ICD-10 Talk with Dr. Heidi Jannenga: How Many ICD-10 Codes Do I Really Need to Know?

November 6th, 2015
Codes, ICD-10, ICD-9, Insurance

Overwhelmed by the sheer size of the ICD-10 code set? Not to worry. As Dr. Heidi Jannenga explains in this edition of ICD-10 Talk, rehab therapy practitioners definitely don’t need to know every single code. In fact, they likely will stick to a few key subsets of codes. Which ones, you ask? Watch this video to find out, and stay tuned to ICD10forPT.com for all the latest ICD-10 news.



ICD-10 Talk with Dr. Heidi Jannenga: Am I Choosing the Right ICD-10 Code?

November 2nd, 2015
ICD-10, ICD-9, Insurance, Patient care

So, you’ve got the general gist of this whole ICD-10 thing. But when it comes to coding for specific patient scenario, you’re a bit less confident. How do you know if you’ve really picked the most accurate codes for a particular patient? In this video, Dr. Heidi Jannenga offers a few key pieces of advice for determining whether you’ve landed on the best possible code.



Will ICD-10 Eradicate Paper Superbills?

September 21st, 2015
ICD-10, ICD-9, Transition

To a regular person, the idea of doing away with something called a superbill might sound alluring. I, for one, would love to trash the supersized energy bill I received after running my air conditioner throughout the month of August in Phoenix. For healthcare providers, however, the term “superbill” has a whole different meaning: it’s “a form used by medical practitioners and clinicians so they can quickly complete and submit the procedure(s) and diagnosis(s) for a patient visit for reimbursement,” explains the American Academy of Professional Coders (AAPC).

Many ICD-10 prep resources—including ICD10forPT—have encouraged providers to create ICD-10 versions of their current ICD-9 superbills, an exercise that:

  1. Helps practitioners get comfortable with navigating the ICD-10 code set, and
  2. Produces a helpful ICD-10 resource specific to each individual practice.

But while converting your ICD-9 superbill to ICD-10 is a great way to learn the ICD-10 ropes, it definitely shouldn’t be your only training activity. Furthermore, keep in mind that paper superbills won’t carry nearly as much weight in the post-ICD-9 world. In fact, relying on a superbill to guide your practice’s coding decisions likely will be a losing strategy with ICD-10. Here’s why:

1. Many ICD-9 superbills contain general codes.

In the interest of saving space, most superbills feature a hefty portion of “unspecified” or “not otherwise specified” ICD-9 codes. And while those codes might be enough to generate payment now, they’re just not going to cut it after the big switch. After all, one of the driving forces behind the move to ICD-10 is the global call for greater detail when coding patient diagnoses. For that reason, “ICD-10 requires you to code to the highest possible level of specificity,” explains this blog post. But mapping one general code to another defeats the purpose of the transition—and, more importantly, puts your practice at risk for denied payments.

2. Crosswalking tools often map ICD-9 codes to non-specific ICD-10 equivalents.

For the superbill conversion strategy to work well in practice, you’d need to find a single ICD-10 code to sub in for each ICD-9 code. And I hate to be the bearer of bad news, but you don’t have a snowball’s chance in the Sonoran Desert of doing that—at least not in a way that would meet the aforementioned specificity standard. In fact, in many cases, the quest to find a one-to-one match for a fairly specific ICD-9 code will actually lead to a less-specific ICD-10 code. The AAPC offers the following example to illustrate this point: CMS’s crosswalk maps the ICD-9 code 845.00, Sprained/strained ankle, unspecified, to both S93.409A, Sprain of unspecified ligament of unspecified ankle, initial encounter, and S93.409D, Sprain of unspecified ligament of unspecified ankle, subsequent encounter. “However, this is incomplete because it does not include a code for a strained ankle,” the article points out.  

3. More coding specificity means more codes.

Superbills are meant to be quick resources, and the ones currently in use probably don’t have enough room to accommodate all relevant ICD-10 codes. That’s because, as this ICD10forPT article states, “…for each ICD-9 code, there could be dozens—sometimes even hundreds—of possible ICD-10 equivalents.” And there’s no way to know which one to use until you have a real, live patient in front of you, because you’ll need to have a complete picture of the patient’s situation in order to select the code that most accurately represents his or her specific diagnosis. So, while your incumbent superbill might fit nicely on one page, your ICD-10 version could explode to nearly ten pages—or even more. As Gayl Kirkpatrick, a solution sales executive for 3M HIS Consulting Services, tells Government Health IT in this article, “We took a two-page superbill in ICD-9 and translated that into ICD-10…It became a 48-page superbill.”

