EMR Adoption, Selection and Implementation Checklist, medical records

ICD-10 Codes: Changes in Medical Coding

by Nitin Chhoda PT, DPT | Aug 1, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Software

ICD-10 codes represent the biggest change to medical billing and coding since the late 70’s. Nitin Chhoda explains why transitioning and implementing this new coding standard will determine the survival of your practice.

Understanding the ICD-9 and ICD-10 codes is important to getting the most from your medical billing.

Without the right medical billing and coding practices, health insurance companies will deny claim after claim.

But there is more to ICD-10 codes than meets the eye. This new coding standard is more than just a hassle you’ve got to go through to get paid.

International Classification of Diseases

The ICD in ICD-10 codes stands for International Classification of Diseases.

From the widest perspective, this codification of health management terms and practices can serve as a way to analyze the health of a population. Epidemics, mortality rates, and all kinds of statistics can be gathered if a common codification system exists.

The World Health Organization (WHO) and The International Health Terminology Standards Development Organization (IHTSDO) take decades to update the ICD, in an effort to better understand the health of populations around the world.

Because the ICD and ICD-10 codes system is what the world is using to identify diagnoses, the United States government also uses it to classify and communicate about medical diagnosis.

For example, medical diagnosis and inpatient procedure coding for Medicare and Medicaid services uses the ICD-9 and ICD-10 codes system for all claims. Any medical billing relating to those services must use the ICD-10 codes.

Transition Time

Right now is an exciting time for medical coding and billing. On October 1^st, 2014, the United States will finally adopt the ICD-10 codes. The ICD-9 codes were adopted in 1977, and since then we have not updated our coding procedures.

And the ICD-10 codes were finalized and endorsed in May of 1990 by the Forty-third World Health Assembly. ICD-10 codes came into use starting from 1994 by many member states.

That has been some push-back, however, because this isn’t going to be the only change the United States undertakes this decade. The ICD-11 codes are being classified already with an estimated finalization scheduled for 2015.

While it may be a few more years before ICD-11 codes are available for adoption, if the U.S. wants to be up to date, two switches will likely occur in the next ten years.

On the other hand, the switch to the ICD-10 codes may present enough of a modernization for now.

After all, the U.S. waited ten years to adopt the ICD-10 codes. And this change is going to be significant enough. The ICD-9 codes number around 13,600. The ICD-10 codes number over 144,000.

Medical Coding Evolves

While not everyone is excited about the change to the ICD-10 codes, there are medical coding professionals who look forward to a more precise system.

There are also plenty of medical professionals who rely on ICD data for research.

By updating to the ICD-10 PDF codes, the United States is joining much of the developed world in building a better resource for health studies within the country as well as worldwide. The complexity that is being introduced will be a challenge to adapt to at first. But overall, everyone will benefit from a more modern system of medical coding.

ICD-10 Codes: What Will Change About Medical Billing

by Nitin Chhoda PT, DPT | Jul 30, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Software

ICD-10 is coming soon and will replace the current ICD-9 terminology. Nitin Chhoda clarifies the changes that are coming in the world of medical coding and how to deal with the upcoming transition to ICD-10.

As with any significant change in procedure, there is a portion of the medical billing and medical coding community that is in panic.

There are also many people who unaware of the extent of impact that the ICD-10 codes will have on them.

To clarify some of the commonly misunderstood aspects of this change, below are the facts about medical coding changes due to ICD-10 implementation codes.

Compliance and Flexibility

The compliance date for switching to ICD-10 codes is October 1, 2014. There have been rumors circulating that that date is somewhat flexible or that extensions will be granted either to individual practices or to everyone.

The compliance date is set and will not be changed. All health care providers must use ICD-10 codes by Oct 1, 2014.

Additionally, many people believe that compliance with ICD-10 codes requirements is only necessary if you are using electronic medical records and an EMR system. This is also an incorrect assumption. No matter whether you use electronic medical records or you are still doing all of your filing on paper, the ICD-10 codes will be required for all medical practices.

Too Many Numbers

Changing from a code system of about 13,600 codes in the ICD-9 to the ICD-10 codes which number over 144,000 sounds daunting. The exponential rise sounds overwhelming, and it should come as no surprise that medical coding professionals are worried that it will be too complex to be practical. There are also serious (and legitimate) concerns about the increase in documentation time, claiming this level of detail is unnecessary.

