Thanks for the reply, Dawn.
Your summation appears to be in conflict with the
statement that precedes it.
******
The ICD9 code book indicates under its
"Level
of Specificity in Coding" to assign
three-digit codes only if there are no
four-digit codes within that code category.
The bottom line here is that if it is in the
ICD9 book it's a valid code as
far as HIPAA is concerned.
******
If the highest level of specificity for a category
is 4 characters, and the coder uses only the 3 character variant, they are
not honoring the "Level of Specificity in Coding" instruction.
I cannot find any reference(s) where HIPAA is
specifically stating that codes which do not follow the "Level of
Specificity in Coding" instruction are compliant simply due to their
presence in the book (as a title).
As we are usually directed to be mindful of the
intent of the regulations, I can't in good conscience, see why they would
allow for variance in the instruction from the code set's maintainers.
-----Original Message-----
From: Ratayski, Dawn
[mailto:[EMAIL PROTECTED]]
Sent: Thursday, October 11, 2001 8:24 AM
To: [EMAIL PROTECTED]
Cc: '[EMAIL PROTECTED]'
Subject: RE: I can't believe I'm
asking this question
Any 3 digit ICD9 code is , it is most
commonly referred to as a title
diagnosis (a "title" that describes the
content of the codes contained
within that title (related directly to the
numeric sequence). If you
reference the ICD9 book you will notice that
every code range is lead by a 3
digit code that defines that category of
codes to follow. It becomes crystal
clear when you compare the structure of the
codes to that of a book. The
chapter name and number represent the title
diagnosis (v22) and the pages
represent the codes (v22.0 to v22.2)
contained within that chapter.
Some companies will not pay a claim if a
title diagnosis code is report as
the primary diagnosis. As far as HIPAA is
concerned, this practice would
still be acceptable so long as you are
denying it for a more specific code
and not denying for a valid code.
According to the HIPAA Code Sets ICD9 is an
adopted code set. Any ICD9 code
is a valid code as per HIPAA. The ICD9 code
book indicates under its "Level
of Specificity in Coding" to assign
three-digit codes only if there are no
four-digit codes within that code category.
The bottom line here is that if it is in the
ICD9 book it's a valid code as
far as HIPAA is concerned.
I hope this information will answer at least
some of your questions.
-----Original Message-----
From: Ratterree, Brent
[mailto:[EMAIL PROTECTED]]
Sent: Wednesday, October 10, 2001 7:21 PM
To: [EMAIL PROTECTED]
Cc: '[EMAIL PROTECTED]'
Subject: RE: I can't believe I'm asking this
question
Martin,
Translating written medical documentation
into codes can be both a science
and art with room for disagreement. Proper
coding guidelines indicate that
the diagnosis is appropriate if you follow
the ICD-9 manual, i.e.,
additional digits are required.
The issue is that current policies and
procedures of providers, payers and
etc. do not necessarily edit for or restrict
diagnosis codes to proper
diagnosis specificity. If your business
accepts V22 today and does not want
to change, I do not see that as violating
HIPAA compliance. HIPAA mandates
transaction sets and the code sets within in
them. What your business does
with or how it validates those code sets is
an internal issue.
Any contrary opinions?
Personally, I would like HIPAA to require
all covered entities to follow the
code sets' guidelines and edit, as much as
possible, for proper coding. [In
the V22 example, an edit for 4th digit
diagnosis specificity.] In my role
as validating claims/encounter data for a
government entity I see many
"unnecessary" coding specificity errors from
providers and payers.
Brent Ratterree
Encounter Administrator
AHCCCS
(602) 417-4571 (voice)
(602) 417-4725 (fax)
[EMAIL PROTECTED]
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]]
Sent: Wednesday, October 10, 2001 3:07 PM
To: [EMAIL PROTECTED]
Subject: I can't believe I'm asking this
question
I am reluctant to
pose this question, but need the
validation.
Here goes...
Is "V22" a
HIPAA-compliant diagnosis code?
{ } Yes, you dummy.
It's right there in the book!
{ }No, It's clearly
marked "Additional Digits
Required" in the 2001 ICD-9 manual.
Martin A. Morrison
Project Management
Consultant
HIPAA
<http://aspe.os.dhhs.gov/admnsimp/>
Implementation/Coordination
Blue Shield of
California
<http://www.blueshieldca.com/>
4203 Town Center
Bl., Ste. D1
El Dorado Hills, Ca
95762
Ph: (916) 350-8808
Fx: (916).350.8623
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- I can't believe I'm asking this question Martin . Morrison
- RE: I can't believe I'm asking this question Ratterree, Brent
- Re: I can't believe I'm asking this question Rhona Moses
- RE: I can't believe I'm asking this question Sweeney, Lisa
- RE: I can't believe I'm asking this question Ratayski, Dawn
- RE: I can't believe I'm asking this question Martin . Morrison
- Martin . Morrison
