An ICD-10 Halloween Hayride Gone Awry

October 26th, 2015
ICD-10, ICD-10 Example

It was a dark and stormy night.

Ugh, seriously? Isn’t there a better way to set the scene? Let’s start this story over: It was a dark and hay-filled night.

There we go.

And a darling couple, donned in clever costumes, headed out to go on their very first hayride. Did we mention it was dark? Right. So, the couple headed out to their local farm to take part in the festivities (Y92.7, Farm as the place of occurrence of the external cause). And that’s where it all began. What began, you ask? The Halloween hayride—gone awry.

Leave the Hay for Horses


“Bless you,” said a kind person from the back of the hay bales. Our couple quickly discovered that hay really should be left for horses, because as it turns out, both of them suffered from J30.2, Other seasonal allergic rhinitis. With tissues in hand—and sneezes in tissues—they cuddled up for the hayride of their lives.

Keep Your Hands—and Heads—Inside the Vehicle

This warning typically ends with “at all times.” You may have heard—and heeded—this very rule while enjoying roller coasters, boat tours, or any other type of moving entertainment. But, our poor couple wasn’t paying attention to the hayride conductor as they both stood up to get a better view of the pumpkin patch. (On a side note, we’re not sure how this move helped them with their view—it’s dark outside, after all). That said, W22.8XXA, Striking against or struck by other objects, initial encounter, perfectly describes the wounds the couple sustained when their heads made contact with a wayward tree branch. Ouch.

Lift with Your Legs

With headaches in full bloom (G44.319, Acute post-traumatic headache, not intractable), the couple decided they’d trudge onward to pick out the perfect pumpkins. “He” (Let’s call him—uh—Jack) picked out an enormous squash—one he was certain would be the perfect companion for the neighborhood black cat that often graces his front stoop. He had big plans for this pumpkin—none of which involved carving it. Putting knife to pumpkin gives him the heebie jeebies. (His last name is O’Lantern, remember?). Did we mention the pumpkin was enormous? Great. Well, Jack reached down to pluck his perfect pumpkin when he heard a loud crack. Unfortunately, the sound wasn’t that of a prized squash pulled from the vine; it was poor Jack’s back, warranting a very vague diagnosis of M54.5, Low back pain. The pair would just have to continue on without a new stoop companion.

Don’t Eat Too Much Candy

Okay, so maybe our parents were right: too much candy can lead to more than just a sugar rush. (It could even lead to a game of candy crush, and nobody wants that. Trust me.) So, as Jack lay down in the back of the hay-filled truck, nursing his back, his lovely gal, Sugar Pie, munched on candy corn. Several handfuls later, Sugar Pie regretted her sugar binge. Her teeth rebelled, giving Jack’s sweet lady one heck of a toothache (K08.8, Other specified disorders of teeth and supporting structures).

Watch Your Back(side)

Our couple had quite the night, and it was almost time to go home. As the hayride approached the farm entrance, Sugar Pie gingerly held her jaw, Jack gripped his lower back, and the spider neither of them noticed crept closer to where they sat. Moments before Jack and Sugar Pie could hop out of the wagon, the spider swiftly sneaked up and bit Sugar Pie right in the rear (S30.860A, Insect bite [nonvenomous] of lower back and pelvis, initial encounter). Not quite the hayride-parting gift she’d hoped for, but a memorable memento nonetheless.


The next morning, Jack and Sugar Pie reflected on their Halloween adventure as the sunrise shined on their round faces. Even though the hayride went awry, they had more fun than they could have imagined. With the black cat by their side, the two pumpkins looked out from their stoop and gave a deep sigh. The costumes, the candy, and even the injuries were too good to be true; their Halloween hayride had only been a dream (G47.9, Sleep disorder, unspecified).

Life in the ICD-10 Lane

October 8th, 2015
ICD-10, Transition

ICD-9 was a hard-headed code set.
It was brutally outdated, and ICD-10 was terminally delayed.
The AMA held it up, and CMS held it for ransom in of the heart of the old, cold coding system.
ICD-10 had a nasty reputation as a complicated system.
They said it was ruthless; they said it was rude.
ICD-9 and ICD-10 had one thing in common: they are both to diagnose.
Providers said, “Faster, faster. My process is turning to dread.”
Life in the ICD-10 lane.
Surely, ICD-10 will make you lose your mind, mmm.
Are you with me so far?

