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.
The switch to ICD-10 doesn’t have to be crazy-expensive, but if you make a couple of big missteps, your whole practice could take a financial tumble. Like navigating a magical hedge maze to retrieve the Triwizard Cup, making the transition to ICD-10 could be full of costly pitfalls. Here are three common ways ICD-10 can empty your bank account—and how to avoid them:
1. Weak Cash Flow
During the transition to ICD-10, it’s possible you may experience a delay in payments due to coding errors and vendor or payer under-preparedness. That’s why you need to do everything in your power to make sure your revenue stream keeps flowing. To that end, you should first assess your current billing workflow to determine how quickly and cleanly your practice currently processes and receives payment for claims using ICD-9 codes. This will allow you to correct any kinks in your workflow and give you a much better sense of how ICD-10 could affect your cash flow after the transition. Depending on the results of your assessment, you may need to consider hiring coders, better training your front office staff on billing, or working with an automated billing service or software.
2. Poor Productivity
While we can expect a certain degree of diminished productivity during the transition, it shouldn’t be severe—or permanent. To keep your clinic running at top speed, start by determining your practice’s most commonly used diagnosis codes and their most specific ICD-10 equivalents. That way, your staff can spend more time billing and less time searching for codes. While you’re at it, a recent Medscape article recommends that you start phasing out unspecified diagnosis codes. Not only can unspecified codes give way to questions that bog down your billers, but they also can cause ICD-10 claim denials.
Another way to prevent productivity loss is to ensure your billing, practice management, and EMR vendors—and payers—are ready for ICD-10. First, find out which of your vendors and payers will be affected by ICD-10. Then, you’ll need to:
- Determine their testing processes and schedules.
- Submit and review test data.
- Update your billing process—and perhaps your vendors—based on the results of your testing.
For more details on external testing, check out our blog post here.
3. Lack of Training
Just as investing in Apple stock when it first went public in 1980 was a good idea, so is training your staff on ICD-10 now—before it becomes a big to-do. Otherwise, you’re in for a rough transition—complete with heaps of staff frustration. Switching to ICD-10 isn’t exactly a small change. The new code set has 55,000 more codes than ICD-9. To further complicate matters, while ICD-9 codes are mostly numeric and have just three to five digits, ICD-10 codes are alphanumeric and contain three to seven characters. So, while some folks will feel the impact more than others, all of your staff members should go through some kind of ICD-10 training to ensure everyone is on board with the change and understands the new coding requirements.
Be patient and flexible with your staff while they learn the new structure, but make sure you develop—and stick to—a training timeline and strategy. To vary your educational style and keep costs down, take advantage of free educational tools, like ICD-10 for PT and the WebPT Blog. We’ve got tons of articles, webinars, handouts, checklists, quizzes, and games to help prepare your staff for the switch.
Knowing three of the most common ICD-10 pitfalls for PTs—and how to arm yourself against them—will help you avoid a financial fiasco come October 1. But that doesn’t mean the transition will be totally easy. Make sure you download The Physical Therapist’s Crunch-Time Guide to ICD-10, and don’t miss WebPT’s upcoming webinar—ICD-10 Bootcamp: Coding Exercises for PTs and OTs—on August 31, 2015, at 9:00 AM PDT / 12:00 PM EDT.
With only about two months to go until the mandatory switch to ICD-10, your clinic should be fully entrenched in its preparations. If you started early, you’re probably feeling pretty good about where you’re at. Maybe you even feel totally ready to tackle the change. But if you didn’t start early—or if you haven’t started at all—you’re likely feeling the pressure on your practice and your bottom line. If your clinic’s staff doesn’t understand how to correctly code using ICD-10, you’ll suffer the financial consequences. Luckily, the Centers for Medicare and Medicaid Services (CMS) have granted providers with a one-year grace period—which could save you some delayed payments and claim denials due to ICD-10 coding errors. But the cost of transitioning to ICD-10 begins well before we actually switch code sets.
To help cover the cost of preparation, you could consider securing a line of credit with your bank or having three to six-months’ worth of cash on hand to keep your clinic afloat. But if those options aren’t available to you—or if you’d rather keep your purse strings tied up—you’ll need a penny-pinching preparation plan. Here are seven tips to help you prepare for the switch to ICD-10 without breaking the bank:
- Clear out your current reimbursement backlog and collections accounts to beef up your cash reserves.
- Take advantage of free educational tools, like ICD-10 for PT and the WebPT Blog, to educate you and your staff. Training is necessary, but it doesn’t have to be expensive.
- Determine your practice’s most commonly used diagnosis codes—and their most specific ICD-10 equivalents—to soften the blow to your productivity come October 1.
- Test with your payers and vendors. Testing externally is free and verifies that all of your software and outsourced services are ready to receive, process, and remit for ICD-10 codes. If they aren’t ready, you might have to consider working with new vendors. That might not be in your budget, but unprepared vendors will cost you more in the long run.
- Asses your current billing workflow. Determine how quickly and cleanly your practice currently processes and receives payment for claims using ICD-9 codes. This will allow you to correct any kinks in your workflow, and you’ll have a much better sense of how ICD-10 affects your cash flow after the transition.
- Test internally. Ensuring your team efficiently and appropriately assigns ICD-10 codes doesn’t cost you much more than time right now, and it will save you a lot of money later.
- Create a retention plan. If any of your staff are already trained on ICD-10, they’re a valuable commodity. Do what you can to keep these employees—and their knowledge—at your practice.
Ready or not, we’ll have to transition to ICD-10 on October 1 (barring any unlikely Congressional delays). Fortunately, it doesn’t have to cost an arm and a leg to prepare your practice. With these seven tips in mind, you can get your clinic up to speed—and keep your savings intact.
