A Practical Guide to ICD-10 for Physical Therapists, Part 1

April 28th, 2014

ICD-10 has five times as many diagnosis codes as its predecessor, ICD-9. And while that might sound scary at first, as a physical therapist, you really only need to know a small fraction of the new code set. Today, let’s talk about two of the major coding categories relevant to rehab therapists: pain and injury. After all, that’s probably why most of your patients are seeking your services in the first place.


One of the main differences between ICD-9 and ICD-10 is the latter’s greater level of specificity—more specifically (ha!), its inclusion of codes designating region and laterality. For physical therapists, location is probably the second most important factor to consider when choosing which ICD-10 code to select—after considering the cause of the patient’s pain, of course. While this additional level of specificity is an asset of the ICD-10 code set, it also means that once it goes live, you will no longer be able to get by using many of the ICD-9 catch-all codes of yesteryear (otherwise known as unspecified codes).

Let’s take limb pain, for example. In her aptly-titled article, “Pain in limb 729.5 doesn’t cut it in ICD-10,” author Bernie Monegain explains that there are more than 30 codes that fall into the pain-in-limb category—and these codes account for everything from region (e.g, upper arm, thigh, and lower leg) to laterality (e.g., left and right). Centers for Medicare and Medicaid (CMS) reports that more than 33% of the increase in ICD-10 codes is due to the addition of new and distinct laterality codes.

According to this article, most of the pain codes are located in three places within the tabular list: the body system chapters, the signs and symptoms chapter, and in category G89 (pain, not elsewhere classified) in the nervous system chapter. However, you can find the most relevant pain-related codes for physical therapists in Chapter 13 (the musculoskeletal or “M” code chapter). The most common examples of musculoskeletal pain codes include M54.5 (low back pain), M25.512/M25.511 (pain in left shoulder/pain in right shoulder), and M25.551/M25.552 (pain in right hip/pain in left hip).

However, if you know what is causing your patient’s pain, you should always code for that underlying condition instead of or in conjunction with the code for pain. According to this article, “The ICD-10-CM guidelines state that if the cause of the pain is known, you should assign a code for the underlying diagnosis, not the pain code. However, if the purpose of the encounter is to manage the pain rather than the underlying condition, then you should assign a pain code and sequence it first.” For a detailed example of this type of scenario, check out this site.


You’ll find injury codes in chapter 19 of the tabular list. While many of the injury coding guidelines that apply to ICD-9 also apply to ICD-10, there are a few important distinctions—one of which is ICD-10’s addition of the seventh character extension, which specifies episode of care. If a particular code requires that you attach a seventh character, you’ll see instructions to do so within the tabular list. According to this article, there are three different seventh character extensions:

  1. A – Initial encounter. This character applies if the patient is receiving active treatment for his or her injury (e.g., surgery, emergency room treatment, or evaluation and treatment by a new medical professional).
  2. D- Subsequent encounter. This code applies if the patient is receiving routine treatment for his or her injury during healing or recovery (e.g., cast removal, medication adjustment, or aftercare). Note that you should not use aftercare codes for injury aftercare. Instead, attach the seventh character “D” to the applicable acute injury code.
  3. S – Sequela. This code applies if the patient is receiving treatment for a condition that occured as a result of the original injury. According to the article cited above, this character applies to “complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequela of the burn. When using extension S, it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The S is added only to the injury code, not the sequela code.”

When selecting the correct code that most specifically represents your patient’s injury, you should also consider the following (as noted here):

  • Injury site. Within chapter 19 of the tabular list, injuries are organized by anatomical site, which makes it much easier to select the most specific injury site possible.
  • Etiology. You should always do your best to account for the cause of your patients’ injuries (e.g., sports, motor vehicle accident, or slip and fall) and/or the activities leading up their injuries by submitting an appropriate external cause code (along with the appropriate injury code). You can find cause codes in chapter 20 of the tabular list.
  • Place of occurrence. If you know where the injury occurred (e.g., gym, athletic field, or swimming pool), you should code for it using an appropriate place of occurrence code. You can also find these codes in chapter 20.