Eager for action and hot for implementation.
The coming transition, the drop of productivity.
You knew all the right codes, took all the right courses.
You went through outrageous hoops, hopin’ to get paid.
There were service lines on the form, pointers on the claim.
You pretended not to notice, caught up in the race.

Diagnosing every evening, until it was light.
You were too tired to make it, but too tired to fight.
Life in the ICD-10 lane.
Surely, make you lose your mind.
Life in the ICD-10 lane, every code all the time.
Life in the ICD-10 lane, uh-huh.
Bummin’ and burnin’, blinded by specificity,
You didn’t see the date of service, took a turn for the worse.

I said, “Listen, baby. You can hear the diagnosis ring. We’ve been up and down this code set; haven’t seen a goshdarn thing.”
You said, “Call the doctor. I think I’m gonna crash.”
“The doctor say he’s comin’, but you gotta give him stats.”
You went rushin’ down that diagnosis,
Messed around and got lost.
Didn’t care, you were just dyin’ to get paid.

And it was life in the ICD-10 lane,
Life in the ICD-10 lane.


So, the transition to ICD-10 has been a bit quiet so far. But, many of the implementation repercussions—like claim denials or payment delays—have yet to rear their heads. This means it could take several weeks—or even months—for providers to get a true sense of what it means to live life in the ICD-10 lane.

How ICD-10 Affects Your Claims

September 25th, 2015
CMS-1500, Codes, ICD-10, Insurance, Transition

There’s no doubt that the ICD-10 transition requires a huge shift in processes. But it’s not only your coding methodology that’ll change; your claims are going to look a little different as well. Here’s how ICD-10 affects your claims:

HCFA Forms are Ready

Wondering whether your beloved CMS 1500 forms are ready for ICD-10? Good news: the form was updated several years ago to account for ICD-10. This “new” form allows for up to 12 diagnosis codes—and you might just need all of those spots to accurately and completely describe a patient’s condition.

CPT Codes will Stick Around

If you’re an outpatient provider who uses CPT codes, you won’t need to change your procedural coding. You’ll continue to bill for the services you provide using the same codes you do now (e.g., 97001, 97110, and 97140). However, keep in mind that if you use superbills, you will need to update those to include ICD-10 codes. Finally, ICD-10 won’t impact the way you currently use any CPT-related modifiers (like KX or modifier 59).

One Service Line Allows for Four Codes

Remember the 12 available spots on the new HCFA forms? While you can submit up to 12 diagnosis codes on a single claim form, only four of those will map to a specific CPT code. That’s because the form only contains four diagnosis pointers per line. This is something that won’t change with the ICD-10 transition. Still, it’s important to include as many codes as you believe are relevant to your treatment.

Code Order Matters

When you’re dealing with multiple codes, you want to list them in order of importance. The first-listed code will be your primary code, which means it’s the code that most strongly supports the medical necessity of your treatment. Proving medical necessity is crucial when it comes to ICD-10; check out this blog post to learn more.

There’s no Minimum Number of Codes

For a claim to process correctly, it must contain at least one code. The number of additional codes you include is up to you. If you, as the clinical expert, believe one code accurately and fully describes a patient’s condition, then by all means, submit only one code. Beyond that, there’s no minimum of codes required on each claim.

Dual-Coding is a No-No

The transition to ICD-10 is determined by date of service. That means all claims with dates of service on or before September 30 must contain only ICD-9 codes, whereas all claims with dates of service on or after October 1 must contain only ICD-10 codes. The two can never appear together on the same claim. So, in order to avoid a dual-coding disaster, you may need to split your claims. Each payer will have its own claim-splitting requirements, so it’s important to check with that payer first before you determine how you’ll separate claims that span the transition date.

That said, some non-HIPAA-covered entities (e.g., workers’ compensation, and auto insurance) may not make the transition. So, you’ll need to continue to submit ICD-9 codes on the claims for those payers. We strongly suggest contacting your non-HIPAA covered payers individually to verify whether they plan to make the transition. Furthermore, as Lauren Milligan explains in this blog post, “Sometimes, you’ll see patients whose primary and secondary insurances require different code sets. In these cases, because you should include only ICD-9 codes on claims for payers who did not make the switch to ICD-10, you’ll need to split the claim and send each piece to the appropriate payer.”


