December 1, 2015

Good Progress to Report on ICD-10 as Work Continues


During recent months I have heard many references to Oct. 1 and ICD-10, but there have been fewer than expected following implementation of the new coding set. I was pleasantly surprised by the quiet. It was a good feeling, a feeling of accomplishment, knowing that all of us in the industry had worked so hard together and actually pulled this off. 


Yes, we had some issues, and we still have some issues, but they are minor compared to what they could have been. But we need to make sure we continue to be diligent. Denials that would have been paid on Sept. 30 need to be appealed, and we need to make sure we do research and push the envelope when needed. 

Productivity continues to rise, in part due to the fact that our coders are an amazing group. They have risen to the challenge and are really excelling at ICD-10. I have seen some great conversations on social media working through new coding concepts and brainstorming. It’s been so energizing. But, as with anything new, once you get immersed in the new coding system you begin to see where there are some issues with the codes and some guidelines and interpretations. Those will get fixed, and for the most part we will have to continue to report these issues and hope for fixes with next year’s codes.

AAPC coders must demonstrate ICD-10 proficiency by the end of the year. Again, our members have risen to this challenge already, with a large majority already demonstrating. And of course, our coders are a competitive bunch, so the fact that we have a 98 percent pass rate is pretty telling.

I am so proud of how the healthcare industry has teamed up to make progress working together. Teamwork is always a key to success, and I think we have proven that. But we need to make sure that we continue to improve and push ourselves. The data that we can get out of the codes will set future policies, so we need to make sure that not only do our physicians use the codes right, but also that the codes make sense. And those policies that are in play must serve the patient as well. The Centers for Medicare & Medicaid Services (CMS) has made great headway and has reacted quickly to issues in the marketplace, as have other health plans. While it may take us a few years to actually see results, I have witnessed some major changes and improvements. Physicians have been working hard to make sure they are doing it right as well.

But our work doesn’t stop there. I was saddened when in the middle of October, I was speaking with a physician who told me he hadn’t submitted any claims in ICD-10 yet. He was lost, and he wasn’t sure where he should start. He’s not alone, and we know there are other physicians like him out there. We were able to help him and get him on the right path, and hopefully those other physicians will be shown the correct path as well when they reach out so they can get paid. Florida Blue is a prime example of those excelling in reaching out; they allowed dual-coding at the beginning and quickly identified outliers and helped them along – kudos to them.

After spending the last five years working to bring ICD-10 implementation to the industry, I can tell you that when Oct. 1 arrived, I was reminded of the Grinch. It came without ribbons, it came without tags; it came without packages, boxes, or bags.

Maybe Christmas doesn’t come from a store; maybe Christmas means a little bit more. ICD-10 came without fanfare, without parades, it came without flaming water skis, and sucking of someone into jet engines, but most importantly, it came without shutdowns and physicians got paid. Maybe the industry needed this plan, working together, holding some hands. It did feel like Christmas when it went off just like we planned.

Let’s just make sure we keep moving forward as a group. Remember, teamwork is crucial, especially as we see changing payment reforms. 


Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.

Rhonda Buckholtz is the vice president of practice optimization for Eye Care Leaders. She has more than 25 years of experience in healthcare, working in the management, reimbursement, billing, and coding sectors, in addition to being an instructor. She is a past co-chair for the WEDI ICD-10 Implementation Workgroup, Advanced Payment Models Workgroup and has provided testimony ongoing for ICD-10 and standardization of data for NCVHS. Rhonda spends her time on practice optimization for Eye Care Leaders by providing transformational services and revenue integrity for Ophthalmology practices. She was instrumental in developing the Certified Ophthalmology Professional Coder (COPC) exam and curriculum for the AAPC. Rhonda is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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