4. Paper is so last-millenium.

The transition to ICD-10 represents a huge step forward for the entire US healthcare industry. This is the code set of the future (of the present, actually—after all, we’re the last major country in the world to take the ICD-10 plunge). It’s not just about us; it’s about collecting and analyzing data to raise the bar for patient care on a global scale. And to do that, we have to move away from the paper systems of old and embrace the technology that will usher us into a new age of health care. Who needs a printed list of codes when they have innovative, intuitive coding tools at their fingertips—tools that allow them to approach coding in a wholly patient-centric way? When you think about it that way, paper just can’t compete.

 

While paper superbills probably won’t disappear as fast as popsicles at an Arizona summer picnic, they will become less useful—and less reliable—come October 1. Looking for a better way to streamline diagnosis code selection? Click here to see a solution that puts paper superbills to shame.    


ICD-10 Talk with Dr. Heidi Jannenga: Why ICD-10?

September 14th, 2015
ICD-10, ICD-9

Our previous ICD-10 Talk video covered the basics of ICD-10 and explained the features that distinguish it from its predecessor, ICD-9. In this second video of our ICD-10 Talk Series, Dr. Heidi Jannenga tells us why the US needs to make the transition to ICD-10. Additionally, she provides clarification around a common point of confusion: is it date of service or date of claim submission that dictates whether a provider should use ICD-9 codes or ICD-10? Check out the video now to find out, and stay tuned to ICD-10forPT.com for more great videos and other educational materials as we get closer to transition time.


ICD-10 Talk with Dr. Heidi Jannenga: What is ICD-10?

August 19th, 2015
ICD-10, ICD-9, Preparation, Transition

As you’re probably—hopefully—well aware, the transition to ICD-10 is happening in about six weeks. And this is no tiny tweak; on October 1, 2015, all HIPAA-covered healthcare providers in the entire US must begin coding patient diagnoses using codes from the new ICD-10 code set. To help rehab therapists take on this change confidently—and emerge from ICD-Day unscathed—we’ve provided tons of free ICD-10 educational materials, from blog posts and guides to interactive games and webinars. And now, we’re upping the ante with video: introducing ICD-10 Talk with Dr. Heidi Jannenga.

In the first video of this new series, Heidi provides a brief explanation of ICD-10 and how it differs from ICD-9. Stay tuned for more awesome ICD-10 Talk videos, and be sure to check out the rest of the resources available here on ICD10forPT.com. Have a question? Submit it using the question form at the bottom of this page, and we’ll round up an answer for you.


Quiz Bowl: ICD-10 Edition

August 13th, 2015
ICD-10, Preparation, Quiz

It’s back-to-school season, and that means kids everywhere are getting back into the swing of classes, homework, and of course, tests. But returning students aren’t the only ones who should be studying up. If you’re a HIPAA-covered provider, you only have about six weeks to prepare for one of the biggest tests the US healthcare community has ever seen: the transition to ICD-10. So, are you an A-plus ICD-10 pupil? We hope so—after all, your payments depend on it. To see how you stack up, take our ICD-10 quiz. Need a study guide? Check out this crunch-time guide to ICD-10.


5 Things Every PT Must Know About ICD-10’s 7th Character

June 30th, 2015
ICD-10, ICD-10 Example, Preparation

The number seven is replete with cultural significance: There are seven days in the week, seven seas, and seven deadly sins. Some people even consider the number seven to be an especially lucky numeral. But for those trying to learn the ropes of coding with ICD-10, the number seven has taken on a whole new meaning.

As this blog post explains, “…the seventh character represents one of the most significant differences between ICD-9 and ICD-10 because ICD-9 does not provide a mechanism to capture the details that the seventh character provides.” Because clinicians and coders haven’t had to account for those details for, oh, the last 35 years or so, they’ve had a tough time wrapping their heads around this tricky caboose of a character. And that’s especially true in the physical therapy space, as ICD-10 coding guidance often is more relevant to physicians than anyone else in the healthcare community.