With these details in mind, give yourself a head-start by getting caught up on all of your billing prior to October 1. It may not be the easiest task, but it’ll save you a lot of headaches as you tackle the transition. And although not much will change in terms of how you complete and submit claims, you’ll be plenty busy adjusting your processes elsewhere. With the transition right around the corner, what are you doing to prepare?

A to Z: What you Need to Know About ICD-10 Aftercare Codes

September 22nd, 2015
Codes, ICD-10, ICD-10 Example, ICD-9

At this point in your ICD-10 journey, it’s likely you’ve noticed that the letters A through Z are no longer reserved for the tiny noodles floating in your favorite childhood soup. In fact, when it comes to ICD-10 coding, you could say that your payments hinge on selecting the correct letter. In ICD-10, letters can indicate a number of things about your patient’s condition, including the category of codes and the phase of treatment. Although this coding logic might not offer you the comfort that alphabet soup once did, these letters of designation do have their place. In terms of ICD-10, Z is just as important as A. But unlike the ABC song, the letter Z doesn’t signify the end. In fact, it signifies the beginning for some rehab therapists—namely, those coding for aftercare. Here’s what you need to know about Z codes—no slurping required:

“Goodbye” to the V57 series

The V57 code series you once knew (and loved) is saying sayonara, as this series isn’t included in the ICD-10-CM code set. If you were to map every one of these V57 codes to a relevant ICD-10 code, you’d end up with one match: Z51.90, Encounter for other specified aftercare. According to the ICD-10 tabular list, this code isn’t able to stand on its own; you also must code for the condition requiring care. Coding for the underlying condition helps prove the medical necessity of your treatment. For more on coding for medical necessity, check out this blog post.

“Hello” to the Seventh Character

If you have the option of submitting a primary diagnosis code that contains a seventh character on your claim, you should take that route rather than selecting one of the aftercare codes. The seventh character indicates phase of treatment, but not all codes require—or allow for—this character. Most of the codes within the musculoskeletal chapter of the tabular list (chapter 13) don’t allow for seventh characters. That’s because most of these conditions result from a healed injury or are chronic in nature—so the phase of treatment is already implied. As for those codes that do require seventh characters (like the ones that appear in chapter 19, also known as the injury chapter): By selecting “D” as the seventh character, you’re indicating that the patient is in the healing and recovery phase of treatment. And if you’ve added a primary diagnosis code with a “D” in the seventh character position, there’s no need to submit an aftercare code, because you’ve already indicated that the patient is in the healing and recovery phase of treatment.

“Maybe” to Z Codes for Surgical Aftercare

Postoperative care aims to bring a patient back to his or her healthy level of function. If you’re specifically providing a patient with surgical aftercare treatment, ICD-10 has a few coding options. To give a couple of examples, you can use Z51.89, Encounter for other specified aftercare, or Z47.1, Aftercare following joint replacement surgery. According to the official ICD-10-CM guidelines for coding and reporting, “Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter.” That said, your clinical judgement and documentation will justify your code selection.

“Sometimes” to Singular Coding

If you’ve selected a Z code as your primary code, it doesn’t necessarily mean you should ditch any additional codes. If there are other codes that apply to your treatment and the patient’s situation, you should include them as well. In some cases, this might mean submitting multiple Z codes to more fully describe the patient’s situation. According to this ICD10 Monitor article, “Aftercare codes should be used in conjunction with other aftercare codes, diagnosis codes and/or other categories of Z-codes to provide better detail on the specifics of the aftercare encounter/visit, unless otherwise directed by the classification.”

One good example of this is in surgical aftercare for a joint replacement. As explained in this WebPT blog post: “If you were treating a patient who had a total knee replacement, you would want to submit Z47.1, Aftercare following joint replacement surgery, as well as ICD-10: Z96.651, Status (post), organ replacement, by artificial or mechanical device or prosthesis of, joint, knee-see presence of knee joint implant.” In this example, the patient received surgery for osteoarthritis relief. It’s assumed the patient is not seeking treatment for osteoarthritis, as he or she has undergone surgery to remedy this condition. Thus, you would use both Z codes to indicate the surgery as well as the joint replaced. For more information on this scenario, check out the blog post.


The use of aftercare codes might not be as cut and dried as you’d like to think. However, that doesn’t mean it needs to be a cause for concern. Just keep in mind that listing Z codes as primary codes should be a last resort. In fact, it may not be appropriate at all. If you have a code that more accurately describes why the patient is seeking therapy, apply that one. While ICD-10 coding might not be as enjoyable as singing your “ABCs” or chowing on some alphabet soup, I hope you’ll still find some satisfaction in knowing how—and when—to apply those oh-so-important letters.

