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

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

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

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


The Penny-Pincher’s ICD-10 Plan

July 24th, 2015
ICD-10, ICD-9, Preparation, Transition

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:

  1. Clear out your current reimbursement backlog and collections accounts to beef up your cash reserves.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.


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.


Breaking News: ICD-10 Implementation Delayed Until October 1, 2015

April 1st, 2014
ICD-10, ICD-9, Transition

Note: This is not an April Fools’ joke.

On March 31, the US Senate voted 64-35 to approve a House-drafted bill that includes a provision to push the ICD-10 deadline back a year—all without a single mention of ICD-10 during a nearly three-hour Senate floor debate. The main purpose of the bill—HR 4302—was to enact a one-year “fix” of the Sustainable Growth Rate (SGR) formula, thus preventing a 24% cut in Medicare’s physician reimbursement rate. This legislation represents the 17th temporary Medicare fix since the passage of the Balanced Budget Act was in 1997. According to an APTA press release, “the final bill replaces the cut with a .5% provider payment update through the end of the year and no update from January 1 to April 1 in 2015.” In addition to the SGR patch and the ICD-10 delay, the bill includes one-year extensions for the therapy cap exceptions process and the Geographic Pricing Cost Index (GPCI). The bill now awaits President Obama’s signature, which, according to social media buzz, should occur today.

As this article explains, no one is quite sure how an ICD-10 delay made its way into the SGR fix bill. Although the legislation was the product of a bipartisan effort, there were senators from both sides who vocally opposed its passage, citing the importance of paying for the quality—not the quantity—of healthcare services. However, in the midst of all this passionate debate, not a single Senator mentioned ICD-10—much to the chagrin of the associations that so vehemently opposed the implementation delay, including the College of Healthcare Information Management Executives (CHIME), the American Health Information Management Association (AHIMA), the Medical Group Management Association (MGMA), the American Medical Association (AMA), the Health Information and Management Systems Society (HIMSS), and the Centers for Medicare and Medicaid Services (CMS).

So, why the silence on ICD-10? One theory is that lawmakers were simply unaware of the ICD-10 provision and its potential implications. As this Government Health IT article suggests, “Perhaps if the Senate had voted down the bill, regrouped, come back with another stab at permanent SGR repeal, someone would have noticed Section 212 saying that HHS cannot mandate ICD-10 as the standard code set before Oct. 1, 2015.” But now that the delay is happening, the healthcare industry must face the financial consequences. CMS estimates that the total cost of delaying implementation will fall somewhere between $1 billion and $6.6 billion, and Resultant founder and healthcare consultant Joe Lavelle projects that waiting another year could cost each of his clients anywhere from $500,000 to $3 million, according to the Government Health IT article.

With no indication that President Obama will exercise his veto rights, this bill should become law today. We’ll update this post as the story unfolds.


How to Convert ICD-9 Codes into ICD-10 Codes

March 25th, 2014
ICD-10, ICD-9

If you’ve ever visited a foreign country, you know how frustrating the language barrier can be. By learning a few key phrases before embarking on your travels, though, you can usually get by without too much trouble. The same goes for ICD-10. Yes, the new codes are complex, and yes, it’s going to take some time to become fluent in the language of ICD-10. But if you go into the transition with a handful of commonly used codes in your back pocket, you’ll feel much less overwhelmed by the switch.

Unfortunately, finding ICD-10 equivalents to ICD-9 codes is a bit more complicated than looking up “please” and “thank you” in your pocket English-to-German dictionary. Because ICD-10 offers a much higher degree of specificity than ICD-9, there are many cases in which a single ICD-9 code has several possible ICD-10 translations. To continue with the language metaphor, choosing the correct ICD-10 equivalent of a certain ICD-9 code is kind of like choosing the correct Eskimo term for the English word “snow.” There are dozens of options, and each one indicates a very specific type of frozen precipitation.

So, with cut-and-dried crosswalking off the table, how should you go about pinpointing the correct ICD-10 version of a particular ICD-9 code? Well, you should start by downloading the complete Tabular List of ICD-10 codes. You’ll find the most up-to-date version here. (Click the link labeled “ICD-10-CM PDF Format” under the section with the heading “2014 release of ICD-10-CM.”) When you open the PDF, you’ll see that the codes are organized by chapter. As a rehab therapist, you’ll deal mostly with chapters 13 and 19—“Diseases of the musculoskeletal system and connective tissue” and “Injury, poisoning and certain other consequences of external causes,” respectively.

If your PDF viewer has a search function, you might be able to find the code you’re looking for—or at least identify a few starting points—simply by entering the appropriate term in the search field. (You can also keyword search at FindACode.com.) Alternatively, you can begin your translation process using this ICD-9 to ICD-10 conversion tool. Remember—and I cannot stress this enough—you absolutely should not use this tool as a “plug-and-chug” crosswalk solution. Most of the time, the ICD-10 codes the tool suggests are not specific enough to use. In fact, you will see the following disclaimer message underneath the search field: “Keep in mind that while many codes in ICD-9-CM map directly to codes in ICD-10, in some cases, a clinical analysis may be required to determine which code or codes should be selected for your mapping.”

