W I L L YO U R P RAC T I C E B E R E A DY ?

THE CLOCK IS TICKING ON THE TRANSITION TO ICD-10

IS THIS YOU?

WHAT IS THIS?

ICD-9• International Classification of

Disease, 9th Revision.• A list of 14,000 numerical

codes used for a specific diagnosis.

• In use for 30 yrs.• Inadequate for further

expansion of current medical science.

ICD-10

ICD-10• An entire new coding system with

69,000 codes.• The number of new codes for any

physician depends upon their specialty

• i.e. Orthopedics – 747 to 17,099!

• 13 codes for different injuries cause by spacecraft

ICD-9 : ICD-10 TWO COMPLETELY DIFFERENT CODING

“LANGUAGES”

ICD-9 COMPARED TO ICD-10

OCTOBER 1, 2015

• No further delay….that is the date of transition

• Affects EVERY healthcare provider covered by the Health Insurance portability and Accountability Act (HIPAA) in the USA.

• Even those medical practices that are CASH ONLY

WHY IS THIS A BIG DEAL?

BECAUSE NO CLAIM WILL BE PAID IF IT DOES NOT USE THE PROPER CODING SYSTEM.

• BEFORE Oct 1 - All claims for services and facility discharges will be processed using ICD-9

• AFTER Oct 1 - All claims for services and facility discharges will be processed using ICD-10.

• This means that for a time after October 1, physicians, staff and billing personnel will be required to work within both coding systems as they submit claims.

GENERAL EQUIVALENCY MAPPING (GEMS) = “TRANSLATOR”

TRANSLATING BETWEEN “LANGUAGES”

English (ICD-9)

“House”

Spanish (ICD-10)

“Casa”

TRANSLATION IS NOT ALWAYS 1:1

English (ICD-9)

“The”

Spanish (ICD-10)

“EL” El Hombre

“LA” La Mujer

MULTIPLE CHOICES TO MORE SPECIFICALLY DESCRIBE THE PATIENT’S CONDITION

ICD-9• 707.14

• “ulcer of lower limb, heel or mid-foot”

ICD-10• L97.401 – L97.429• I70.234 - I70.744

• “ulcer of lower limb, heel or mid-foot”• Laterality (L vs. R)?• Skin breakdown?• Fat exposed?• Muscle breakdown?

PHYSICIANS WILL NEED TO DOCUMENT IN MORE DETAIL

ICD VS. CPT

• ICD = International Classification of Disease (diagnosis)• i.e. “bronchitis”

• CPT = Current Procedural Terminology (treatment)• i.e. = Antibiotic prescription

• The only coding changes for PROCEDURES will be for those that are in a facility (hospital, surgery center, etc)

PREPARING FOR THE TRANSITION

1. Appoint a Transition Coordinator (or team)

• Responsible for all aspects of the transition

• Should be allotted the time to attend to all the details.

• Communicate plan and timeline to all office/professional staff

• Convey the importance of this change in providing patient care

PREPARING FOR THE TRANSITION

2. Establish a Plan• Refer to CMS timelines• Identify tasks to be

completed and in what order.

• Assign start and completion dates for each task

• Create a budget• Learn the required

resources (i.e. GEM)

PREPARING FOR THE TRANSITION

3. List Every Place Codes are Used • Coding manuals• Medical records• Superbills• Practice Management and Billing Systems• Physician Orders• Authorizations/pre-certifications• Locations Outside the Primary Practice Site

PREPARING FOR THE TRANSITION

4. Authorize a Budget

• Software upgrades• Licensing costs• Hardware procurement• Staff training• Revision of forms• Work flow changes

PREPARING FOR THE TRANSITION

5. Begin Training

• Obtain ICD-10 coding books early in 2014

• Look up/translate most commonly used ICD-9 codes

• Begin “double-coding” as many patient encounters as possible (i.e. document both in “English” and “Spanish”)

• Many EMRs are already loaded with both sets of codes (like EMRx!). If so, review those codes with every patient encounter.

PREPARING FOR THE TRANSITION

• Begin 6-9 months before transition date.

• Many online sources for training

• Certified coders may see many ICD-10 coding modules integrated into the CEUs they must take to maintain certification

PREPARING FOR THE TRANSITION

Communicate Early with Vendors!

EMR/Practice Management System

• Is the practice’s EMR ready with the ICD-10 codes? If not, when they will be?

• What costs are involved?• How much tech support will

they provide?• How will those updates be

installed into the system? (cloud-based vs. server-based)

PREPARING FOR THE TRANSITION

Communicate with Vendors

• Clearinghouses

• Coding services

• Billing services

• If their software is not up to date, they cannot process claims!

PREPARING FOR THE TRANSITION

• All affiliated practice locations – hospitals, ASCs

• All referral medical facilities – labs, radiology

PREPARING FOR THE TRANSITION

• Communicate with the Insurance Companies!

• Rules for coverage

• Rules for authorization

• They will expect office personnel to be “bi-lingual”

PREPARING FOR THE TRANSITION

• Set up a Testing Schedule with all parties involved (office staff, coders, billers, clearinghouses, insurance companies) long before October 1st

• You want to assure the entire system from front to back end works smoothly so there are no rejections of claims!

PREPARING FOR THE TRANSITION

• Submit pre-October 1st claims ASAP to keep them from getting caught up in the deluge of glitches that will likely occur after that date.

PREPARING FOR THE TRANSITION

Emergency Fund• Cash Reserves• Lines of Credit• Smoothes practice

management during possible delays in reimbursement.