ICD-10 is here. Many physician practices have been holding their breath and hoping that ICD-10 will just go away. If your practice has been procrastinating, now is the time to make sure you have a plan in place for a successful transition to ICD-10.
Over the past six years, the health care IT industry has been through a lot of changes. A virtual parade of acronyms have started in Washington, D.C., and made their way to your front door. E-prescribing, PQRI, PQRS, and meaningful use are government programs that offer “carrots and sticks." Each program offered the “carrot,” an increase in reimbursement from Medicare and/or Medicaid reimbursement for early adopters and the threat of an eventual “stick” that would come in the form of a decrease in Medicare and/or Medicaid reimbursement.
ICD-10: Mandatory and Detailed
ICD-10 is different. ICD-10 is mandatory, not optional. ICD-10 is required for all HIPAA-covered entities, not just Medicare and Medicaid. Finally, ICD-10 offers no carrot. It is all stick. Practices who did not successfully transition to ICD-10 on Oct. 1, 2015 will see all of their claims denied.
Images of thousands of new codes, including codes like flaming water skis and walking into lamp posts, spring to mind. While it is true that there are approximately 55,000 new codes in ICD-10, most practices will only use a small percentage of these codes.
The best place to focus your efforts is to understand what ICD-9 codes are being used today and what ICD-10 codes you will need in October.
Many practices use a superbill or encounter form that lists the most common procedures and diagnosis used by their providers. The average practice has between 200 and 300 ICD-9 codes listed that cover 95% or more of their patient encounters. By using a conversion tool to convert these ICD-9 codes into ICD-10 codes, most practices can easily identify the 800 to 1,200 ICD-10 codes they will need.
The good news is that most practices will use a small subset of the new ICD-10 code set. The bad news is that the paper superbill will cease to be an efficient tool for most practices. If you are using a paper superbill, make sure that you replace that with an electronic superbill or with an EHR.
Unspecified Codes in ICD-10
One of the secrets of ICD-10 is that unspecified codes still exist in the new code set. Many practices use unspecified codes in ICD-9 as a shortcut or a catch-all code. Today, many unspecified ICD-9 codes are benign. There are no negative consequences. Claims get paid as expected.
There are two concerns surrounding the use of unspecified codes in ICD-10. First, the short-term concern is that payers will deny claims that use certain unspecified ICD-10 codes. All payers may not handle this the same way, nor at the same time. The second concern is a long-term concern. The federal government continues to shift away from fee-for-service, towards an outcomes-based reimbursement model. Under an outcomes-based model, providers will be required to use more specific ICD-10 codes to demonstrate the severity of their patient’s diagnosis and treatment, to maintain or increase reimbursement.
ICD-10 is a significant transition for physician practices. The greatest risks are protecting physician productivity and cash flow. Practices that identify the codes they use today, translate those codes into ICD-10, and make workflow adjustments for physicians to document and bill correctly in ICD-10 will thrive during the transition to ICD-10.
About the author: Matthew Menendez is vice president and an ICD-10 specialist for White Plume Technologies, LLC, located in Birmingham, Alabama. Matthew has prepared more than 7,000 medical users to successfully transition to ICD-10. He has worked with physicians to help eliminate major information processing barriers, from patient encounter to clean claim submission, by automating and expediting complex, error-prone and time-consuming paper processes. He has conducted over 100 webinars that specifically address ICD-10, its impacts on physician productivity, and revenue cycle efficiency. Matthew discusses practical strategies to survive and thrive during the transition to ICD-10.