ICD-10 codes are structured to be more logical to use and the codes are more clinically accurate than the ICD-9 codes. Medical coding should be easier, not harder.

The structure itself is improved so that you will be searching through categories which contain more specific codes than the previous version. Of course, every change requires some learning and adjusting. But once medical coders settle into the new system, they may find they like it better than the previous system.

Introduction of Unnecessary Tests

One concern voiced by clinicians is that with a more complex and detailed set of ICD-10 codes, medically unnecessary tests will need to be taken with patients so that a diagnosis can be made and the correct code can be assigned.

Fortunately, this is not the case. Nothing about the ICD-10 codes should dictate what medical tests and procedures are prescribed for your patients. The ICD-10 codes are intended for documentation of what is found by the clinician.

If a diagnosis hasn’t been made, the code used will be dictated by the symptoms. The ICD-10 codes are more flexible in this way than the ICD-9 codes, and they still contain the non-specific codes that can be used when you cannot make a diagnosis.

Many medical professionals are nervous about the change to ICD-10 codes. Before you worry about what this change will mean for you and your practice, remember that the ICD-10 codes were designed by and for clinicians like yourself.

ICD-10 Codes: What Are They?

by Nitin Chhoda PT, DPT | Jul 27, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

On October 1, 2014, ICD-10 codes will officially be implemented. Adjusting from old to new medical codes can be very frustrating without a physical therapy software to rely on.

Nitin Chhoda explains how switching to electronic medical records will make the transition simpler.

A lot has changed since the implementation of ICD-9 coding. New diseases have been discovered, a better understanding of old ailments is available, and advances in treatment have made the old codes obsolete.

Therapists have been struggling for years trying to code for treatments and services that didn’t quite fit the range of possibilities available through the new techniques and technology. That’s all changing with the switch to ICD-10 codes in October 2014.

New Coding Options

The good news is that several thousand new coding options will be introduced into the current system of 13,600, making it easier for practice owners to bill for new treatments and procedures.

While it opens up multiple opportunities for clinics, the number of new codes will wreak havoc with practices without electronic medical records. ICD-10 codes are the first coding update since 1977 and it’s going to take the medical field by storm.

The ICD-10 codes represent the 10^th update of the International Statistical Classification of Diseases and Related Health Problems (ICD). It includes many codes not used in other countries.

While many therapists may never provide services to those from a foreign land, they must be aware of the differences in coding when dealing with insurance providers in other countries, along with modifications made by those sovereigns.

Greater Latitude

The upcoming changes in coding offers therapists greater latitude when submitting reimbursement claims and providing treatments. The deadline for implementation has been pushed back many times.

The most recent delay, from Oct. 1, 2013 to Oct. 1, 2014, was partly instituted to allow those in the medical field to establish an EMR in their practice to facilitate the use of the new codes.

ICD-10 codes are significantly different from the old codes, range from 3-7 digits in length, and are used for documenting a diagnosis. An EMR will make the transition significantly smoother, but will still require extensive planning and staff training.

To add another level of difficulty to the transition, before therapists could use the new coding, they had to implement HIPAA’s 5010 transaction standards. Claims for reimbursement that don’t use the ICD-10 codes after the deadline will be rejected.

Major Changes

The changes in coding affect medical providers, impacts insurance companies, and how practice owners are reimbursed. The ICD-10 codes reflect changes in all facets of healthcare, from new diseases and vaccines to medications and treatments.

The changes provide therapists to code in greater detail and offer more specific details about each diagnosis. The coding allows therapists to provide new services and offers more opportunities to be paid, but clinic owners should expect the changes to be disruptive at first.

In a world of international travel where pandemics are a real concern, the new ICD-10 codes will assist health and medical authorities track contagious and potentially devastating diseases that include various types of flu, HIV and AIDS, along with cancers in all its many forms. They will assist organizations that include the World Health Organization and the Center for Disease Control.

The ICD-10 codes represent an update that’s long overdue.

The new coding allows for a greater range of diagnosis and will be required if therapists are to be reimbursed for their treatments and services.

The first ICD codes were developed by Jacques Bertillon in 1893 France and adopted by the U.S. in 1898.

Technology and medical knowledge has improved steadily throughout the centuries and the latest incarnation of the ICD codes provides therapists with the tools to manage patient care and the profitability of their practices more efficiently.

