December 1, 2015

ICD-10: Some Challenges Remain


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.


Holly Louie, RN, CHBME

Holly is the Compliance Officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho.  Holly is the 2016 President of the Healthcare Billing 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 is a popular guest on Talk Ten Tuesdays.

Related Stories

  • Continuing Struggle: Correct Code Assignment
    Coders are encouraged to learn more about the clinical conditions associated with the patient encounters they are coding. As coders, we often struggle with assigning the correct codes. There are many gray areas in the guidelines and instructional notes, and…
  • C&M Meeting, Part I: The Latest Update on Procedure Code Proposals
    The ICD-10 code set is growing, and feedback from the medical community on the changes is needed. This is the first in a series of articles encompassing a review of the Coordination and Maintenance Committee meeting, which was held March…
  • UnitedHealthcare Begins Crackdown on Level 4 and 5 ED Codes
    Three key takeaways from this effort by healthcare giant UnitedHealthcare UnitedHealthcare (UHC) is continuing its quest to revamp many facets of our healthcare industry. Last year, they adapted mandatory policies for the use of the SA modifier to indicate that…