“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:
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:
- You still must document ICD-10 codes for dates of service on or after October 1.
- You can’t submit both ICD-9 and ICD-10 codes on the same claim.
- You still have to make your best effort to code to the highest level of specificity.
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.
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.
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.
You have fewer than 100 days to make sure you and your staff are prepared to kick some ICD-10 you-know-what come October 1, 2015. Hopefully, you’ve been vigilant in your ICD-10 preparations, but if you haven’t, you’re in luck. I’ve outlined the five steps you need to take in the next three months to get ready:
1. Gather your resources.
You’re already taking advantage of a pretty great resource: the ICD10forPT website. Make sure you poke around the whole site, because we’ve got loads of blog posts, downloadable checklists and one-sheets, and even an interactive game and quiz. But there are tons of other helpful—and free—resources out there, too. Don’t forget to check out the WebPT Blog for even more posts on ICD-10 and how to prepare your practice for the switch.
2. Develop a strategy.
Before you begin your hardcore prepping, you should first assess the impact the ICD-10 switch will have on your organization. Examining your clinic’s current diagnosis coding touchpoints—everything from patient scheduling and referrals to documentation and billing—will help you narrow down your to-do list. But it’s not enough to know what you need to do; you also must make sure you take the necessary actions to get the job done on time. That means you’ll need to develop a detailed timeline and budget.
A great way to ensure your clinic accomplishes all the necessary training tasks is to assign specific tasks as well as target start and completion dates. Obviously, the October 1 deadline is a hard stop, so working backwards from the transition date may help you lay out your ICD-10 prep calendar. But remember, you can’t leave everything until the end. To make sure you stay on track, you’ve got to:
- prioritize your tasks;
- figure out how long it will take to complete each one; and
- determine how much the switch will cost your clinic, factoring in variables like staff training, system updates, and the potential need to hiring coders.
3. Talk to your partners.
ICD-10 prep doesn’t involve only your clinic; you also need to verify that your external partners and payers are prepared. To do so, make a list of all the software and outsourced services on which your practice depends. Then, contact all of them—from EMRs and billing services to payers—and make sure they’re ready to receive, process, and remit for claims containing ICD-10 codes. Keep in mind that if you’re currently shopping for any software, you’ll want to factor ICD-10 into your buying decision. It would be pretty awful to discover that your brand-spankin’-new EMR doesn’t function like you need it to, especially when reimbursement is on the line.
4. Train your staff.
Of course, ICD-10 will impact some staff roles more than others, but even those folks who might not be directly impacted still play an important role in your clinic’s preparations, so you definitely want to get your whole staff involved. Not only can everyone support each other, but they also can hold each other accountable for staying on top of deadlines. With so little time left to prepare, sticking to your timeline is crucial. It’s going to take longer than you think for everyone to unlearn more than 30 years’ worth of coding with ICD-9—and get comfortable coding with ICD-10.
Switching code sets is a huge change. ICD-10 is a whopping five times the size of ICD-9. Plus, the new codes are alphanumeric and contain three to seven characters; the old ones, on the other hand, are mostly numeric and have just three to five digits. So, be patient and flexible with your staff while they learn the new structure. Also, remember that your staff likely have different learning styles, so take advantage of the wide variety of ICD-10 resources to mix up your training approach. There are lots of little ways to squeeze in ICD-10 training every day—things like pop quizzes and practice exercises. And don’t forget the metaphorical gold stars for staff members who give it their all.
5. Test your systems and processes.
Testing for ICD-10 compliance might seem complicated, but like humidity in the South, it’s unavoidable. How you test depends on a couple of factors: documentation and billing. That’s why it’s crucial that you test both internally and externally. All vendors should be testing at some point before October, but you’ll need to check with them to make sure you know exactly when and how they plan to test. Then, take advantage of those testing opportunities to minimize your risk for reimbursement delays and ensure that your practice is totally ready for October.
Switching code sets is a huge undertaking, but it’s not Mission Impossible. I know 14 weeks doesn’t seem like a lot of time, but if you and your staff work hard and efficiently, you can still be prepared for ICD-10 come October 1 (and certainly more prepared than if you did nothing at all). Looking for more resources? Check out the Physical Therapist’s Crunch-Time Guide to ICD-10.
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.
Even though we have under four months until the October 1, 2015, deadline to transition to ICD-10, the American Medical Association (AMA)—which has long opposed the switch—is still doing its best to put the kibosh on our nation’s transition to the nearly-outdated coding set almost everyone else has already adopted. But instead of shouting from a soapbox, the AMA is now scrambling for safe harbor.
Despite having years to prepare for ICD-10, the AMA claims that “ICD-10 will significantly overwhelm physician practices with a 400 percent increase in the number of codes physicians must use for diagnosis.” Therefore, the association believes clinics need more time to learn how to properly bill using the new code set. According to the AMA Wire, at this year’s Annual AMA Meeting, the organization passed a new policy, which asks the Centers for Medicare & Medicaid Services (CMS) to not “withhold claim payments based on coding errors, mistakes or malfunctions in the system” for two years after implementation—a move the AMA believes will help prevent disruptions in cash flow.
While maintaining cash flow during the transition is a good thing, it’s only a temporary solution to a long-term problem. It’s too soon to tell if CMS will agree to the AMA’s request, but even if it does, giving folks more time to get up-to-speed may result in some clinics further procrastinating in their preparation efforts. A lack of claim payment penalties doesn’t mean you can stop or delay educating yourself or your staff on how to code using ICD-10. The real safe harbor is knowing your clinic is ready to bill—and get paid—once the transition comes. Take advantage of the resources we make available on this website to ensure you’re ready.
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.
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.
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:
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.
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.
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.