Looking for a way to connect the ICD-10 dots? Here’s an example from CMS:

Description of injury: Left knee strain occurred on a private recreational playground when a child jumped off of a trampoline and landed incorrectly.

  • Injury code: S86.812A (strain of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter)
  • External cause code: W09.8XXA (fall on or from other playground equipment, initial encounter)
  • Place of occurrence code: Y92.838 (other recreation area as the place of occurrence of the external cause)
  • Activity code: Y93.44 (activities involving rhythmic movement, trampoline jumping)

What You Absolutely, Positively Must Know About External Cause Codes

April 23rd, 2014
Codes, ICD-10

The ICD-10 code set might possibly be some of the most boring reading material on the planet—unless, of course, you’re into that sort of thing. But I think it’s safe to say that the mainstream media probably isn’t, which is most likely why they’ve spent so much of their time highlighting the more entertaining aspects of the coding manual: specifically, the external cause codes in Chapter 20. Sure, these supplemental codes offer a healthy dose of comic relief to an otherwise dull subject matter, but they’ve spurred quite a few questions and some concerns. So here are the five things you absolutely, positively must know about external cause codes:

1. Most of the time, they’re optional. Per the ICD-10-CM Official Guidelines for Coding and Reporting, “Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required.” However, even though there’s no national requirement forcing the issue, there are a plenty of good reasons to include external cause codes when you can. After all, they do “provide valuable data for injury research and evaluation of injury prevention strategies.” And according to this article, such data could instigate important preventative education and action. Take motorcycle accidents, for example: If data showed a high frequency of motorcycle accidents in a particular area, local leaders could use that information to demonstrate the need to devote budget dollars to additional motorcycle safety education.

2. You can’t use them all the time—even if you want to. In some cases, adding an external cause code to a diagnosis code simply doesn’t make sense, like in the case of T36OX1 (poisoning by penicillins, accidental), which has the cause built right in. And external cause codes can’t stand alone; they must always be paired with a principal diagnosis code.

Not sure to which codes you can apply an external cause code? Check the tabular list. Above each applicable diagnosis code category, you’ll see instructions to do so.

3. There are four types of external cause codes, each of which answers one of the following questions:

  • How did the injury or condition happen?
  • Where did it happen?
  • What was the patient doing when it happened?
  • What it intentional or unintentional?

You can apply as many external cause codes as necessary to fully explain the patient’s condition. Here’s an example: Let’s say this is the first time you’re treating a patient for a strain of his right Achilles tendon. You’d select the diagnosis code S86.011A (strain of right Achilles tendon, initial encounter). After examining the patient, you find that the patient’s injury occurred as a result of running on the treadmill at a gym he visits for recreation (not work). To code for this, you’d submit the following external cause codes:

  • Y93.A1 (activity, treadmill)
  • Y92.39 (gymnasium as the place of occurrence of the external cause)
  • Y99.8 (other external cause status, recreation or sport not for income or while a student)

4. If you choose to use them, you only need to do so at the initial encounter (for the most part). Typically, you need only to report place of occurrence, activity, and external cause status codes during the patient’s initial evaluation. However, there are a few codes—specifically those that describe how an injury happened—that you can report at other points throughout the patient’s care. These codes usually require a seventh character designating the encounter type.

5. If you’re using multiple external cause codes for a single diagnosis code, report them in order of significance. The first cause code you list should be the one that most closely relates to the principal diagnosis; the last code you list should be the one that least closely relates. However, according to the official coding guidelines, external cause codes for the following events take precedence over all other external cause codes, in the following order of significance (abuse should be listed first no matter what else you code):

  1. Child and adult abuse
  2. Terrorism events
  3. Cataclysmic events
  4. Transport accidents

See, despite all the fuss over external cause codes—and the jokes about patients being struck by an orca—they’re really not that bad. Want a more in-depth look at external cause coding? Check out section 20 of the official coding guidelines. As always, if you have questions, leave them in the comments section

ICD-10 Will Cost Small Physician Practices Big Time. Good Thing You’re Not a Physician

April 7th, 2014

In a recent study, the American Medical Association (AMA) reported that ICD-10 may cost small physician practices up to $226,105. My conclusion? Physical therapists’ transition to ICD-10 is going to be a breeze compared to their MD colleagues. Now, I’m not saying every step of this process is going to be a walk in the park; but I am saying it won’t cost you or your practice hundreds of thousands (or even tens of thousands) of dollars to make the switch—unless, of course, you do something really silly, like invest in a prehistoric server-based electronic medical record (EMR) and hire a full on-site IT staff to support it. But you’d never do that—you’re already using the best web-based physical therapy EMR on the market, right?

