Updated on: November 28, 2016

ICD-10 is Up and Running, but Much Anxiety Remains

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Original story posted on: October 5, 2015

EDITOR’S NOTE: The following is part one of a two-part series dealing with challenges facing physicians in their adoption of ICD-10.

The day finally came and went. I must admit, I am relieved there were no more delays in ICD-10 implementation. It is time to move forward. But ICD-10 anxiety is still very prevalent in the industry, particularly among practitioners.

How has your facility or medical practice fared since Oct. 1? Did you have any glitches? One of my facilities was unable to load the Centers for Medicare & Medicaid Services (CMS) 1500s to the clearinghouse, but the UB04s were uploaded just fine. It was a minor system error that was corrected very quickly. 

 

Another struggle is that hospital coders not as familiar with ICD-10-PCS are struggling with documentation that is not concise enough to select an ICD-10-PCS code, so there is a need for additional queries. We anticipated this during the implementation process, but it still slows down claim processing. In addition, inpatient coders are not as confident in selecting a PCS code, and many have had little time to dual code to build productivity and skill.

Another problem we have encountered is that for referrals to lab and X-ray, many physicians still have been sending over the referrals with ICD-9 diagnosis codes instead of ICD-10 codes after Oct. 1, resulting in backlogs in patient services when referrals had to be sent back to the provider for correction. Don’t forget that all referrals and pre-certifications for services provided on or after Oct. 1, 2015 require an ICD-10 code.

ICD-9-CM is no longer accepted for all HIPAA-covered entities, so to all physicians and practitioners: do not use ICD-9 codes for referrals, pre-certifications, or insurance claims.

We also have had some issues with the electronic health record in cases in which physicians are using “favorites” and problem lists for which ICD-9 codes were linked. You have two choices: convert all your ICD-9-CM codes to ICD-10-CM codes, or delete your favorites and outdated problem lists and start over. This is the perfect time to clean up these outdated problem lists and favorites.  

Another valid concern is payment. Will we get paid promptly, or will our claims be delayed or denied? We will probably not know for a few weeks if there are problems with payment. So stay diligent and work the denials promptly, stay alert for delayed payments, and check each remittance to ensure that you are paid correctly. I recommend dedicating adequate staff to undertake this important task. 

I recently returned from a national conference at which I spoke to hundreds of physicians who are still struggling with ICD-10. Some physicians are still not convinced they are ready. Many have not received any formal training on ICD-10 and some are still struggling to understand the coding concepts unique to ICD-10. Many physicians have not had the proper training to understand ICD-10 and will need to get up to speed quickly.

The key issue that must be addressed is this: will the documentation support the code specificity in ICD-10? Physicians need to review their top 25 ICD-9 codes and then review the top ICD-10 codes they now must use, and understand if there is additional documentation they must include to support ICD-10. Even though CMS has given us a grace period in selecting a more specific code, the code selected must be in the appropriate category, and laterality must be reported and documented. In many cases when reviewing medical records, this is not always evident. Other payors also may not be as forgiving as CMS. Doctors are still asking me, “should I get training now, or should I wait?” Doctors, if you have not been trained, get training as quickly as possible. Time has run out!

Also keep in mind if using an electronic health record that ICD-10 codes are incorporated in your system. When selecting the diagnosis, don’t just pick the first code in the “pick list.” If your electronic health record (EHR) is using IMO to guide your coding with “qualifiers,” make certain you enter the appropriate key phrases to allow IMO to assist in code assignment. Another suggestion is to download a coding application for your iPad, iPhone, or Android. There are many good products on the market, either free or at a very low cost, that will help with code selection as well. Another excellent tool is to invest in an ICD-10 code book. During this transition, I recommend at a minimum to have a code book in every coding department and physician practice. The investment is well worth it. 

Understand that productivity will be reduced during this transition, which is expected, so don’t panic if it takes longer to select an ICD-10 code.

 

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.
Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner

Deborah Grider has 34 years of industry experience and a recognized national speaker, consultant and American Medical Association Author who has been working with ICD-10 since 1990 and is the author or Preparing for ICD-10, Making the Transition Manageable, Principles of ICD-10 and the ICD-10 Workbook, Medical Record Auditor, and Coding with Modifiers for the AMA. She is a senior healthcare consultant with Karen Zupko & Associates. Deborah is also the 2017 American Health Information Management Literacy Legacy Award Recipient. She is a member of the ICD10monitor editorial board and a popular panelist on Talk Ten Tuesdays.

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