ICD-10 Coding is Coming – Run NOW!

I had the opportunity to sit in on some preliminary ICD-10 training being given by the Practice Management Institute (www.pmiMD.com) last week.  It was their goal to inspire confidence and a “we can do this” attitude, but honestly, the reactions I witnessed (or had myself), looked more like despair that would soon be mixed with alcohol and anti-anxiety meds.  I was a bit disheartened.  I came out of that meeting thinking “ICD-10 coding is coming- Run NOW!”

Chicken Little
I do so hate to sound like Chicken Little shouting that “the sky is falling”.  I was also seeing some benefits to updating the codes and coding.  I mean, yeah, with new technology, new procedures, and new techniques, there needed to be new codes and new code availability to cover them.  It also simplifies some things to have one CPT code, rather than a CPT code plus some DX codes.  The specificity of the codes will also make the data more valuable because you are giving more information.  Disease and treatment patterns can be studied more accurately.   The spread of disease can be studied and possibly better contained.  However, this is a beast with many tentacles, on par with the biggest of government programs and endeavors ever conceived.  Have no doubt, it is going to change the way you document patient encounters and bill out, forever.

Let’s start with the easy stuff and work our way along the ICD-10 trail.



5010
The first step towards ICD-10 implementation should be fairly painless for you.  The first step is the 5010 (format) implementation, which is scheduled to begin 1/1/2012.  I say “painless for you”, because although the 5010 electronic billing format will affect you, there is little you can do about it.  The implementation of 5010 is up to your software vendor, the clearing houses, the insurance companies etc.  The 5010 format change is to accommodate for the ICD-10 coding which is due to begin the following year on 10/1/2013.

CMS & GEMS
I’ve talked about your best source of information always being CMS first:  https://www.cms.gov/ICD10/

One of the tools you will want to become acquainted with is GEMS, a coding cross-walk tool that CMS is providing.  Now, don’t think that it’s going to be that easy, plug in an old code, spit out a new result.  As we discovered in the discussion, when you crosswalk a code from ICD-9 to ICD-10 it can have a single code match up, however, it may have up to 70 or so new ICD-10 coding options.

Increased documentation, Increased time to document, Increased time to code
Coders have a basic idea of how their lives are going to change with these new codes, but your doctors probably do not have the first clue about what it is going to mean for them.  It was strongly recommended that you start training your doctors and office now, that there will be MORE DOCUMENTATION and it will be much more detailed.  Of course your mileage will vary depending upon the condition and your specialty – the more specialized you are, the more documentation detail you can count on doing.  The down side= time.  The upside=better, more accurate payments, payments that reflect the increased complexity of what you do.

Here were some time estimates given for documenting under ICD-10

• About 15% more time to document an encounter
• About 3% more time for the physician per encounter to log the additional info
• More time spent to log information requested for new levels of specificity – you will probably be seeing fewer patients a day as a result.
• Additional time to fix, fill in, or answer multiple questions from billing staff, if the provider’s documentation is not “complete” enough as originally documented.

Getting Paid
Claim denials will increase.  Reimbursement patterns will change.  With the new codes, insurance houses are going to have to learn the new codes and train their systems about how and what to pay on them.  Consequently we heard several times, “your payments may be delayed and run slow for a while as implantation begins”.



What ICD-10 considerations your doctors and office should be considering and working on.

EHR 

• It will be almost impossible to document and track everything you need to without one.

Basic Training

• Allowing weekly training time for the staff to “up their skills” up to and through the ID-10 transition (i.e. the staff’s knowledge of anatomy and physiology, medical prefixes and suffixes
• Plan to have your billers and coders take an icd-10 class, and a class to learn how to use the book… it will be a must to know how to use, look up, and reference the reference book and materials properly or you will not succeed.

Advanced Training

• You would be wise to have at least one CPC (certified professional coder), it may even become a requirement in the near future as CPCs have their own license number and are required to have it attached to the billing stating that it is correct and accurately coded.
• Have more than one properly licensed coder in the office.  (The doctor may want to have at least two CPC coders in the office (more if it is a large office).  Have a billing coder at the computer and a documentation coding assistant to work with them, so that the documentation coder can help the doctor get and log all pertinent information at the time of the encounter (this would save both the doctor and the coder time to log the encounter and time for fixing errors later).

Best Bet

• Be proactive. 
• Develop and follow an implementation time line for your office.
• Focus on what specifically your office does (not a broad and overwhelming “everything”).

In the end, ICD-10 is coming.  Kicking and screaming about it won’t help.  You need to be aware, make realistic plans and implementation goals, and work your plan or you will lose money for sure when the implementation begins.