If you’re smart about the process—you study the new codes, gather great resources (like the ones you’ve found here), hire an expert ICD-10 coder (or train someone already on your staff to step into this role), partner with vendors who have your best interest at heart, and squirrel away at least six months’ worth of cash revenue—then you may end up with a few hurdles to overcome, but it won’t be all that bad. Speaking of partnering with the right vendors, the AMA study found that the majority of the cost physician practices will incur to make the transition comes from the price to adopt or upgrade an electronic health record or project management system. A recent Medical Group Management Association (MGMA) study came to a similar conclusion: Almost 87% of physicians surveyed needed to?or already had to?upgrade or replace their EHR software to use ICD-10 codes. Almost 37% have/had to cover the cost?a staggering $12,885 per full-time physician.

Unfortunately for physicians, the AMA found that the cost to transition to ICD-10 will be even higher than what they originally predicted back in 2008, which means many practices may be approaching the switch unprepared. Additionally, many physician-specific EHR vendors?which have to deal with both meaningful use certification and the ICD-10 transition?aren’t releasing necessary updates until as late as this summer, leaving physicians little time to practice with the new codes and the new technology. According to the MGMA study, only 4.8% of medical practices feel that they have made significant progress in terms of overall readiness for ICD-10.

Luckily for physical therapists, niche, cloud-based EMRs cost a small fraction of that scary number above—and they update automatically, so users always have access to the latest in technological advancements and compliance tools. And many physical therapy-specific integrated billing services are already ready for the transition, too. Kareo, for example, has an ICD-10 100% Success Plan, which lays out steps from now through October 1, 2014, that providers should follow to ensure a successful transition. Over the next three months, Kareo also plans to release new ICD-10 tools and features, including top code reports and ICD-9 to ICD-10 crossreferencing resources.

Whether you’re a physician or a therapist, one of the most important things you can do to prepare for the transition is to learn the codes and the new coding structure?and ensure your staff does, too. Interestingly enough, the AMA found a pretty big discrepancy in how physicians feel about their coding prowess compared to how they actually perform: “One common theme from our interviews is that physicians have a false sense of belief that they have been correctly coding in ICD-9, when in fact coders report that rather than continually querying the physician, they recode on their own. Therefore, the challenges physicians will face in moving to an even greater number of codes are likely to persist and in fact be exacerbated.” Providers and coders also have a difference of opinion when it comes to their greatest ICD-10 transition concern: “…coders reported that physician-coding communication would be one of their greatest challenges; whereas physicians reported that productivity loss would [have] the greatest impact…” Both are legitimate concerns, but there’s good news for outpatient practices. According to the AMA, providers in hospital settings can expect a nearly 50% drop in productivity. Providers in ambulatory practices, on the other hand, can expect just a 10% decline (so you’ll have much more time to spend improving your provider-coding communication).

How do you feel about the upcoming ICD-10 transition? Are you ready? Are you concerned? Tell us how you’re feeling and how we can help in the comment section below.

CMS Says ICD-10 Benefits Outweigh Prep Work

April 2nd, 2014
ICD-10, Transition

According to the Centers for Medicare and Medicaid Services (CMS), the work providers will have to do in preparation for the ICD-10 transition is temporary. The benefits for providers and patients alike, on the other hand, are forever—or at least until ICD-11. “From proper observation and documentation to improved clinical documentation, progress notes, operative reports, and histories, the benefits of ICD-10 begin with enhanced clinical documentation enabling [providers] to better capture patient visit details and lead to better care coordination and health outcomes,” CMS writes. So, although you might feel more than a bit overwhelmed as we get closer to the October 1, 2014, transition deadline (27 weeks and counting), there is a light at the end of the tunnel. Come 2015, you’ll be an ICD-10 expert, and instead of worrying about transition plans and preparedness strategies, you’ll be able to kick back and enjoy the fruits of your labor (as described on this CMS page and in this SuccessEHS article):

