paying for the performance of a mangnesium. Therefore, the ICD-9 Code for hyper and hypomagnesemia is the same.

The adoption of the ICD-9 codes by physicians and EMR vendors was convenient but it presented a number of problems for precision in documenting diagnoses for a patient encounter. ICD-10 will solve most of these problems, as does SNOMED, but because of the enormous expense of moving to a new system, there has been a 15-year delay in their adoption. Eventually, that change will be made. The good news for SETMA is that the solutions we have built for ICD-9 will work with any system; however, whenever the change is made, the transition will require a great deal of work on our part.

Limitation of One Diagnostic Description Per ICD-9 Code

For ICD-9, NextGen only allows the assignment of one description to each code. Because there is limited space to create those descriptions and because of the need to organize codes in an intuitive manner, abbreviations had to be used in order to be able to give adequate and discreet descriptions which are intelligible.

For instance, if you spell out "otitis media", this takes up a great deal of the space allowed for ICD-9 code descriptions. Therefore, SETMA adopted the abbreviation of "OM" for "otitis media." "Osteoarthritis" is another such instance.. SETMA adopted "OA" as the title of the category in which forms of "osteoarthritis" is found. Once you know that, it is easy to find all of the diagnoses associated with either by simply typing "OM" or "OA" in the ICD-9 search engine in NextGen.

Almost seven years ago, when SETMA began doing charge posting in the examination room, during the patient encounter, with the provider associating ICD-9 diagnostic codes with CPT procedure codes, it was necessary to have a robust and extensive ICD-9-Code list in order to minimize or eliminate the need to "type in" a diagnoses, which would then not work with charge posting. As a result, we have built a list of ICD-9 Codes which is over 8,300 in number. These are intuitively organized so that they are easy to find and easy to use. In order to facilitate providers learning this information, tools are available in the EMR, on our Intranet and by notebook.

ICD-9 Code Support Tools

The tools which support the ICD-9 function are found in the following places:
  1. In the EMR:

    1. On AAA Home - this is the front page of our EMR -- and it provides links to all of our ICD-9 Tools by clicking the "T" (which stands for "tutorial" beside each of the following

      1. ICD-9 Code Tutorial T
      2. Charge Posting Tutorial T
      3. E&M Code Recommendation Tutorial T

    2. On the Assessment Template

      1. List of the ICD-9 Codes in a searchable file either by alphabet of the word which begins a code or by clicking the "%" sign by alphabet of a series of letters anywhere in the code description.
      2. A Key to the ICD-9 Code list of the abbreviations which begin a category of codes
      3. A key to the ICD-9 Code list of the complete words which begin a category of codes
      4. A key to the ICD-9 Codes which list abbreviations which are found within a code description.

  2. In Notebook form - the above named tools are available
  3. On SETMA's Intranet - the same tools are available
Now SETMA is posting these functions to our website, so that anyone who is interested in how we do this simple but critical task can review or download the material.

Hierarchical Conditional Codes (HCC and RxHCC)

There is one additional place where ICD-9 Codes are critical to the successful management of patients and of a medical practice. That is in the identification of and reporting of HCC and RxHCC codes. Our HCC tutorial describes how SETMA has solved this problem and has improved the care of patients and has being successful in reporting our care to CMS via the ICD-9 Codes which are designated either HCC or RxHCC by CMS.
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