October 1st is Looming: Why Physicians Need To Practice ICD-10

October 1st is Looming: Why Physicians Need To Practice ICD-10

The ICD-10 deadline is looming and it’s getting closer by the second. October 1st is just around the corner and while there have been a number of delays to one of the most momentous changes to diagnosis and inpatient hospital coding, the time has come. Every medical practice across the United States must be proficient in using ICD-10 coding on their claims and transactions with health plans for all services provided on and after October 1st, 2015. The best way to keep your office running smoothly is to ensure all physicians practice before October 1, 2015.

The week of implementation could be a challenge if your providers and staff are not fully prepared. It is not the time to find out you and your staff are lacking the proper training to enact ICD-10 coding. CMS or the Centers for Medicare and Medicaid Services has already issued a statement that as of October 1, 2015 all claims must be filed with an ICD-10 code or they will be denied. Other insurers are expected to do the same. Lost income and unpaid claims quickly add up as your expenses climb higher and higher.

CMS has agreed to limited flexibility on claims. The contract reviewer will not deny a claim billed under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis if the code used is a valid ICD-10 code from the correct family.  Keep in mind, this applies only to Medicare fee for service claims. No other insurance company or healthcare payer has agreed to any flexibility. Do not expect leniency, practice to ensure your codes are as specific as possible.

ICD-9 contained around 13,000 codes. Many physicians and their practices are extremely proficient in knowing common codes and using them frequently with very little time spent researching the correct codes. However, ICD-10 increases the number of codes to over 68,000. That’s more than 5 times the number of codes. Unprepared medical offices can expect billing delays as they spend massive amounts of time researching the correct codes. This is time and money going to waste. It’s crunch time. The time to prepare is now.

Know Your Revenue Stream

Physicians should review the patient records for the last 6-12 months of their practice. By determining the most frequent conditions and the high revenue instances you can determine your practice’s top treated conditions. Once you have a firm grasp of your top conditions, check the related ICD-10 code set. Determine which key concepts must be documented and select the most specific ICD-10 codes possible. Remember, you are now dealing with 68,000 codes.

When treating a diabetic patient, “controlled” and “uncontrolled” indications no longer exist in ICD-10. Ophthalmic documentation and coding must address:

  • Type I or Type 2
  • Diabetic retinopathy; proliferative or nonproliferative
  • Nonproliferative retinopathy must be documented as mild, moderate or severe
  • With or without macular edema

ICD-10 codes are much more thorough than previously used. By identifying the key concepts, you can check that your documentation processes accurately collect this information. Knowing this information beforehand allows physicians and their staff to limit the time spent researching and reviewing their most common cases. This also helps eliminate the chance of a large majority of claims being denied.

Practice, Practice, Practice

With less than a week before ICD-10 goes live, this time should be spent practicing as much as possible. Whenever possible, perform internal and external partner testing. As patients come into your practice, prepare all documentation and billing information with ICD-9 and ICD-10 codes. This dual coding will allow you to see if you are gathering all the necessary information from your patients. Practice some of the frequent patient conditions you identified as well as more complicated patient scenarios to see if you are capturing the documentation necessary for coding. Carefully walk your way through all of your systems to ensure ICD-10 is properly supported.

If you and your staff are struggling, focus on the conditions most commonly treated in your practice. Create cheat sheets whenever necessary or refer to one of the many cheat sheets offered by the CMS or the AAO such as the Guides on AAO, under Resources and Seminars for Learning ICD-10-CM – American Academy of Ophthalmology for quick-reference guides to start learning how to code common procedures in ICD-10.

For further training opportunities, visit the CMS created website Road to 10. In addition to a number of basic webcasts, such as Preparation on the Road to 10, they also offer specialty webcasts aimed at orthopedics, cardiology, and pediatrics, among others. Physicians should also make use of the interactive self-learning tool created by the World Health Organization. It is imperative to prepare now! Improper use of the new ICD-10 system will lead to rejected claims, high information request costs, and lost time spent researching and correcting coding claims. These instances affect your practice’s finances, your staff’s morale, and the quality of your patients’ treatment. You became a physician to help people and deliver top quality care. Do not let ICD-10 slow you down. All physicians and their staff must practice now before it’s too late.

For more information on ICD-10 implementation and available resources, contact us or contact our billing and collections team at Agnite Health LLC at 844.318.2150.

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