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Digital Issues

ICD-10 Implementation Deadline Firm

The new ICD-10 coding system will take effect on Oct. 1, 2013, the Centers for Medicare and Medicaid Services has confirmed, quelling rumors that the target date for implementation of the new diagnostic code sets will be delayed.

Any ambulatory services provided on or after that date must use ICD-10-CM diagnosis codes, says the agency, which stresses that there will be no grace period. "I can assure you that this is a firm date," said Senior Technical Advisor Pat Brooks of CMS' Hospital and Ambulatory Policy Group in a conference call with medical providers, coders and billers last week.

The more complex and detailed ICD-10-CM system consists of 69,099 diagnosis codes as compared to the 14,315 codes in the current ICD-9 system. Another component of the new system, ICD-10-PCS codes, are for inpatient procedures only. CPT codes will continue to apply to outpatient procedures.

CMS has been updating the ICD-9 and ICD-10 codes annually to keep them current, but such updates have made planning for the transition difficult, the agency acknowledged during the conference call. In response to requests from vendors, system maintainers, payors and educators, CMS is proposing a limited code freeze, which would halt annual updates as of Oct. 1, 2011, and allow only limited updates to both coding systems on Oct. 1, 2012, and on Oct. 1, 2013 (for ICD-10 only) "for new technologies and diseases." Regular annual updates to ICD-10 would begin on Oct. 1, 2014.

CMS will announce a final decision on the code freeze proposal at the meeting of its ICD-9-CM Coordination and Maintenance Committee on Sept. 15 and 16.

Irene Tsikitas

U.S. Drops Antitrust Charges Against Idaho Surgeons

A group of orthopedists from Boise, Idaho, charged with boycotting workers' compensation cases in order to force higher reimbursement rates have settled an antitrust lawsuit with the U.S. Department of Justice.

The federal government charged that between 2006 and 2008, the Idaho Orthopaedic Society, the Idaho Sports Medicine Institute and a group of surgeons, all based in Boise, collectively boycotted cases involving workers' compensation insurance in order to force the Idaho Industrial Commission to raise its reimbursement rates, according to a published report.

"The boycott resulted in a shortage of orthopedists willing to treat workers' compensation patients, causing higher rates for orthopedic services," said the Department of Justice in a statement.

The orthopedists admitted to no wrongdoing in the settlement, which prohibits the surgeons and the orthopedic groups from any future collaboration to establish fees and contract terms.

Kent Steinriede

Unprepared Facilities Endanger Patients, Says Safety Group

How prepared is your staff and, more importantly, your facility to rescue a patient from a sudden, life-threatening situation? According to the Pennsylvania Patient Safety Authority, small oversights can hinder even trained personnel and practiced emergency plans, putting patients at risk.

A data review examining the authority's 2008 reporting period chronicled 56 instances in which an emergency response was delayed by a lack of appropriate equipment or supplies. The authority cites reports of emergency carts that weren't replenished after use, were missing critical supplies or medications, were stocked with outdated drugs or weren't readily available when needed.

"These reports give all healthcare facilities the opportunity to take a second look at their rapid response protocols to ensure everything that can be done is being done to provide a positive outcome in an emergency situation," says Mike Doering, the authority's executive director.

The data review, published in the June issue of the authority's quarterly Pennsylvania Patient Safety Advisory, includes checklists and strategies to assist administrators in maintaining their facilities' readiness to handle emergency situations.

David Bernard

InstaPoll: Has Your Facility Ever Faced a Medical Malpractice Suit?

Regardless of the outcome, being named in a medical malpractice lawsuit is one of the most traumatic events that can befall a surgical facility and its administration. Have you ever been a defendant? Tell us in this week's online poll, and check back next week to see the results.

Last week's InstaPoll asked you what was the most important factor in your decision when choosing an accrediting body for your facility. The results, based on 65 responses:

  • Convenience / timing of surveys: 10%

  • Cost: 14%

  • Ability to meet the standards: 15%

  • Survey methodology: 23%

  • Prestige associated with the organization: 39%

    Dan O'Connor

  • News & Notes

  • Tip of the week How effective is the communication between you, your patients and their escorts? Sallie Piazza, RN, CNOR, describes how a facility can, with a little customer service training, deploy volunteer staffers as "surgical ambassadors" to improve patient satisfaction and keep family members informed. Each ambassador serves as a liaison between the bedside, the perioperative staff and the waiting room to address non-medical questions and concerns and provide status updates throughout the process.

  • Medical mission seeks volunteer The International Medical Alliance needs a general surgeon to complete a team of more than 60 surgeons, nurses and dentists headed to Somoto, Nicaragua, from July 28 to August 8. Volunteers must pay their own airfare, but the Nicaraguan government will provide room and board in Somoto. The IMA is also seeking monetary aid to help cover the cost of shipping 3 tons of donated supplies and equipment to the country. The group's founder and president, Ines Allen, can be reached at InesAllen@internationalmedicalalliance.org or (760) 485-8963.

  • Nurse-patient ratios examined California's state-mandated 1-nurse-to-5-surgical-patients staffing ratio would reduce patient mortality, alleviate nurse burnout and improve quality of care and boost employee retention if adopted in states that have not legislated such workforce ratios. A study published in the April issue of the journal Health Services Research compared staffing information and outcomes data from hospitals in California against that of New Jersey and Pennsylvania, which haven't enacted nurse-to-patient requirements. An opinion piece cites the study as an argument for national staffing standards in the name of patient safety, even as hospitals cut costs. "Unless Congress mandates a federal standard for nurse-patient ratios, (patient) deaths will continue," it says.

  • What robots can't do Using a surgical robot to treat endometriosis resulted in no significant differences in blood loss, hospitalization or complications during or after surgery as compared to the use of standard laparoscopic techniques, says a study published online this month in the journal Fertility and Sterility. While researchers had hypothesized that robot-assisted visualization of the surgical site would vastly improve outcomes, but their review of 78 cases using either 1 method or the other showed otherwise.

  • Smoking and colon cancer A study published in the June issue of the journal Gastrointestinal Endoscopy links smoking to the presence of difficult-to-detect flat adenomas in the colon. The precancerous polyps, found on the right side of the colon, are more aggressive than raised adenomas, which researchers say may explain why smokers often present with colorectal cancer at a younger age and at a more advanced stage than nonsmokers do. They note that high-definition colonoscopes may be necessary to detect flat adenomas when screening smokers.
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