Clinical Benefits

  • Make more informed clinical decisions as a result of more thorough documentation, collection, and evaluation.
  • Achieve new insights and identify new trends thanks to greater specificity, laterality, and detail of patient diagnoses. (This also improves our nation’s ability to report, track, and evaluate public health.)
  • Take advantage of more opportunities for research, trials, and studies because injury classifications will be more accurate. (Plus, because most of the world already uses ICD-10, we will be able to conduct comparative research with other countries.)

Operational Benefits

  • Access more information to better match patients with providers and have more productive and more frequent communication with other healthcare professionals.
  • Use specific patient condition information to make better decisions regarding capital investments and resource allocation to address practice needs.

Professional Benefits

  • Introduce new procedures and diagnoses because the code set is more flexible.
  • Support credentialing and certification through clearer objective data.
  • Improve quality and efficiency reporting by using more specific measures.

Financial Benefits

  • Increase the likelihood of reimbursement through more thorough documentation of patient complexity and level of care. (Plus, the specificity of ICD-10 codes should provide payers with enough information to eliminate the need to request copies of medical records.)
  • Reduce your audit risk exposure because the diagnosis codes are more specific.
  • Facilitate peer-to-peer comparison and benchmarking by using more objective data.

Do you see the light at the end of the ICD-10 transition tunnel? If so, what benefits are you most looking forward to? Tell us in the comment section below.

New Research Finds Less than 10% of Physician Practices Ready for ICD-10

March 20th, 2014
ICD-10, Preparation, Testing Week

The Medical Group Management Association (MGMA) published the findings from their most recent ICD-10 readiness survey and the results are, well, scary. According to Jeff Wood in this ICD-10 Hub blog post summarizing the findings, the researchers found that “less than 10% of physician practices have made significant progress toward preparing for the upcoming conversion to ICD-10.” While this demonstrates an improvement from MGMA’s June 2013 survey, it’s not much.

For physicians, one of the issues may very well be their EHR. The survey found that:

  1. Most (almost 87%) need to—or already had to—upgrade or replace their EHR software to use the new codes. Almost 37% have/had to cover the cost—$12,885 per full-time physician.
  2. Only about 8% have started internal ICD-10 testing with their EHR vendor.

It’s not just MDs who are less than raring to go. Wood writes that “almost 60% of the 570 medical groups polled had not heard from their payers about when end-to-end testing would begin” and “nearly 50% [of respondents] had not received a testing date from their clearinghouse.” Despite the results of this readiness survey, there’s been no news about another transition date delay—although I’m sure many providers and payers were hoping that would be the case.

So what does this mean for PTs, OTs, and SLPs? We’ll, it means it’s a great time to be a therapist. Although the transition to ICD-10 may not be a total picnic, you’ve got a lot less to worry about than your physician counterparts. For starters, your EMR implementation costs are a fraction of that frightening figure above. And you don’t have to demonstrate meaningful use this year in addition to making the transition to the new super specific coding set. And that means you and your team can focus solely on learning—and implementing—the new codes. And if you’re a WebPT Member—or plan to become one—you have an EMR that will ensure everything is working smoothly well before the transition deadline. Plus, all of our billing software partners are ready (or almost ready), too. Some—like Therabill and Medisoft—are already accepting ICD-10 codes (along with their ICD-9 counterparts) and most—including CollaborateMD, AdvancedMD, and Kareo—participated in Medicare’s ICD-10 Testing Week to verify their own ICD-10 readiness.

Want to learn more about WebPT and our integrated billing partners? If you’re already a member, head to the Community section of WebPT by clicking the people icon in the top-right corner of any screen within the application. If you’re not yet a member, call us at 866-221-1870, option 1.

What do you think about the survey findings? Tell us your perspective in the comments section below.