ICD-10 Coding Practice for OTs: Down Syndrome

August 31st, 2015
ICD-10, ICD-10 Example, Preparation, Transition

Are you an ICD-10 coding expert? Do you feel prepared to take on the complexities that are an inevitable—yet, crucial—component of the new code set? No? Well, not to worry. ICD-10 is certainly complex, and you should take this transition seriously. Still, you shouldn’t let fear (and frustration) get the best of you. With that in mind, what can you do to make the transition smoother? Practice, practice, and well, more practice. Speaking of practice, here’s an occupational therapy coding example from compliance expert Rick Gawenda. Walking through this example should help you fine-tune your coding skills. Here’s the situation:

The Patient

The patient is a 7-year-old female with Down syndrome (meiotic). Her parents have been referred to occupational therapy, because she’s having problems with her posture and walking. She appears to be suffering from muscle weakness. How would you code for this?

The Codes

Primary Code

  • Q90.0, Down syndrome. More specifically, this code indicates the patient’s diagnosis of Trisomy 21, nonmosaicism (meiotic nondisjunction).

Additional Codes

With ICD-10, you should indicate the reason for outpatient therapy whenever possible. In this case, you would use the following codes:

  • R26.2 for the difficulty walking or R26.89 for other abnormalities of gait and mobility
  • M62.81 for generalized muscle weakness
  • R29.3 for abnormal posture

The Description Synonyms

You’ll have to use your clinical judgement to determine whether you’d code R26.2 (difficulty walking) or R26.89 (other abnormalities of gait and mobility). During your evaluation, you likely will find that one code is more appropriate than the other. One way to determine which code you should select: review each code’s description synonyms. Here are the description synonyms in this situation:

Difficulty walking. The description synonyms for R26.2 are:

  • Difficulty walking
  • Walking disability

Other abnormalities of gait and mobility. The description synonyms for R26.89 are:

  • Cautious gait
  • Gait disorder due to weakness
  • Gait disorder, painful gait
  • Gait disorder, weakness
  • Gait disorder, postural instability
  • Gait disorder, multifactorial
  • Toe walking and toe-walking gait
  • Limping/limping child

The Summary

When all’s said and done, coding to the highest level of specificity requires you to change your mindset. When you account for additional information pertaining to each patient’s condition, you’re able to determine which codes accurately explain the scenario. Feeling better about the transition after reviewing this example? Want to see more examples like this one? Watch WebPT’s free ICD-10 bootcamp webinar. In it, we provide step-by-step guidance on how to code for this example—and ones that are even more complex. With our help, you’ll be ready well before October 1.

Here’s What You Need to Know About the AMA and CMS Announcement

July 14th, 2015
ICD-10, ICD-10 Delay, Preparation, Transition

“Extra! Extra! Read all about it!” When it comes to the Centers for Medicare & Medicaid Services (CMS), there’s no shortage of “extra” announcements in the news these days. And even though it’s not in print, ICD-10 news is especially important right now, as implementation is slated to take effect in just a few short months. If you’ve been following our blog, you’ve seen us cover everything you need to do before October 1 to prepare your clinic, but mistakes happen. That’s why CMS—with a push from the American Medical Association (AMA)—made a move that could help soften the blow of the transition. So, even if your preparedness doesn’t quite fit the bill (literally), you still have a chance of receiving payment come October 1. Here are the details of the recent announcement:

Flexible Review

CMS and the AMA want physicians and other practitioners (therapists included) to make a successful transition to ICD-10. So, they recently announced a 12-month period during which, according to CMS, “Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.” So, what does that mean?

Are providers off the hook for coding mistakes on Medicare claims?

The short answer is “no,” because:

However, if your claim doesn’t contain any errors other than those related to code specificity—and you’ve used a valid code from the correct family of codes—Medicare won’t deny your claim within that 12-month period.

How does this decision affect Medicare quality reporting?

CMS won’t apply accuracy penalties for programs like Physician Quality Reporting System (PQRS) as long as the eligible provider “submitted the requisite number/type of measures and appropriate domains on the specified number/percentage of patients, and the EP’s only error(s) is/are related to the specificity of the ICD-10 diagnosis code (as long as the physician/EP used a code from the correct family of codes),” says CMS.