With that in mind, here are a few PT-specific tips for filling the seventh position:

1. If you need to include a seventh character, you will see instructions to do so.

The seventh character only applies to certain categories of codes. This is why it’s so important that you check the instructions for each category and subset of codes. As this blog post explains, “You must assign a seventh character to codes in certain ICD-10-CM categories as noted within the Tabular List of codes—primarily Chapter 19 (Injury, poisoning and certain other consequences of external causes) and Chapter 15 (Pregnancy, childbirth and the puerperium).”

If you don’t see instructions to include a seventh character, then leave the seventh position blank. Adding a seventh character to a code that does not require one will make the entire code invalid.

2. For most PT-related codes requiring a seventh character, there are three options.

In general, when it comes to seventh characters, the injury chapter—Chapter 19—is the one to which PTs need to pay the most attention. For injuries, poisonings, and other external causes, the seventh character provides information about the episode of care, and the ICD-10 codes for most of these conditions require one of the following seventh characters:

A – Initial encounter

This indicates that the patient is receiving active treatment for his or her injury, poisoning, or other consequences of an external cause. However, contrary to popular assumption, this phase of treatment is not limited to the patient’s first visit. In other words, you can use “A” as the seventh character on more than just the first claim. In fact, you can use it on multiple claims.

D – Subsequent encounter

This describes any encounter that occurs after the active phase of treatment has ended. During this phase of treatment, the patient is receiving routine care while healing or recovering from his or her injury.

S – Sequela

The seventh character “S” is reserved for complications or conditions that arise as a direct result of an injury. A commonly used example of a sequela is a scar that results from a burn.

3. The majority of PT encounters fall into the “D” bucket.

One of the most popular questions we get here at ICD10forPT is, “Which physical therapy encounters qualify as active treatment?” And while we haven’t been able to come up with a one-size-fits-all answer to this inquiry, here’s what we’ve deduced from our research: According to this CMS document, examples of active treatment include “initial evaluation of the condition, which may be in the emergency room or at a physician’s office or clinic, encounter for surgical treatment of the condition, and evaluation and continuing treatment by the same or a different physician.” For these types of encounters, use of the seventh character “A” is appropriate.

The document goes on to note that appropriate uses of the seventh character “D” include encounters “for rehabilitation, such as physical and occupational therapy.” Based on this guidance, it’s safe to say the majority of PT visits occur during the healing/recovery phase of treatment (and would thus require the subsequent encounter designation). However, it appears that the “initial encounter” designation is appropriate in situations involving evaluation.

4. If you add a seventh character to a code with fewer than six characters, you must fill each empty slot with a placeholder “X.”

Let’s say, for example, that you’ve selected the diagnosis code S44.11, Injury of median nerve at upper arm level, right arm. As indicated at the beginning of the S44 code category, you must add a seventh character to this code. You determine that, because the patient is receiving routine care for the injury in the healing and recovery phase, the appropriate seventh character is “D.” However, because this particular code contains only five characters, you’ll need to insert an “X” in the sixth position before you can put “D” in the seventh position. This ensures that the first five characters correctly link to the required seventh character (leaving the sixth position blank, on the other hand, would dissociate the “D” with the rest of the code). Thus, the correct code would be S44.11XD, Injury of median nerve at upper arm level, right arm, subsequent encounter.

5. Fracture codes have their own set of seventh character options.

Typically, PTs receive fracture diagnosis codes from referring orthopedic physicians and surgeons. However, it’s important to know the differences between the seventh characters that apply to fractures and those used for other diagnoses. Here is the list of the ultra-specific seventh characters reserved for fracture coding:

  • A – Initial encounter for closed fracture.
  • B – Initial encounter for open fracture.
  • D – Subsequent encounter for fracture with routine healing.
  • G – Subsequent encounter for fracture with delayed healing.
  • K – Subsequent encounter for fracture with nonunion.
  • P – Subsequent encounter for fracture with malunion.
  • S – Sequela.

To make matters even more confusing, certain categories of fracture codes require seventh characters from a special list that accounts for the type of fracture. There are 16 seventh characters contained within the list, which you can review in more detail in this blog post. A final word on fracture coding: As the aforementioned post explains, the fracture aftercare codes that appear in the ICD-9 code set will go away forever on October 1. Instead, those coding for traumatic fracture aftercare will “assign the acute fracture code with the appropriate seventh character.”