The ICD-10 Preparation Timeline for Your Practice

by Nitin Chhoda PT, DPT | Jul 24, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Back in 2013, many clinicians breathed a sigh of relief when the Department of Health and Human Services delayed implementation of ICD-10 codes until Oct. 1, 2014.

That deadline is almost upon us and now is the time to establish a timeline that provides sufficient time for software installation, staff training, system testing, and rectifying any difficulties that arise.

Impact Analysis

The first step is to review the ICD-10 codes to obtain an understanding of the changes, how the transition will impact the practice and affect systems already in place.

Practitioners will need to conduct a complete inventory of manual and electronic systems that will be used in conjunction with the new codes, as they will need to be upgraded.

The American Medical Association estimates this phase will take 3-6 months to complete.

Contact EMR, Billing Software and Clearing House Vendors

The installation and integration of new systems and/or upgrades takes time and it’s essential to work closely with vendors on costs, work completion dates and support should problems arise.

Look for a vendor that maintains responsibility for updates, support, tools and training to minimize costs and facilitate a speedy transition. This phase of the project should take 2-3 months.

Contact Others In The Network

Practitioners will need 2-3 months to contact billing services, clearinghouses and payers to determine when their systems will be operational and ascertain when testing between the systems can commence.

Inquire as to the necessity of a contract changes that might be required as a consequence of the transition.

Vendor Upgrades

The IT work necessary for a transition of this scope will take vendors 3-6 months and they must be ready to deliver the appropriate system upgrades in sufficient time for training and testing.

Other systems concerned with public health and quality reporting will need upgrading to comply with usage of the new codes.

Internal System Testing

Two to three months will be required to test the level of preparation of documentation, billing and coding systems to ascertain that they function as they’re supposed to.

A practice conducts many types of transactions each day and the system should be put through a thorough shake-down process for each.

Documentation Updates

Clinicians should be prepared to invest 2-3 months examining their forms for patient encounters, superbills, and other data collection documentation. Make changes where needed to ensure that all details are included. Templates may need to be modified. It is critical to have a customizable electronic medical records system that allows you to create and maintain your own clinical documentation templates.

Training Staff

Develop a training schedule for staff that ensures each member understands and has a working knowledge of the new codes, how they affect the practice, and compliance issues. It will take 2-3 months for this portion of the practice’s timeline.

External Testing

Contact payers, clearinghouses and billing services to schedule and conduct testing with each entity to ensure the practice can send and receive from them.

This can be done over the course of 6-9 months, as each company completes its own updates and upgrades.

Oct. 1, 2014 – The Big Day

Implementation of ICD-10 codes goes into effect on this day. Any claims with a date of service after October 1, 2014 that don’t use the new codes will be rejected. Even if all systems are in place before Oct. 2014, the new codes can’t be used before the official implementation date.

ICD-10 codes will result in major changes in the way clinicians document their patients’ visits and submit reimbursements. Claims submitted with ICD-9 codes (with dates of service after October 1, 2014) will be rejected and practitioners won’t be paid. Clinicians who begin now can be fully ready when the changes go into effect.

Reverse Engineering ICD-10 Preparation

by Nitin Chhoda PT, DPT | Jul 21, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The transition to ICD-10 codes will impact a host of office systems and software, along with the human element of practices.

Several articles and checklists are available online with advice and suggestions on how to prepare for implementation of the new codes, but the bottom line is that those who don’t prepare sufficiently will suffer financial losses due to rejected reimbursement claims.

Glitches and errors with implementation are inevitable, and the objective for the practice should be to minimize issues with the transition.

Claims will be affected with a project of this scope and clinicians would do well to review their preparations beginning with the anticipated end result, and do so as if they were facing a natural disaster.

Create A Contingency Plan

To ride out the coming storm of ICD-10 transition, practitioners should create a comprehensive list of monthly expenses that includes their bills and payroll.

Plan on putting aside at least three month’s-worth of cash to cover expenses in the event that the reimbursement flow decreases.

Budgets And Deadlines

Practitioners will face a multitude of expenses in the form of staff training, software and office system upgrades. Practices must establish a timeline to accomplish their goals, from where and how staff will receive training to when software and hardware will be installed.

If problems occur, clinicians will know where the delays are, allowing them to adjust their plans accordingly.

Communicate With Others

Everyone from payers, vendors and clearinghouses must comply with implementation of the new codes. To assist clinicians with their own project deadlines, it’s a good idea to communicate with others in the practice’s network to discover when each entity plans to have their systems in place so testing can begin.