ICD-10 Ombudsman

The ICD-10 Ombud—what? According to my handy-dandy online dictionary, an ombudsman is “a person (such as a government official or an employee) who investigates complaints and tries to deal with problems fairly.” And as part of this announcement, CMS described its plans to designate an ICD-10 ombudsman to investigate and help providers with their ICD-10 troubles during the transition. CMS hasn’t released many details about this resource other than the fact that the ombudsman will work closely with regional Medicare offices to better assist providers. As October 1 approaches, CMS will release more details on how you can contact the ombudsman for ICD-10 assistance.

Advanced Payment

What happens when there are system, administrative, or ICD-10 implementation problems with Medicare contractors? A conditional partial payment might be available. However, providers must repay any advanced payment, and they’re only eligible to receive such payments if they meet certain conditions.

What are the conditions?

CMS describes them in 42 CFR Section 421.214. Essentially, to receive advanced payment, Medicare suppliers can apply through their applicable Medicare Administrative Contractor (MAC).


Ultimately, CMS will review its flexible, 12-month timeline and adjust it based on the success of ICD-10 adoption. And don’t forget: Just because providers have some wiggle room when it comes to coding for complexity, it doesn’t mean they’re totally off the hook. The ultimate goal is to submit the most complete and accurate code—the first time, every time.

Father’s Day Flubs

June 18th, 2015
ICD-10, ICD-10 Example

Being a dad isn’t easy. You have plenty of responsibilities on your plate, and a trip to the emergency room is the last thing you need this Father’s Day. But if, on June 21, you do find yourself in a pinch—or a scrape—ICD-10 offers the perfect, and most specific, code for your injury. Interest piqued? Well then, you’re in luck. Because just like the theme song to “Fresh Prince of Bel-Air” says, “Now, here is the story all about how your life got flipped—turned upside-down. And I’d like to take a minute; just sit right there. I’ll tell you all about some diagnosis codes that weren’t pulled out of thin-air.” That’s how the tune goes, right? No? Oh well. Here’s the story:

The Early Bird Gets the Burn

Happy Father’s Day! It’s 6:30 AM, the kids aren’t quite awake, and your wife is still snoozin’. You seize this rare opportunity make yourself a cup of coffee. Plus, you might just get to drink it while it’s still hot. Mmm. Sweet molten java. You lift the cup to your lips and BAM! Your child comes running around the corner and slams into the table. Pretty soon, you’re wearing your sacred boiling cup of caffeine and you’ve earned yourself a diagnosis of: “T20.03XA Burn of unspecified degree of chin. Initial encounter.” Ouch.

The Peanut Butter Wins

Okay, now that your kid has slammed his or her head into the table, your wife is awake, and your other child is crying from the bedroom, it’s obviously time for breakfast, and even though it’s technically Father’s Day, you’re the chef. Nursing your scalding chin, you head over to the freezer and pop some frozen waffles in the toaster. What does your wife and kids love best with their waffles? Peanut butter. Unfortunately for you, you discovered within the last year that you’re actually allergic to peanuts. But as long as you keep the gooey goodness on the knife, you should be okay. As you spread the peanut butter on the waffles, you chat with your family about the day’s plans, absentmindedly licking your fingers. Uh oh. Your lips begin to swell and you’re quite sure you’re experiencing your good-ol’ “Z91.010: Allergy to peanuts.” You quickly rinse out your mouth, and your wife grabs a benadryl. It looks like it’s naptime for you, poor Dad. And the score? Peanut butter: 1. Dad: 0.

Swing, Batter, Bad-er?

You wake up from your anti-histamine-induced dream, ready to take on the rest of your holiday. Your family bought all of you tickets to the game. What game? The baseball game of the season. Even better, you have great seats. The family piles into the car, and you head to the stadium. With the best view in the house, you’re getting in on all of the action. And—of course—your team is winning. The game is so good that you forget about your burnt, and swollen, face. It’s now the eighth inning, and the visiting team is up to bat. You quietly whisper “strike,” but much to your dismay,  the batter hits the ball so hard you hear a deafening “crack.” But the sound wasn’t coming from the bat smashing into the baseball, but rather the baseball smashing into your head. Diagnosis? “W21.03XA, Struck by baseball, initial encounter.” Next thing you know, you’re at the hospital with a doctor hovering over you. “Good game,” you say.

