What’s the Buzz on ICD-10?

October 2013 has arrived with much flurry about a lot of hot topics: the ACA, debt ceiling, government shut down, the HIX.

 It’s probably easy to lose sight that we are finally less than a year away from the 2014 ICD-10 deadline, right?  So, unless you have been living in a cave or on a deserted island for several years, the mention of this pending ICD-10 implementation is familiar, maybe too familiar.
For years we have heard: “You better get ready for ICD-10.   It’s coming on ‘blah blah date’ whether you like it or not!”

 If you are like me, when you feel as if you have been beat over the head with an issue, you want to just ignore it or pretend it doesn’t exist.  Well it does exist and it has existed in a variety of customized “national” versions for quite some time all over the world.

NOTE:  The US will use ICD-10-CM for diagnosis coding (CM standing for “Clinical Modification” of the World Health Organization International version with 68,000 codes) and the ICD-10-PCS for inpatient hospital procedures (PCS standing for “Procedure Coding System” unique to the US with 76,000 codes).

  It’s amazing, as Americans we believe ourselves to be so “progressive” and “innovative”, but in this instance, we are seriously lagging behind.  The great benefit of ICD-10 is that it allows the true “clinical” status of the patient to be “translated” into codes.

How it Works: Characters 1-3 (the category of disease); 4 (etiology of disease); 5 (body part affected), 6 (severity of illness) and 7 (placeholder for extension of the code to increase specificity)

  These codes then can be measured and analyzed to compare treatment regimens and outcomes.  This statistical data (that) can provide valuable information to help ensure quality, standardized care for all patients regardless of geography, gender, socio-economic status, etc.

 I am sure your inbox and mailbox are flooded with offers from this company and that company, all hawking seminars and coding guides.

Note: CMS offers numerous free resources for ICD-10 preparation.  Visit the CMS ICD-10 website, sign up for CMS ICD-10 Industry Email Updates or follow them on Twitter.

I want to look at just a few key points to help guide you in the direction you need to go to get ready for this challenging, but exciting change to the medical billing world.

• Due to the addition of characters/digits in the ICD-10 tables, it is important to verify with you’re your software vendor that they have made the appropriate changes to accommodate these additions.   Clinicians will also now in some cases “code” more than the previous limit of 4 diagnoses.  Your practice management software provider will need to take this into account as well. 

Note: The HCFA 1500 form is being revised also to “make room” for the added characters as well as codes in general.  The revised CMS-1500 form (version 02/12) will replace version 08/05. The revised form will give providers the ability to indicate  whether they are using ICD-9 or ICD-10 diagnosis codes. ICD-9 codes must be used for services provided before October 1, 2014, while ICD-10 codes should be used for services provided on or after October 1, 2014. The revised form also allows  for additional diagnosis codes, expanding from 4 possible codes to 12. Medicare will begin accepting the revised form on January 6, 2014. Starting April 1,  2014, Medicare will accept only the revised version of the form.

• If you utilize a trading partner (i.e. clearinghouse) for submitting claims or submit directly to payers, you should monitor communications published on their websites or enroll for e-mail newsletters to keep abreast of their progress on the implementing ICD-10 processing.  If they require testing by you, make sure you begin as early as possible to ensure any glitches can be identified before the deadline.

• Thorough medical billing specialists utilize guidelines such as: Medicare NCDs and LCDs and commercial payers’ medical policies when verifying coverage based on the medical necessity of procedures.  Any policies that reference ICD-9 codes will (all) be re-written in order to convert them to the proper ICD-10 standard.  This is another item that should be monitored on payer websites to keep up to date on the availability of the updated guidelines.

If you are unfamiliar with medical policies as mentioned above and would like more information on how they affect your reimbursement, follow this link for a free white paper on “Understanding Medicare Fiscal Intermediaries LCDs and How They Affect You” or for blog article “Reviewing Commercial Carrier Medical Policies/Clinical Guidelines” click here.

• A great preparation tool to determine how this change will affect your workflow process in to perform a “dry run” through your current documentation for your most used ICD-9 codes.  Have appropriate staff practice converting them to ICD-10.  This should give you a basis to begin making any necessary process changes and identify the extent of additional staff training that may be required.As with any change, preparation is the key. 

Now is the time to get “your ducks is a row.”