ICD-10 Has 312 Animal Codes—And There’s a Good Reason for That

March 10th, 2014
Codes, ICD-10

By now, you’ve probably heard more than a few ICD-10 jokes—”a man walks into a lamppost…” for example. And although they’re pretty funny—and not entirely unfounded—there’s actually a reason why ICD-10 contains so many ultra specific diagnostic codes, at least according to Richard Averill, senior vice president of clinical and economic research at 3M Health Information Systems. Here’s some of what Averill has to say (paraphrased) in response to some very good questions posed by Tom Sullivan, editor of Government Health IT (also paraphrased):

Q: Macaws are (almost entirely) native to South America, so why does the US need codes for macaw injuries?
Remember the avian flu? Well, that was originally transmitted by a bird. If the US experiences another bird-source outbreak, we’ll have the necessary codes to accurately report it to the United States Centers for Disease Control and Prevention (CDC).

Averill also points out that most of the codes people are using as punchlines are actually already in ICD-9; there are just many more in this new set, which brings us to another question.

Q: The sheer volume of codes has a lot of people concerned. Considering that most practitioners will only ever use a small subset of the codes, why are there so many?
The coding system is similar to a dictionary in that even though there are 470,000 words in the unabridged version, we only use a fraction of a percent of those words in a typical conversation. But the fact that 470,000 words are available to us doesn’t make it any more difficult for us to carry on a conversation. The same goes for the coding system. In most situations, you’ll only use a small subset of the codes. But there may come a time when you wish to describe something out of the ordinary, and in that case, the unusual codes will be there for you to use.

According to Averill, the large number of codes came about not as a result of bureaucracy, but rather because the medical community asked for this level of specificity to better do their jobs. Additionally, Averill says: “John Hopkins Bloomberg School of Public Health noted that to further research in the area of non-fatal injuries, we must be able to more accurately describe the nature of the injury sustained and correlate the nature of the injury with the mechanism of the treatment and outcome.” In short, he says, “they’re arguing that we need the detail to really understand outputs.”

Q: Could we put the ICD-10 data to use? Perhaps to determine the likelihood of injury based on sport?
Yes. If we as a country require providers to report these injuries at that level of specificity, we’d have a national database we could use to track trends. We could also go one step further by tracking patients who suffer football-related concussions during childhood, for example, to see if they also experience learning difficulties or seizures later in life. However, right now providers are not required to record such detailed information.

Q: What’s the best example of how ICD-10’s specificity can actually help improve health management?
In ICD-9, there’s no way to code which trimester a pregnant woman is in, which is an incredibly important piece of information to have if you’re treating someone for preeclampsia or other complications. Also, using ICD-9, “in rheumatoid arthritis [cases], we don’t even know what joint is involved. And so if we’re really trying to understand care, and a patient has rheumatoid arthritis in the knees, hips, and so on, [his or her] ability to recover from, say, a stroke may be significantly impaired, especially compared to having rheumatoid arthritis only in [his or her] little finger.”

According to Averill, there are many cases in which ICD-10’s specificity is actually incredibly beneficial to the healthcare community as a whole. There aren’t “just a couple of examples.” And we couldn’t agree more. Who knows what brilliant insights will come from the data that specifies whether a patient sustained his or her injury in an opera house or an art gallery?

As HealthLeaders Media writer Cheryl Clark points out here, there are lots of reasons why ICD-10—and all of its specificity—will be a very good thing:

  1. It’s a much-needed update to outdated or non-existent 1970s medical terminology
  2. It improves public health tracking
  3. It discourages fraud
  4. It allows providers the opportunity to code reasons for patient non-compliance
  5. It details accidents and injuries in a way that will allow for trend identification
  6. It better describes—and allows tracking of—adverse events that take place within a healthcare environment (clinic, hospital, etc.) as well as those that result from medical device complications
  7. It allows providers to track the specifics of procedures based on level of difficulty
  8. It creates jobs
  9. It supports the transition to EHR/EMR

So what do you think? Do you see the benefits of ICD-10’s specificity or do you think 68,000 codes is a bit much? Tell us in the comments section.

