HITECH Act

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.

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.

Three Biggest Mistakes to Avoid with the ICD-10 Transition

by Nitin Chhoda PT, DPT | Jul 13, 2015 | Healthcare Practice Management, Medical Billing, Physical Therapy Billing, Physical Therapy Management

Dramatic Decrease in Productivity

When Canada implemented ICD-10 codes, it was only a fraction of what the U.S. plans to add on October 1, 2014.

The problem – productivity among physicians and billers/coders never returned to pre-implementation levels.

The American Academy of Professional Coders predicts the same for U.S.

The organization indicated that the sheer number of codes, combined with the new and unfamiliar alpha-numeric code combinations, could reduce productivity by up to 50 percent.

That translates into reduced reimbursements and greater turnaround times on claims.

The first few months of implementation will be a critical time for practices financially as they deal with inevitable errors that mistakenly deny claims and requiring multiple resubmissions, further slowing down the system and cash flow.

Insufficient Billers/Coders

Experienced billers and coders are in short demand and those with in-depth knowledge of ICD-10 codes are even fewer.

Practices may find that those with expertise are taking employment as trainers and consultants, further narrowing the pool of ICD-10 specialists available to work in practices.

The lack of billers/coders familiar with ICD-10 codes will slowly increase as more are trained, but the shortage doesn’t bode well for practice owners trying to maintain their cash flow.

Complacency (The Notion that ‘It Will Get Delayed’)

Many practice owners aren’t moving as quickly as they should and preparing sufficiently for the coding transition, out of a sense of complacency.

Some are hoping another delay in implementation will buy them more time, while others either aren’t sure where to begin or view it as a simple software upgrade.

Some see the coding change as an inconvenience, and not one that’s a high priority.

The Centers for Medicare and Medicaid Services has indicated there will be no more delays and the implementation will occur on Oct. 1, 2014 as planned. The organization has an extensive array of data, resources and timelines to assist practices prepare.

Clinicians that aren’t ready on implementation day will face severe consequences. Any claims with a date of service after October 1, 2014 without ICD-10 codes will automatically be denied.

The ICD-10 transition will affect every practice.

Extensive training for staff, electronic medical record software upgrades and hardware systems will be required.

The procedure will place added stress on staff, disrupt normal office procedures, and affect the financial health of clinics.

Procrastination won’t make the ICD-10 transition go away and it’s far better for practices that prepare for the deadline over time instead of waiting until the last minute and hoping for the best.

Clinicians that don’t prepare their practices will suffer from reduced productivity and the inability to collect on reimbursement claims.

Preparing for the ICD-10 Transition

by Nitin Chhoda PT, DPT | Jul 6, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Many clinicians describe the change to ICD-10 codes as exciting, but others use words that include scary and expensive. Training in the use of the new codes will be required for many employees, especially for coders/billers, which has many in the profession viewing the transition with trepidation.

The American Health Information Management System (AHIMA) has determined that it will require about 16 hours and $500 to fully train coders working in a small practice who are already experienced in ICD-9 protocols.

The training expands to 57-62 hours for all others. AHIMA indicated that most coders should receive their training three to six months prior to ICD-10 implementation so the information remains fresh in their mind.

More Codes For All

ICD-10 contains 141,000 alpha-numeric codes, but all practices won’t use the full complement of codes.

General physicians may use 30 more, while rheumatologists and orthopedic surgeons may use up to 60 percent of the new codes. ICD-10-CM codes are used for a diagnosis and description of symptoms.

ICD-10-PCS codes are those that will be used to describe procedures, but only in the U.S. for inpatient hospital environments.

Easing The Transition

Using an EMR and computer assisted coding will significantly reduce problems. EMRs are capable of handling all the new codes. Additionally, some systems identify potential problems and notify billers/coders before the claim leaves the office for reduced denials.

The systems still rely on human operators and will help alleviate an expected reduction in productivity the new codes will engender.

One problem that many have overlooked is a decrease in morale associated with the transition. Many coders/billers are anxious and nervous about the new coding.

Their primary worry is being able to maintain the expected cash flow to practices. It’s a legitimate concern and one that clinicians and billing specialists will need to work on together.

Training Opportunities

The Centers for Medicare and Medicaid Services, the World Health Organization, professional billing/coder organizations, and some insurance providers have developed training modules and tools to assist individuals in their quest for reliable training options.

Coders are the professionals that bridge the gap between clinicians and insurance companies to ensure practitioners get paid.

One of the biggest problems facing billers/coders is finding the time to learn ICD-10 coding while maintaining their normal work day with ICD-9 coding.

Online education is a convenient remedy that can be a cost effective solution for practices.

Plan For Contingencies

The best way to learn is by doing and professional coder/biller organizations highly recommend that anyone who will be working with the new codes conduct simulations using actual claims.

The exercise provides practical experience and helps familiarize coders/billers with codes before the official rollout.

Clinicians need to establish a crisis committee to formulate a backup plan to accommodate slow-downs in reimbursements during the first few months.

The U.S. is one of the last countries to adopt the ICD-10 coding and it’s coming at a time when many practices are still involved in meeting meaningful use standards and changes associated with Obamacare.

When Canada implemented ICD-10 codes in the 2000s, productivity was sharply reduced for months and the same is expected for the U.S., but many problems will be greatly alleviated through appropriate planning.

Making the Case for ICD-10 Codes

by Nitin Chhoda PT, DPT | Jul 3, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

ICD-9 codes were originally designed as a classification system to compile statistics, but as a code set, ICD-9 does not provide the information that payers desire for reimbursements or the type of data needed to monitor situations that include disease outbreaks by entities like the Centers for Disease Control (CDC) or the World Health Organization (WHO). In other words, it is now an outdated code set.

Implementation of the new International Classification of Diseases is mandatory and there are a number of compelling reasons for the transition, from patient management to identifying and addressing potential pandemics.

The codes were developed by the health division of the United Nations and the U.S. is one of the last countries to implement the codes, a move that has been criticized by other nations.

Codes For A New Era

The ICD-9 system is running out of number combinations to adequately describe new diseases and illnesses, terminology and technological advances since its implementation in 1979. The ICD-10 codes employ an alpha-numeric diagnosis and procedural system that’s more specific.

ICD-10 is designed for significantly more specificity and accuracy, which can increase the amount of documentation required for reimbursements.

The new system offers the ability to code for new diseases, techniques and procedures as they emerge in coming years.

Identifying Fraud, Trends And Abuse

The new codes provide additional oversight for payers, allowing them to identify instances of fraud, trends among practitioners, and individuals who are abusing the system.

It’s a tool that insurance companies have indicated can be used to significantly reduce the cost of healthcare.

Grading Performance

Utilization of ICD-10 codes allows payers and professional organizations to monitor how clinicians are utilizing available resources in an effort to provide better patient care and effective management to reduce overall costs.

The new codes provide payers and government officials with a means to grade the individual performance of medical providers and facilities, establish reimbursement rates and set public health policies.

Improved Analytics For Practitioners

The new codes offer analytic tools for clinicians, allowing them to track patient illness, injury and disease trends.

Clinicians will have enhanced tools to monitor instances of everything from cancer and domestic abuse to diabetes and obesity rates.

Practitioners have no choice but to transition to ICD-10. Modifying patient records to reflect the new codes will require a significant investment of time and effort, but many medical professionals are looking forward to a change that has the potential to improve patient care.