 

Even if seven isn’t your lucky number, these five tips should get you on the path to seventh-character success without too much misfortune. Still have questions? Submit ’em in the question module at the bottom of this page, and we’ll do our best to get you an answer.


7 ICD-10 Myths Exposed

June 16th, 2015
ICD-10

ICD-10 is kind of a big deal, which means there’s a lot of information about the new code set floating around out there. And—no surprise here—not all of that information is reliable. To help you separate fact from fiction, I put together the following list of the biggest ICD-10 misconceptions that are creeping through the grapevine:

1. Clinicians weren’t involved in the development of ICD-10.

Contrary to popular assumption, ICD-10 wasn’t created in some bureaucratic vacuum, totally void of clinical input. In fact, the new code set is the product of the same collaborative process used to develop and maintain its predecessor, ICD-9: a “public forum that continually welcomes input from individual physicians, physician specialty societies and other healthcare stakeholders,” notes this Greenway Health blog post. “From the beginning, all of the content of it really came from the clinical community,” said Sue Bowman, senior director for coding, policy, and compliance at the American Health Information Management Association (AHIMA), in the same post.

2. ICD-10’s sheer number of codes will make it nearly impossible to use.

While ICD-10 definitely contains more codes—about five times more, to be exact—than ICD-9, the added volume won’t necessarily make the code set more difficult to use. This FierceHealthIT article drives home that point with a dictionary analogy: “It won’t be more complex…just like adding words to a dictionary doesn’t make it harder to use.” Furthermore, the new code set includes an alphabetic index to guide users to the correct sections and subsets, and there are plenty of easy-to-use digital search tools—like this one—to help with code selection. Just be sure to steer clear of automatic crosswalking solutions that do not account for clinical analysis. (To learn why you shouldn’t trust crosswalks with your ICD-10 code selection, check out this blog post.)

3. ICD-10 already is out of date.

Sure, many countries already are gearing up for ICD-11, but ICD-10 isn’t going out of style anytime soon. In fact, since its introduction in the early ’90s, ICD-10 has undergone continual updates to ensure it’s always on-par with modern medicine. And while, as this post explains, CMS plans to pump the brakes on those updates during the year following ICD-10 implementation in the US, maintenance will resume as normal in October 2016.

4. The transition to ICD-10 will wreak havoc on clinic productivity and cash flow.

Yes, it’s going to take some time for the healthcare community to adjust to the new code set, but it’s not like providers will descend into a world of complete and utter chaos on October 1. In fact, as long as clinics make adequate preparations, their workflows should return to normal within a few weeks. As this ICD10 Monitor article explains, “AAPC studies show that productivity returns to normal following 40-80 hours of work with the new code set, not years.” Furthermore, if you’ve been diligent about getting your vendor ducks in a row—that is, ensuring that all of your clinic’s vendors and partners are ready for ICD-10—then your bottom line shouldn’t take too big of a hit. According to this article from Power Your Practice, it might take coders and payers a little bit of time to get into the swing of things after ICD-10 goes live, but “any decline in reimbursements will only be temporary.” Additionally, “Once your coders and payers gain their footing, ICD-10’s specificity may actually lead to higher reimbursements for your practice.”

5. Documentation must be absurdly specific for claims containing ICD-10 codes to be reimbursed.

Due to ICD-10’s plethora of crazy-specific codes, there’s a perception that patient documentation also must be crazy-specific. But the truth is, clear, complete documentation already is essential to providers’ compliance efforts—and that’s not going to change on October 1. So, if you’re already in the habit of creating detailed patient documentation, you shouldn’t have to change your tune too much once ICD-10 rolls around.

6. GEMs are an all-in-one solution to ICD-10 coding.

As explained in this post, GEMs—or general equivalence mappings—were “never intended to serve as single-code translation dictionaries.” Why? Well, due to their clustered structure, GEMs may map one ICD-9 code to several different ICD-10 codes, and vice-versa. And while they are useful for converting large batches of data—the kind associated with long-term clinical studies, for example—they’re not reliable enough for patient documentation.

