A massive change is coming to the medical billing arena on Oct. 1, 2014 with the official rollout of the ICD-10 codes. ICD-10 codes will replace the ICD-9 codes currently in use, adding more than 68,000 new coding options that will directly affect documentation, billing and reimbursements for all healthcare providers.
So who does this impact?
Does it impact the front desk, the clinician or the biller?
The answer – It impacts every single person in your practice. Those who won’t prepare will learn the hard way, and the lessons will reverberate through the staff for a long time.
Here are 10 things to know to prepare your practice for the upcoming ICD-10 code switchover on October 1, 2014.
1 – ICD-10 Replaces ICD-9
After Oct. 2014, only ICD-10 codes will be accepted for billing and diagnostic purposes. Remember, this applies to the date of service, not to the date of submission of the claim. So if the date of service is before October 1, 2014 and submitted after October 1, 2014 (and there will be several cases like this in your practice), you’ll still use ICD-9 to code those visits.
Any claim with a date of service after October 1, 2014, that doesn’t use ICD-10 codes will automatically be rejected, but practitioners can’t use the new codes before the official launch date.
The new alpha-numeric codes represent the International Classification of Diseases for expanded accuracy.
2 – The Change Is Mandatory And Necessary
It’s a mandatory transition that all clinicians must make if they want to be paid. The codes reflect new diseases, conditions, treatments and technological advances.
It’s the first update in 30 years, providing clinicians with additional coding tools to diagnose and treat patients.
3 – ICD-10 Codes Affect Everyone
The new codes affect all healthcare providers, from clinicians to hospitals. Being prepared will minimize delays and denials in payments and ensure that everyone in the office is familiar with the technology being used to implement the change.
4 – Your EMR Should Map ICD9 to ICD10 to SNOMED Codes
An electronic medical record sofware like In Touch EMR will help your practice adapt to this monumental coding change. Sophisticated systems like In Touch EMR will seamlessly managing all the new codes and allowing your practice to bill efficiently. The system you choose must have a crosswalk between ICD-9, ICD-10 and SNOMED codes built in. A system like this will allow you to generate compliant documentation and clean claims, allowing you to maintain or increase cash flow in your practice.
Here’s an example of a crosswalk, which should automatically exist in your EMR system. This crosswalk will train, and alert your clinicians about ICD-10 and make the transition seamless.
We’re going to use the sample ICD-9 code of lumbago, one that most rehab professionals are familiar with.
M545 Low back pain
SNOMED Concept ID(s)
279040009 Mechanical low back pain (finding)
402245001 Angry back syndrome (disorder)
298236009 Lumbar spine stiff (finding)
279039007 Low back pain (finding)
247368002 Posterior compartment low back pain (finding)
301407002 Tenderness of right lumbar (finding)
279041008 Lumbar trigger point syndrome (finding)
278860009 Chronic low back pain (finding)
301408007 Tenderness of left lumbar (finding)
278862001 Acute low back pain (finding)
300957005 Postural low back pain (finding)
279042001 Lumbar segmental dysfunction (finding)
161894002 Complaining of low back pain (finding)
267982002 Pain in lumbar spine (finding)
202794004 Lumbago with sciatica (finding)
As a clinician, you need access to this crosswalk at your fingertips, as the countdown towards October 1, 2014.
In fact, your EMR system should have the capability to show you which ICD=9 code corresponds to which ICD-10, and which SNOMED code. This will train your clinicians to understand which ICD-9 codes correspond to which ICD-10 codes right away.
When the big day comes in October 2014, this ‘crosswalk capability’ in your technology will make your transition seamless. Without this capability, practices and billers across the country will be scrambling to adjust to the new changes.
Even if you don’t have a crosswalk like this built into your EMR system, you’ll need to purchase / identify crosswalk data for the most common ICD-9 codes in your practice and start studying that data right away.
5 – Early Preparation Is Critical
The change-over takes place promptly on Oct.1, 2014 and reflects a one-year delay issued by the Department of Health and Human Services. While that may sound like plenty of time, early preparation is critical to the process.
Clinicians will need time to install any needed software, train employees, conduct tests and work out any bugs in their system.
An implementation strategy must be developed, along with a timeline and impact assessment evaluation. Practitioners will need to communicate with vendors, clearinghouses and insurances agencies to ensure security and compliance.
6 – CPT Codes Will Stay The Same
ICD codes are for making a diagnosis and current procedural terminology (CPT) codes are for medical and rehab billing. The next generation of ICD-10 codes won’t affect the use of CPT codes for physician services.
7 – Identify Any Needed Documentation Changes
The change to ICD-10 will require clinicians to modify or change their documentation processes. In fact, a significant increase in documentation time is expected, according to several industry sources.
Practitioners using an EMR must have the ability to create custom templates for documentation.
This will make it easier to implement any changes needed, allowing practices to take full advantage of the codes for enhanced care and revenues.
8 – Make Conversion a Top Priority
The change to ICD-10 codes should be a top priority for clinicians across the nation, even though it will require a significant amount of time and effort to ensure the transition goes smoothly.
The change-over represents a complete overhaul of the coding system and clinicians that don’t invest the time to prepare properly will find significant delays in reimbursements, or potentially costly system glitches.
Part of the conversion process includes a contingency plan in the event that a major problem manifests.
Employees should be cognizant of who to contact and be able to do so 24/7 to have their office systems up and running again quickly. It’s best for practices to have a financial contingency in place in case payments are delayed or paused for a period of time. A line of credit, or access to emergency funds is important to meet expenses like rent, payroll and supplies.
10 – Invest in Education for your Staff
The best thing practitioners can do for their practice is to educate themselves and their staff to keep informed of any changes relating to the coding change.
Identify and schedule training for anyone within the office that will be directly involved with the billing and coding process. The clinicians and the billers need to identify courses on ICD-10 preparation and study crosswalks by working closely with their EMR vendor.