5 Steps You Can Start Taking Today to Prepare for ICD-10

January 22nd, 2014
ICD-10, Preparation, Transition

So, you’ve heard: ICD-10 is coming—dun, dun, dun. Just kidding about that last part. While there are several preparatory tasks we really think you should get started on now (if you haven’t already), ICD-10—contrary to what some people believe—is nothing to be afraid of. But it is something to take seriously. So what can you do to prepare? Well, here are our top five next steps and when to take them:

1. Accept the facts (today)

Sure, you could go through all five stages of Kübler-Ross’s mourning process before finally landing on acceptance, but we suggest you make it a quick trip. Beginning on October 1, 2015, you will only receive reimbursement for claims you submit with ICD-10 diagnosis codes. The sooner you accept this fact, the better. Use this as motivation—you have a deadline. And I don’t know about you, but I sure work better with a firm end date.

2. Elect a lead—or a team (this week)

There’s someone in your office who excels at this sort of thing—and that may or may not be you. This person is a born project manager with a knack for research and a love of all things organizational. This is your ICD-10 implementation lead, so go buy him or her a coffee—or maybe a personal espresso machine.

Depending on the size of your office, you may need to elect an ICD-10 team, but at the very least, every practice needs one head ICD-10 honcho who is responsible for staying up to date on the latest and greatest in the world of diagnosis codes—and translating that information into comprehensible tidbits and action items for everyone else. Looking for a place to start? Assign your lead the first task of compiling a list of great ICD-10 resources like CMS, APTA, and AdvancedMD. (Bonus points if he or she puts WebPT at the top of that list.)

3. Create a plan (next week)

Now that you’ve got your lead and a host of really helpful resources, it’s time to start laying out a plan—that is, what you want to accomplish by when. Just like you do for your patients, we recommend using the SMART goal method—setting learning objectives that are specific, measurable, attainable, realistic, and timely. You can start by taking a look at your current diagnosis code processes and determining how these will need to change in the coming months to accommodate the new codes—an ICD-10 compliance audit, if you will.

And it’s not just about your internal processes. If you outsource your billing or use an electronic medical record for documentation, make sure that your vendors are ready to handle the new codes as well. If they aren’t prepared—or don’t seem confident in their ability to transition—you may need to start looking for new partners. (In case you’re wondering, WebPT will be ready to handle the new codes well before the October go-live date, and we’ve made it our mission to provide you with a wealth of free educational resources so you’ll be prepared, too.)

You could spend every waking moment between now and October 1, 2015, preparing, and you still might hit a snag or seven when it’s time to submit—not on your end, but on your payers’. That’s why experts recommend having at least six months’ worth of cash revenue available to ensure you can weather the potential storm of delayed reimbursements. If you can’t save this much in advance, Heidi Jannenga suggests “having a plan B, such as a line of credit or supplemental income to ensure your clinic’s viability during the transition.” She cautions not to “wait until after October 1 because you’ll have to vie for financing and pay higher interest rates.”

4. Start training (next month)

You’ve got your lead, and you’ve got your plan. Now, it’s time to begin training—and that means including everyone in your office, whether it seems immediately beneficial or not. As an industry (and as a nation), we’ve been using ICD-9 codes for the past 30 years, and it’s going to take a while to unlearn what we’ve learned, so start sooner rather than later—especially because there are five times as many ICD-10 codes as there are ICD-9 codes. Whereas ICD-9 codes are mostly numeric and have three to five digits, ICD-10 codes are alphanumeric and contain three to seven characters. While that may not sound like a big difference, it is.

As you begin training, pay attention to what your trainees need in order to be successful. Are they audio, visual, or hands-on learners? Knowing this will help you and your lead train effectively. Look back at your list of resources; there is a lot of great information out there in a variety of formats. And as the year wraps up, even more resources will begin to surface.

5. Test, test, test, and test some more (next year)

  1. AdvancedMD succinctly summed up this stage in three sentences:
  2. “Test that your office staff can competently work with the redesigned workflow [and new codes].
  3. “Test each redesigned process.
  4. “Test integration with partners.”

Beginning on the first of the New Year, your clinic should be almost (you still have your patients after all) singularly focused on ensuring that come October 1, 2015, you’ve got ICD-10 on lock. That is, you and your staff know the ins and outs of the new codes and how to properly use them, as do your partners (billing, documentation, etc.). So start testing and keep testing until you are 150% confident.