7. There’s going to be another ICD-10 delay.

The anti-ICD-10 camp—which includes some pretty powerful physician advocate groups—has made strong pushes for another delay, but so far, those efforts have come up short. The federal government is standing firm on the October 1, 2015, transition date, and the closer we get to that go-live moment, the less likely it is that we’ll see another pushback. So, hold on to your hats—all signs point to the ICD-10 switch going forward as scheduled.

What rumors have you heard about ICD-10? Tell ’em to us in the comment section, and we’ll let you know whether or not they’re legit.


Third-Party Payers and Billers Fall Behind in the ICD-10 Prep Game

May 5th, 2015
ICD-10, Preparation

Moving a claim from submission to payment is a little like moving a football down the field and into the endzone. As every NFL fan knows, scoring a touchdown (i.e., getting paid) requires flawless execution at multiple touchpoints. And if one person drops the ball, your chances of putting points on the board (i.e., money in the bank) could be in serious jeopardy—and I’m not talking about America’s most beloved nightly quiz show.

That’s why, with less than half a year to go before the transition to ICD-10, many members of the healthcare community are concerned not about the initial ball-handlers—like providers and coders—but about the claim recipients and processors. Because as every insurance payment fan knows, the claim game is a lose-lose if billing vendors and third-party payers don’t perform on their end of the play. To circle back to the football analogy: Even the best quarterback in the world can’t throw a touchdown pass without a capable receiver to catch it.

Similarly, no amount of training and testing on the provider end can overcome a lack of ICD-10 prep work on the billing service and payer end, and according to reports cited in this Hospitals & Health Networks article and this Modern Healthcare article, payers and billers still have some work to do in the lead-up to the ICD-10 kickoff. “CMS has reported an 81 percent success rate in tests of incoming claims,” the Hospitals & Health Networks article states. But while a pass completion rate of 80-plus percent would be outstanding on the football field, it’s not so comforting to those who depend on timely claim reimbursement to maintain consistent cash flow. As the article goes on to point out, “…the American Medical Association has led an organized physician outcry declaring that a 19 percent failure rate would be ruinous to many practices.”

Of course, like many statistics, that percentage is a little misleading—a lot misleading, actually. In the Hospitals & Health Networks article, Sue Bowman, the senior director of coding policy and compliance for the American Health Information Management Association, pointed out that “…only 3 percent of the rejected claims…had to do with ICD-10 problems.” The rest of the rejections stemmed from issues with provider identification, service location validity, and other errors that have nothing to do with diagnostic coding. Furthermore, Bowman noted that in general, private payers have been proactive with their testing efforts—and in many cases, they’ve had even more testing success than Medicare has reported.

Still, Michelle Durner, president of Applied Medical Systems of Durham, North Carolina, worries that smaller payers won’t be ready to roll by the October 1 deadline. “The larger payers, Medicare and Blue Cross Blue Shield, they’ll be there,” Durner told Modern Healthcare. “With some of the state Medicaid agencies, I’m maybe not quite as confident. And with the smaller payers, I just don’t know. You just cross your fingers and hope. Just like with 5010, I don’t think it will come off without a hitch.”

Billers aren’t quite on top of their testing game, either—at least not based on the survey results published in the Modern Healthcare article. “…a majority of billers surveyed (57%) have not conducted basic, ‘internal testing’ of the ICD-10 handling capabilities of their systems,” the article states. Even worse: “Just 16% have conducted gold standard, external ‘end-to-end’ testing—in which a claim is sent, approved or rejected, and an explanation of what happened, called an electronic remittance advice, is returned.”

So, what’s stopping billers from gaining yards on the testing front? Well, according to the above-cited survey, top barriers include outdated technology (i.e., the need for software upgrades), problems with provider-submitted documentation, and uncertainty over the possibility of another ICD-10 implementation delay.

And while ICD-10 resistors could still throw out a hail-mary attempt at another implementation delay, their chances of success are, by most estimations, slim to none. What does that mean for PTs who depend on billers and third-party payers to maintain consistent cash flow? Well, you can only do so much to whip your vendors and partners into shape; at the end of the day, you’ve got to have your own back. So, if you haven’t already done so, start saving cash reserves now—or look into alternative ways of securing a financial cushion before ICD-10 go-time.