What a day. You’re on some effective pain medication as you finally pull up to the house, about 7:00 or 8:00. You yell to your kiddos, “Yo, smell ya later.” You look at your kingdom and you’re finally there, to sit on your throne as the Father of the Year. And before you know it, it’s June 22, and this Father’s Day is finally—and painfully—over. You can’t wait to see what next year has in store. You’re sure your family will hit it out of the park—and hopefully not into your head.

On a more serious note to all of you dads out there: Thanks for all that you do for your families. We hope you this holiday is injury-free and fun-filled.

Dual Coding: When One isn’t the Loneliest Number

June 1st, 2015
Codes, ICD-10

October 1 is fast approaching, and that means it’s nearly time for ICD-10 implementation. Hopefully your staff is trained and prepared to use the new codes in all of their updated and more descriptive glory. While you might be clear on the deadline and what you need to do to prepare for it, the idea of dual code submission might not be as crystalline. Here’s the lowdown:

The Dates

First, you can’t submit both ICD-9 and ICD-10 codes on the same claim. Not happening. So, which code set should you use? That depends on the claim’s date of service—not the date of submission. That means any claims submitted for dates of service before October 1 should contain ICD-9 codes. And the ones with dates of service on or after October 1? You guessed it: Those claims should contain ICD-10 codes. This is something you will need to monitor closely in your clinic. In the event that you do end up submitting a claim containing both ICD-9 and ICD-10 codes, you must split the claim. (Just be sure to ask your payers about their splitting specifications first.) So, even though ditching ICD-9 altogether—at least at first—isn’t feasible, it doesn’t mean you need to be stuck in dual coding limbo.

The Do

You probably don’t want this dual coding period to continue on for too long—and luckily for you, there are some steps you can take to shorten the process. Start by examining how quickly you’re preparing claims; then, adjust your processes to accommodate those timelines. Or, set goals to get the claims out even more quickly. Ideally, you should submit all claims within 24 hours of the date of service. This will help speed up the process of denial management. Another way to shorten your dual coding time is to figure out how long a typical claim is open. Once you have a rough idea of how long it takes for both ICD-9 and ICD-10 codes to process (again, not on the same claim), you’ll be able to account for any additional processing time.

The Deal

If you already have solutions in place to help you transition to ICD-10, that’s great. If not, you should start looking for some software solutions—sooner, rather than later. If you do already have systems in place, then—in addition to examining your own processes—you’ll want to ask your EMR system, third-party vendors, billing services, and clearinghouses if they can handle both ICD-9 and ICD-10 codes. Ideally, all of your vendors will have already taken this transitional period into consideration.

The nitty-gritty details of the transition to ICD-10—including dual coding—might seem a bit muddy. However, with some preparation, it doesn’t have to be a big mess. Are you ready to handle coding for both ICD-9 and ICD-10? Share your thoughts in the comments section below.

5 ICD-10 Questions to Ask Your PT Software Vendor

May 18th, 2015

Having the right EMR in place can help ease your practice’s transition to ICD-10—emphasis on the “right.” So, if you already use EMR in your clinic, it’s crucial that you make certain your vendor is ready for ICD-10. With the October 1 implementation date fast approaching, it’s about time you find out if your system is truly prepared to handle the transition. Shopping for a new system? Then ICD-10 readiness should be at the top of your buying checklist. To find out whether your current or future EMR is equipped to handle the switch, ask each vendor these five questions:

1. Is your system compatible with the new code set?

Ideally, your EMR software should be ICD-10 compatible long before October 1, 2015. That way, you’ll have a chance to test the new codes using fictitious patients before full implementation. If your EMR isn’t ready yet, you’ll need to find out exactly when the software will be ready so you and your team can conduct internal testing.

2. Will both ICD-9 and ICD-10 codes be available after the October 1 date?

Even after ICD-10 implementation, non-HIPAA-covered entities (think auto and workers’ compensation claims) might still require ICD-9 codes. To avoid claim denials due to incorrect submissions, you’ll want to be sure that your system can handle both code sets.