Interested in seeing a few other suggested timelines? Here’s one from AdvancedMD and one for small- to medium-sized practices from CMS. Now, it’s important to note that both timelines suggest that ICD-10 preparation should have begun months ago, but not to fret. There’s still plenty you can accomplish in the time you have left. You’ll just have to step on the gas, pick up the pace, give it some gusto—you get the idea.

Have you started preparing? If so, what steps have you found most useful? Tell us your thoughts in the comments below.

There’s a New CMS-1500 Claim Form Coming to a Practice Near You

January 9th, 2014
CMS-1500, ICD-10

The Centers for Medicare and Medicaid (CMS) recently revised the CMS-1500 form in preparation for the new ICD-10 diagnosis codes. On the new form (version 2/12), providers will be able to include up to 12 possible codes (this is an increase from four possible codes on version 8/05) and note whether they’re using ICD-9 or ICD-10. As a reminder, in order to receive reimbursement, providers must continue to use ICD-9 codes through September 30, 2015, and switch to ICD-10 beginning October 1, 2015.

Medicare will begin accepting the new form on January 6, 2014, and will stop accepting the old form on March 31, 2014. Note: Medicare will only accept CMS-1500 claim forms from providers who are exempt from electronic submission. CMS recommends that providers who use service vendors check with those vendors to determine when they’ll switch to the new form.

For more ICD-10 information, visit CMS’s website and check out this blog post.

ICD-10 Lessons from Those Who Went Before: Australia and Canada

December 10th, 2013
ICD-10, Transition

On October 1, 2015, ICD-10 will become mandatory in the United States. But we aren’t the first to make the transition—not by a long shot. In 1998, Australia adopted ICD-10, and in 2001, Canada did as well. So although the US appears to be a little behind the times, it might be for the best. After all, there are plenty of things we can learn from those that went before. Just ask Carl Natale of ICD-10 Watch. He wrote a few articles on the topic, and here, we’ll summarize his main points:


According to Natale—who cited source Debbie Abbott, the ICD-10 Implementation Officer for Queensland Health—Australians love ICD-10. However, although Australia runs on a similar healthcare system (citizens can choose to buy their own insurance or participate in government run programs), there are several distinct differences. The first is that Australians started out only using ICD-10 for inpatient coding, and the second is that their hospitals operate on a single diagnosis-related group (DRG), which is conducive to ICD-10. Despite these differences, there are still several key learnings we can take away from our friends Down Under. After all, their coders were back to their previous productivity rates within three month of implementation. Here’s why:

  • Assessment began early—consultants helped identify the processes clinicians were using with ICD-9 to determine “who needed to know what” and when.
  • Training began early—18 months before implementation.
  • Testing began early—early enough to identify the areas where more education was necessary and where workflows needed alteration.

Are you seeing a pattern here? I am: start early. Assess, train, and test—early. The more we can understand upfront, the better prepared we’ll be to make the transition. But that doesn’t mean we can iron out all the kinks ahead of time. And according to the Australians, “it’s expensive,” which is all the more reason to consider a few more tips from another country that went before.


Whereas the Australians had an easy transition, the Canadians did not. But they did do a great job of learning from their mistakes and passing along that wisdom. Natale referenced Gillian Price, Project Director Canada at QuadraMed, in an article where he cited several lessons the US can—and should—learn from our neighbors to the North. Here are four:

  1. Take control of your own learning: CMS has some great resources, but don’t leave it up to them to hand-feed you the information you need. Do your research. Teach yourself and share your knowledge.
  2. Get everyone involved: It’s not just your coders who should understand the differences; everyone in your office should know the ins and outs of ICD-10 and how the transition is going to impact your entire practice.
  3. Plan for the unexpected: Save. Save. Save. Make sure that you have enough funds available—experts recommend at least six months’ worth—to keep your clinic afloat in the face of potential loss of revenue.
  4. Collaborate: According to Natale, “Price is very proud of Canada’s very collaborative culture. She says it was a key part of learning from mistakes and making ICD-10 transitions smoother.” So let’s work together—and make the best of it.

There you have it: a handful of helpful takeaways from Australia and Canada that we can use to make the US transition that much easier. Want more details? Here are Natale’s full articles about Australia and Canada.