However, this tool does give you a good idea of where to start. For example, 719.46 (Pain in joint, lower leg) is one of the most commonly used ICD-9 codes among physical therapists. If you enter this code into the ICD-10 conversion tool I referenced above, it will generate a single result: M25.569 (Pain in unspecified knee). At first glance, it would appear that this code is the definitive equivalent of 719.46—after all, it’s the only ICD-10 code that appeared in the search results. The problem is, this code—though technically correct—is not the most correct code because it is not the most specific code available.

The whole point of ICD-10 is improved data due to increased specificity. If you do not use the most specific code possible, you risk having your claims rejected. Thus, you should avoid using an “unspecified” code if a more specific option exists. And in this case, there is almost certainly a more specific code available.

To find it, open the Tabular List and head to chapter 13 (the “M” code chapter). Scroll down to M25.56, the “Pain in knee” category. There, you’ll see code options for both the left and right knees. Chances are that you, as the therapist, know which knee is causing pain for the patient. Therefore, you should select a code that accounts for laterality: M25.561 (Pain in right knee) or M25.562 (Pain in left knee).

Furthermore, keep in mind that if it is possible to code for the specific condition that is causing the pain, you should absolutely do so. In this case, for example, if you determine that the patient is suffering from patellar tendinitis, you would select either M76.51 (Patellar tendinitis, right knee) or M76.52 (Patellar tendinitis, left knee) as the diagnosis code for this patient.

Finally, make sure you read the instructions at the beginning of each chapter and category. In some cases, you may need to submit an external cause code or attach a seventh character. At the beginning of chapter 13, for example, you’ll see the following directive: “Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition.” Basically, if you know additional details about the cause of the patient’s condition, you should account for them using supplemental external cause codes from chapter 20. To continue with the knee pain scenario, if the patient developed patellar tendinitis as a result of running on a treadmill, you would indicate this scenario using the code Y93.A1 (Activity, treadmill).

So, to recap, when searching for the ICD-10 equivalent of a particular ICD-9 code, follow these steps:

  1. Use a simple conversion tool (like this one) to find a starting point.
  2. Consult the Tabular List (which you can download here) to determine whether a greater level of coding specificity is possible.
  3. If possible, code for the actual condition (e.g., patellar tendinitis) rather than the result (e.g., pain in knee).
  4. Within the Tabular List, check chapter/category headings for additional instructions regarding external cause codes or seventh characters.
  5. If applicable, identify pertinent external cause codes within chapter 20 of the Tabular List.

Have you started creating a list of ICD-10 equivalents to your most frequently used ICD-9 codes? If so, what advice or questions do you have? Share your thoughts in the comment section below.


ICD-9 vs. ICD-10: An Example

January 17th, 2014
ICD-10, ICD-10 Example, ICD-9

We’ve talked plenty about ICD-9 and ICD-10, including the differences and improvements. The best way to truly see how much better and more precise ICD-10 diagnosis codes are than ICD-9 is through some examples.

ICD-9-CM ICD-10-CM
Description Mechanical complication of other vascular device, implant, and graft Mechanical complication of other vascular grafts
Number of codes 1 code (996.1) 49 codes, including:
T82.311A — Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.312A — Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.329A — Displacement of unspecified vascular grafts, initial encounter
T82.330A — Leakage of aortic (bifurcation) graft (replacement), initial encounter
T82.331A — Leakage of carotid arterial graft (bypass), initial encounter
T82.332A — Leakage of femoral arterial graft (bypass), initial encounter
T82.524A — Displacement of infusion catheter, initial encounter
T82.525A — Displacement of umbrella device, initial encounter
Description Pressure ulcer Pressure ulcer
Number of codes 9 location codes (707.00 — 707.09); show broad location, but not stage 150 codes that show more specific location and stage, including:
L89.131 — Pressure ulcer of right lower back, stage 1
L89.132 — Pressure ulcer of right lower back, stage 2
L89.133 — Pressure ulcer of right lower back, stage 3
L89.134 — Pressure ulcer of right lower back, stage 4
L89.139 — Pressure ulcer of right lower back, unspecified stage
Page 3L89.141 — Pressure ulcer of left lower back, stage 1
L89.142 — Pressure ulcer of left lower back, stage 2
L89.143 — Pressure ulcer of left lower back, stage 3
L89.144 — Pressure ulcer of left lower back, stage 4
L89.149 — Pressure ulcer of left lower back, unspecified stage
L89.151 — Pressure ulcer of sacral region, stage 1
L89.152 — Pressure ulcer of sacral region, stage 2
Description Angioplasty Angioplasty
Number of codes 1 code (39.50) 854 codes: Specifying body part, approach, and device, including:
047K04Z — Dilation of right femoral artery with drug-eluting intraluminal device, open approach
047K0DZ — Dilation of right femoral artery with intraluminal device, open approach
047K0ZZ — Dilation of right femoral artery, open approach
047K34Z — Dilation of right femoral artery with drug-eluting intraluminal device, percutaneous approach
047K3DZ — Dilation of right femoral artery with intraluminal device, percutaneous approach
047K4ZZ — Dilation of Right Femoral Artery, Percutaneous Endoscopic Approach

ICD-10 offers a lot more codes and much more specificity, right? That’ll certainly help documentation accuracy.