Updated on: November 21, 2016

Staying on Top of ICD-10

Original story posted on: June 15, 2015

There are so many ICD-10 bills popping up in Congress these days, you may be left wondering what you should do. Many of us might consider the approach of sticking our heads in the sand and hoping it all goes away.


But the bottom line is that this marks a sure indication that ICD-10 is truly going to happen. These bills are not aimed at killing ICD-10; they only shed light on where we may be failing and where you should probably put some focus on action plans in your office.

For example, H.R. 2652 calls for “lack of enforcement,” or dual coding for providers, for a period of two years. At first thought you might raise your fist with a cheer and perform some type of happy dance, but when you analyze this you quickly can begin to understand how it may hurt your practice financially. That’s for reasons such as the following:

  1. Some will allow dual coding and some won’t – can your staff handle the burden of submitting and tracking in two systems? Will they be able to consistently track days in A/R or follow up on claim submissions or resubmissions?
  2. What happens if you submit ICD-9 codes to one plan only to find out they need ICD-10 because they are not dually capable? Will your PM system allow you to swap out codes easily? How much staff time will it take to resubmit and research?
  3. If you submit in ICD-9 and others are treating patients in ICD-10, your conditions may not match up, and this could cause unnecessary record submission, denials, and appeals or more physician time on the phone.
  4. With policy changes, patients may qualify quickly under an ICD-10 code, whereas ICD-9 was more vague; this could cost you more staff time to research, submit more records, and/or require physicians to spend more time in peer-to-peer calls.
  5. What about disease management tracking in your own practice; how will you be able to maintain systems/recalls/reporting under two coding systems?
  6. How would you handle templates for documentation or billing templates? Which codes will it pull from?
  7. If you are using electronic health record (EHR) systems, how will the use of two coding systems affect your quick pick lists?
  8. Most vendors have released ICD-10 solutions, so how much will it cost you to reverse these?

As we get closer to implementation, more information like this is going to pop up as we begin to get ready. The bottom line is that once the information is dissected, we can begin to understand how suggestions like this can actually hurt providers way more than it could help. Like the old adage says, if it sounds too good to be true, chances are it is.

Be sure to stay on top of these issues and develop action plans for your practice on areas you may have forgotten about; chances are doing so will highlight where you may be falling short on implementation efforts.

But whatever you do, don’t stick your head in the sand, because ICD-10 is not going to go away.

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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