3. Will ICD-10 require a system update? If so, how much will it cost?

Some EMRs may require a costly update to switch to the new code set. If this is the case with your vendor, then I recommend investigating a new system. ICD-10 adoption is mandatory, so your software vendor needs to change no matter what; otherwise, it’ll go out of business. In my book, your practice shouldn’t have to foot the bill for a healthcare change that your vendor has to make. Furthermore, any system that requires excessive downtime or an expensive upgrade is most likely outdated, which means it probably won’t handle the switch so well. That could leave you saddled with unusable or glitchy tools or inaccurate claims. And what if it can’t handle the switch at all? In that case, you won’t have access to your documentation, patient records, schedule, or even your billing until your vendor gets with the program.

4. How will the system help with transitioning from ICD-9 to ICD-10?

Do you know how to code using the new ICD-10 code set? Are you positive you can find the most applicable ICD-10 code for each of your “go-to” ICD-9 codes—all without batting an eyelash? I’m going to take a wild guess that you aren’t quite to that point—yet. That’s why you need a system in place that will help you find the most complete and accurate code. Your system should make it easy for you to select the right code. However, it should never—ever—spit out one-to-one crosswalk conversions. That’s because a direct, all-encompassing ICD-9 to ICD-10 conversion simply doesn’t exist. According to this HIMSS article: “Although the implementation or use of an EMR can help with the documentation challenges providers will be confronted with in the new ICD-10 world, the use of an EMR alone is not a magic bullet.” So, if your current vendor offers a magic bullet, be wary. No software can produce a perfect one-to-one crosswalk without you, the practitioner, playing a vital role in the decision-making process. Thus, I recommend choosing an EMR that empowers you to select the most specific and correct code through the use of an intelligent and integrated tool.

5. Will you offer ICD-10 support? If so, how much will it cost?

Ideally, your system will offer ICD-10 support through educational resources and by having staff members available to answer phone calls and emails. A system invested in your success will offer all of this—for free. If you’re concerned about ICD-10’s complexity and how it will affect your staff’s productivity, be sure to find out how your system’s support team will help ease the transitional burden.

If you haven’t already, it’s time to start asking your vendors the right questions to find out how they will assist you during this time of change. And if you come to find that they aren’t prepared for ICD-10, then it’s time to shop for an EMR that is.

Why ICD-10 KOs ICD-9

March 17th, 2015
ICD-10, ICD-9

If you get a kick out of watching diagnosis codes fight head-to-head in the boxing ring—hypothetically at least—then you’ve come to the right blog post. We’re six months out from ICD-10 implementation, and it looks like ICD-9 doesn’t stand a chance of winning (not even by way of another SGR fix). As you size up the competitors, there’s no doubt that the ICD-10 diagnosis code set is bigger and badder than its predecessor. It weighs in with nearly 70,000 codes—five times more than ICD-9’s set includes. And if you’re placing your bets based on that sheer size difference alone, then this might not seem like much of a fair fight. But keep in mind, knocking out your opponent requires more than basic brawn; you need smarts, too. Without further ado, here’s why, in the match-up against ICD-10, ICD-9 is ready to throw in the towel:

ICD-9 is a Bleeder

Okay, so ICD-9 isn’t vulnerable to actual wounds, but there are several reasons the old code set needs some cleaning up:

  1. ICD-9 is significantly older than ICD-10, but that doesn’t mean it’s wiser. In fact, at more than 35 years old, it’s simply outdated when it comes to modern healthcare standards.
  2. With only 13,000 codes, the set lacks specificity as well as the flexibility necessary for adapting to future healthcare developments.
  3. Because the current code set is so limited, much of the diagnosis data is inaccurate. And another jab? That incorrect data further fuels distorted reimbursements.

ICD-10 Goes the Distance

ICD-10 doesn’t rely on haymaker tactics, throwing wild punches to knock out its opponent. The new code set is extensive by design and has five times as many codes as ICD-9 (with mortality and morbidity data to boot). It’s complex, flexible, and designed to accommodate evolving healthcare documentation standards. The specificity of of the new code set allows for:

  • accurate data measurements of everything from quality of patient care to outcomes.
  • clearer clinical research.
  • more effective detection, verification, and response to public health threats.
  • fewer coding errors.
  • easier identification and prevention of healthcare fraud and abuse.
  • reduced claim rejections.
  • accurate provider performance-tracking.

And the Winner is?

ICD-10 KO’s ICD-9. I don’t know which contender you put your hypothetical money on at the beginning of this post, but I hope you’ve come out a little richer—at least in knowledge—in the end. Are you still a diehard fan of ICD-9? Check out this post and download the infographic to see why you should readjust your betting strategy. Do you have questions? Comment in the section below.