New Rules And Compatibility

It’s critical for clinicians to identify the top 10 ways the transition will affect their practice. Some payers, such as those for Workers’ Compensation, may be exempt from the change, and this varies from one state to another. It’s best to speak with the insurer in your state.

Practitioners will have to conduct due research to ensure they have a system that’s compliant and compatible with clearinghouses and payers.

Education, Skills and Resources

Staff will need sufficient time to be trained in the new alpha-numeric codes, their usage and how they will affect their daily duties. Compile a list of resources the office and staff can utilize. It’s never too early to begin the familiarization process.

Coding is a specialized field and some clinicians may find that hiring a biller/coder who already has expertise with the new codes is more cost effective for the practice.

Fix Existing Problems

Before attempting software installations and upgrades, identify and fix any problems with existing systems, software and processes.

Problems anywhere within current systems and practices will create even more difficulties later on.

Acceptance Is Key

ICD-10 implementation is mandatory and the U.S. is one of the last countries in the world to adopt the system. Each practice should have a designated person to become an expert on all the nuances, rules and regulations of ICD-10.

That individual will be a key element in the creation and development of an implementation program that’s compliant, compatible and helps guard against reimbursement rejections.

Sufficient preparation for implementation will reduce stress throughout the practice and ensure that claims are reimbursed promptly. It’s understandable that clinicians are anxious about the change to ICD-10 codes, but with only a little while to go before the codes are in common use, practitioners have no time to waste.

Preparing to Weather the Storm of ICD-10

by Nitin Chhoda PT, DPT | Jul 20, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

There’s much to do before the mandatory transition to ICD-10 codes and little time to accomplish a mountain of tasks. Much of the ICD-10 code preparation plan enacted by clinicians will depend upon the size of their practice.

The deadline is Oct. 1, 2014 for the exclusive use of the new codes and it’s very unlikely that clinicians will receive another reprieve in the form of a nationwide delay.

Where To Find Help

Before an implementation strategy can be created, it’s essential to know what resources are available that can provide assistance.

The Centers for Medicare and Medicaid Services is a primary resource and has a multitude of data for different sized practices and facilities.

EMR vendors, coding/billing software vendors, and the American Health Information Management Association can also prove helpful.

Creating A Strategic Planning Team

Few practitioners have enough time in the day to treat patients and become ICD-10 experts. Creating a project team will free clinicians to conduct the daily business of the practice and allow them to obtain essential facts upon which to make informed decisions.

Budgeting and Planning

Implementation will affect practices in a variety of ways that includes software upgrades, purchasing hardware and manuals, and obtaining staff training.

The project team should take no more than two months to provide clinicians with the needed data to develop a realistic budget and secure appropriate funding for needed changes, based upon a comprehensive audit of the clinic’s current systems.

Communication Between Staff and with Vendors is Critical

Communication is a key ingredient in ICD-10 preparation and it will be an ongoing process. Practitioners will need to inform staff about the changes, how it will affect them, and establish a training schedule that doesn’t interfere with the operation of the practice.

Communication extends to all the vendors, payers and clearinghouses with which the practice interacts. Find out when their systems will be in place and when testing can begin.

Glitches in the system can’t be avoided, making it imperative for clinicians to monitor other entities to determine their readiness, ensure software systems are compatible and perform testing.

Testing Your Level of Preparation for ICD-10

There will be multiple tests prior to the 2014 deadline. Systems will need to be tested to determine if claims can be submitted, and if documentation can be completed accurately and efficiently. Staff will need to be proficient in their understanding of the new codes and the ways it will affect them.

Documentation And Coding Principles May Need Modification

The forms and documents a practice currently uses may need significant changes or modification, or new templates may need to be created to facilitate the documentation and coding process.

Billers and coders will need in-depth training and extensive practice in the practical application of the codes to avoid claim rejections.

They will also need sufficient time to work with any changes in the forms they use to gain proficiency.

Even with the best laid plans, practitioners should be prepared for glitches, errors and last minute changes among the entities with which they routinely communicate.

The change to ICD-10 codes represents major changes in the way clinicians document their patients’ complaints, along with the software and systems they use to do so.

Being prepared for potential problems doesn’t mean practitioners are pessimistic. It demonstrates a realistic and responsible attitude that will help practices weather the ICD-10 storm.