ICD-9 is showing its 40+ year age. A vast amount of research, discovery and development has occurred in the past 40 years, and ICD-9 has no capacity to collect or record this new information in a statistically relevant way.
Until full implementation of ICD-10, the US remains out of sync with the rest of the medical-reporting world. The ICD is used internationally to navigate, understand, and compare healthcare systems and services. Because it is functional in 194 World Health Organization member states, the ICD-10 has become the foundation for analysis of global health trends. US data is excluded because it is not tracked per ICD-10 standards, which means American health care trends are not now monitored in terms of global implications. The ICD-10 Clinical Modifications (ICD 10-CM) module is the correlative to international disease coding standards and its implementation will bring America into the global statistics-tracking community.
By now, all ophthalmology practices should be involved in some process of transition to the new coding matrix contained in ICD-10. The differences between it and the ICD-9 are significant. The new version introduces much more specificity into billing codes, expanding the base from 13,000 (or so) codes to over 68,000. For eye care professionals, that means adding code specificity for right eye versus left eye, initial encounters versus subsequent encounters and other added differentiations. Accounting for each aspect of care will require more detailed, ICD 10-specific documentation beginning with the first visit. Until the doctor is comfortable with the changes in coding, documentation of eye assessments and diagnoses may take more time to complete.
There will be no more delays – this change is coming.
The deadline for implementation of ICD-10 is just around the corner. Although the transition might be rough for some, it does not have to be harsh. Whether your ophthalmology practice is large or small, chances are there will be some operational and financial bumps that you will have to endure along the transitional road to ICD-10.
The prep work requires a sufficient time investment.
The switch to ICD-10 includes learning the new codes that are relevant to your practice, training your staff accordingly, and testing to ensure everything is ready to go before the deadline arrives. This is one circumstance where over-training may not be a bad thing! Thorough and effective training before the changeover can also prevent losses in productivity during the transition period. Make sure your ICD-10 training includes all staff members who have a “hands on” position in the practice. Clinical and billing staff need the most training but your entire staff should be at least trained on an “overview” of ICD-10.
Master relevant codes and lingo.
There are 155,000 codes in ICD-10. While it’s impossible to be familiar with all of them, focus on the codes that are pertinent to your specialty. To be properly reimbursed, your team must pay extra attention to the terms “initial” and “subsequent”, as this has an effect on how claims are coded. Auditors will insist that documentation of visits match their coding.
Money is an undeniable part of the equation.
Denial of claims at the outset of ICD-10 is a real possibility and may lead to interruptions of income. Complying with ICD-10 may require substantial investments in staff training and new software or upgrades to your existing office programs. Maintaining cash reserves for such contingencies is highly recommended. Budget adequately for these expenses—owners/providers should be prepared with extra cash revenue, a line of credit, or enough supplemental income to get through the early stages of ICD-10. Ideally, these funds won’t have to be accessed, and the best way to ensure that will be through ample preparation for the transition to come.
Have a denied claims process in place and ready to go.
There should also be a plan in place for dealing with denied claims. Your practice may experience a rise in denied claims at the outset of ICD-10, and they will have to be addressed quickly in order to minimize financial impacts. Quick identification of the causes and recognition of patterns in the denials (i.e. are they coding or payer issues?) can make it easier to spot and prevent future claim denials. The best way to avoid denied claims in the early stages of the transition will be to ensure your office staff has been well-trained long before the October 1, 2015 deadline arrives.
Your office should have a specified compliance officer (or team).
Larger offices may have enough staffing to internally manage the required changes, but smaller practices may need assistance from a practice management and billing service. It is a good idea to have a person (or team) who will regularly check coding to ensure compliance and to catch any errors that may lead to delayed or denied claims, thus costing your practice time and money. They should also identify staff who need more training so productivity is not impacted.
Confirm vendors are prepared as well.
Contact Advantage Administration, Inc. and other EHR (Electronic Health Records) vendors to ensure they have the proper software to suit your practice’s needs, and that it will be ready on time.
All ophthalmology practices have work to be done before the big date—October 1, 2015. Getting it right before the October 1st deadline will help keep practices running smoothly upon ICD-10 implementation.