Updated on: November 28, 2016

ICD-10: Some Challenges Remain

By
Original story posted on: November 30, 2015

Although ICD-10 implementation has gone amazingly well, there are specialty-specific challenges arising for some practices and groups. For example, orthopedics has an incredibly large list of extremely specific codes. That can be very frustrating for physicians who must treat patients when it is not their primary or only specialty, and they may not document sufficiently to capture the most specific code.  

 

In addition, the pick lists in some electronic health record (EHR) products are so massive that the providers become frustrated and simply pick something close – or the first unspecified code they see. 

Denials have been higher for some specialties, and that has negatively impacted cash flow significantly. This is predominately due to local coverage determinations (LCD) and national coverage determinations (NCD) error issues. We applaud the Medicare Administrative Contractors (MACs) in resolving these identified issues relatively quickly, but when there are numerous issues, it compounds problems and worsens payment disruptions for some specialties. 

Radiology was especially hard hit in one jurisdiction, with one MAC having ICD-10 code omissions that created incorrect denials for some surgical procedures, some interventional procedures, chest X-rays, and CT/MR of the head. On top of the local issues, the NCD for bone density scans omitted the diagnoses for osteopenia, which is a very common finding. Those claims will not be re-adjudicated until 2016, per the Centers for Medicare & Medicaid Services (CMS). Three months or more is a very long time to wait for payments.

Coder production also seems to be directly related to specialty, size of practice, and opportunity to practice and gain proficiency prior to October. Practices that are not limited to a single specialty or a smaller, finite set of codes are lagging a bit behind in coder production.

Now that we are over most of the hurdles, we know that unspecified codes are still prevalent. If the requirements for more specificity are going to take effect in 2016, the industry needs to begin focusing on those next steps now. 

We will need sufficient time to continue education and training and documentation improvements required.

 

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.
Holly Louie, RN, BSN, CHBME

Holly Louie is the compliance officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho. Holly was the 2016 president of the Healthcare Business and Management Association (HBMA) and previously chaired the ICD-10 Committee. Holly is also a national healthcare consultant and testifying expert on matters related to physician coding, billing, and regulatory compliance. She has previously held compliance officer positions in local and international billing companies. Holly is a member of the ICD10monitor editor board and a popular guest on Talk Ten Tuesdays.

Related Stories

  • CMS Announces the Resumption of Medicare Audits
    The hiatus of audits was short-lived.  The ongoing COVID-19 pandemic and resulting public health emergency (PHE) has brought about massive and quick changes in the healthcare industry, notably among them the temporary suspension of Medicare Fee-For-Service (FFS) audits. The Centers…
  • News Alert: CMS Orders Halt to Loan Repayment
    Action applies to the Medicare Accelerated and Advanced Payment Loan Program. In March, the Centers for Medicare & Medicaid Services (CMS) expanded the Accelerated and Advanced Payment Program (AAP) due to the COVID-19 public health emergency (PHE), in an effort to…
  • Overview of ICD-10-CM and PCS Coding Guideline Changes for 2021
    The Inpatient Prospective Payment System (IPPS) Final Rule for the 2021 fiscal year has been finalized, including updates to the guidelines that need to be implemented for ICD-10-CM and PCS. The following is an overview of what’s in store for…