It’s Coming: Ready or Not?
It’s Coming: Ready or Not?
- October 5th, 2009By Karen Schnell, CPC, HSC Medical Billing & Consulting, LLC & Peter Garrison, CPA, Harding, Shymanski & Company, P.S.C.
When discussing the new ICD-10-CM standards effective October 1, 2013 with our clients, we generally hear one of three responses: “I have plenty of time”, “That’s three years away”, or “The deadline will probably change anyway.” If you agree, think again!
The deadline is set in stone and the government insists there will be no more delays.
Many incorrectly assume that ICD-10 is merely deletions, additions, and revisions to the current codes. This cannot be further from the truth. It is a complete revamping of the ICD-9 classification system. The current 14,000 ICD-9 codes are deleted and replaced with over 68,000 ICD-10 codes which have much greater specificity.
Physicians will be required to document and provide much more detailed information for an ICD-10 code to be assigned. For example:
• You can’t just indicate acute otitis media. Code H65.1 will indicate the otitis media but then you must add a digit/character to indicate right or left and add another digit/character to indicate if it is initial or recurrent to get the final code of H65.114.
• A wrist fracture is open or closed, right? Wrong. ICD-10 requires you to indicate the specific bone and area of the bone (shaft, distal, proximal) that is affected and if it is the right or left wrist. In order to assign the required 7th digit, besides indicating open or closed, it also requires the indication of initial or subsequent, and if it is subsequent what the status is: healing, delayed healing, union or malunion.
• There are 9 codes for Pressure Ulcer in ICD-9 to indicate location. In ICD-10, there are 125 codes in order to show a more specific location and depth.
o ICD9 Code for Lower back pressure ulcer is 707.03 (this includes the sacrum).
o If just a lower back pressure ulcer is indicated in ICD-10, the choices are:
L89.131-L89.139 Right lower back, select 6th digit for the stage
L89.141-L89.149 Left lower back, select 6th digit for the stage
L89.151-L89.159 Sacral region, select 6th digit for the stage
The first milestone is January 1, 2012. Before ICD-10 can be implemented, electronic claim files and remittance advices must be upgraded from the ANSI 4010 to the ANSI 5010 format. This will involve upgrades to computer software and testing with the providers’ clearinghouse and payers.
Before January 1, 2012, there are many more tasks to complete. Simply believing that training staff and physicians on the use of the new coding system is all you need to do will undoubtedly lead to claim denials and more staff time to fix errors, both resulting in slowing down cash flow. Physicians need to grasp the financial impact of these changes, and should start now so they are ready. Review how this new system is going to affect the budget, the current computer systems, policies, workflows, processes, payments, and staffing. Set up a steering committee within your organization that includes the appropriate people on your staff, and include professionals to advise as needed.
There have been many surveys conducted on what the implementation of ICD-10 will cost both in total and individual groups. Nationwide estimates are as high as $8 billion dollars overall. The cost for individual practices and payers will vary greatly depending upon size. This is why it is imperative to start budgeting now.
Some of the things that should be reviewed for budget and preparation are:
• There should be a point person and a committee appointed to oversee the implementation.
o Do you have a current staff member that is capable and has the time?
o Will the members of the committee be able to fit this into their schedule or will it require overtime?
o Do you need to outsource versus assigning a staff member as a point person?
• Will computer vendors be ready and who are these vendors? Many people just think of their practice management vendor but ICD-10 touches many programs.
Practice management system
Electronic medical records (EMR)
Coding lookup programs
Lab or Radiology interfaces
Clearinghouse
Payers
o Will there be a fee associated with any of the upgrades needed by these vendors? If there isn’t a direct fee, will it still cost you by an increase in rates and decrease in allows? The impact to payers and clearinghouse will be just as large or larger. They will be looking for ways to recoup their expenses.
o If you don’t currently have an EMR or coding lookup program, will you need them?
• Besides computer software, ICD-10 will touch many areas of practices.
Policies
Fee tickets
Advanced Beneficiary Notices (ABN) and the policies and procedures you utilize to determine if the ABN is needs to be provided to the Medicare patient.
Work flow processes
o Does your staff have the time to devote to updating all of your existing policies, fee tickets, processes, etc.?
• Documentation
o Is your current documentation satisfactory to extract what is needed to assign and ICD-10 code to it?
o Do you currently pay transcription costs? Will the documentation need to increase thus the cost of the transcription?
We want to help you with your questions regarding ICD-10. For the answers, please attend HSC Medical Billing & Consulting, LLC and Harding, Shymanski & Company P.S.C.’s presentation on, “What You Need to Know” and “What You Can Do to Prepare” at the Valeo Conference in November.
For more information about the authors or Harding, Shymanski & Company call 502-584-4142 or visit www.hsccpa.com.
October 14th, 2009 at 9:42 pm
Great article.