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Are you getting ready? Prep your practice for ICD-10

August 8, 2013

By Walt Whitley, O.D., Jason Miller, O.D., and Chuck Brownlow, O.D., AOAExcel™ medical & records consultants

Whether your practice has begun to prepare or not, the U. S. health care system will formally adopt the International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System (ICD-10-CM/ICD-10-PCS) Oct. 1, 2014, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

Initially set to launch Oct. 1, 2013, a delay provided optometrists and other health care providers more time to get an understanding of the pending changes, determine how it will affect their practice, and decide how to implement ICD-10 within their practices.

The transition to ICD-10 will allow providers and payers to more accurately describe each patient’s diagnosis.

Optometrists will continue to use the Current Procedural Terminology (CPT) published by the American Medical Association (AMA) and the Healthcare Common Procedural Coding System (HCPCS Level II) to describe health care services and products they provide patients.

Providers practicing in hospitals will be required to use ICD-10-PCS codes for inpatient procedures and treatment in addition to ICD-10 CM for diagnosis.

Is ICD-10 needed?

The International Classification of Diseases (ICD) was originally created to aid in research and statistical analysis regarding disease within the world’s population. The current version used in the United States is ICD-9th Edition, which is a numeric representation of diseases and conditions for health care billing.

ICD-9 disease codes are five digits: three before the decimal point and two after. Although used for the last 30 years, ICD-9 does not account for advancements in technology. Also, many diagnosis categories are full and many diagnoses are not descriptive enough for each specific condition.

ICD-10 will address many of the shortcomings of ICD-9, such as reimbursement, health care quality, ability to add new diagnoses, and greater specificity. ICD-10’s greater detail may eventually mean that reimbursement would more accurately reflect the services provided. Health care quality will be evaluated for medical processes and outcomes. ICD-10 will be flexible enough to incorporate new diagnoses and procedures. Lastly, each diagnosis will be exact enough to identify diagnosis and procedures precisely.

Before we go any further, it is important to understand the differences between ICD-9 and ICD-10. The chart on page 32 will provide a brief overview of the difference.

Essentially, there will be more specificity for each disease, taking into account the anatomical site affected, the etiology of the condition, and the severity of each disease state.

Take these steps now

There are numerous steps optometric practices can take as you prepare for the inevitable. The key is to start preparing now (see additional links and resources below for specific timetables for ICD-10 transition).

  • Go to the CMS website – Here you can find all the up-to-date information on ICD-10, email updates, webinars and links for specific provider information, as well as timelines for implementation (http://cms.gov/Medicare/Coding/ICD10/index.html).
  • Evaluate your current documentation – Take a look at your current records to see how your clinical documentation would be graded in ICD-10. Remember, the purpose of ICD-10 is to more accurately describe each patient’s condition and documentation is what drives coding. During your history, is it comprehensive enough to fully describe the encounter that will go along with your findings? One helpful tip would be to practice and improve on your everyday documentation that is driven by each clinical condition. This will allow you or your coder to have enough information for ICD-10 classification.
  • Determine who will be affected – Another step you can take as you prepare for ICD-10 is to evaluate all aspects of your practice where ICD-9 is currently used. Many examples exist, including authorizations, pre-certifications, physician orders, medical records, superbills, EHR systems, coding manuals and public health reports. For staff who will use ICD-10, establish a training timeline to allow every affected individual ample time to understand these changes while providing the necessary training.
  • Know your top codes – There are several programs, websites and services available to help navigate the new ICD-10 codes and allow a comparison to ICD-9.

We recommend taking a look at your current top 10 to 20 ICD-9 codes for your practice to see examples of what the ICD-10 codes will be.

These same programs will also allow you to compare ICD-10 codes to their previous classifications. Document these codes as a guide to improve accuracy when ICD-10 comes around.

Once again, one of the main differences will be the greater specificity of these various diseases and conditions. Examples are available at www.aapc.com/icd-10/codes or www.icd10data.com.

By entering an ICD-9 code, e.g. 365.11, the calculator provides the ICD-10 code and description, H40.11XX, primary open-angle glaucoma, stage unspecified.

All that’s left for the doctor/ staff is to indicate right /left/ both eyes where the X appears in the third space after the decimal point, (1=right eye, 2=left eye, 3=both eyes) and to specify the stage as the final digit (0 = unspecified, 1 = mild, 2=moderate, 3=severe, and 4=indeterminate).

ICD-10 is coming in October 2014. Although it sounds overwhelming, the implementation guidelines are organized in a manageable timetable for your transition that will take you through the process.

Numerous vendors of educational/informational/training products and services for ICD-10 implementation make it seem that the changeover will be extremely complicated, the training will be deep and wide, and that it will cost thousands of dollars to get an office converted to the new coding system. Yes, ICD-10 will be different. Yet at this time you can do the steps above to prepare your practice at very little expense.

January 2014 will be early enough to launch your education/preparation efforts. In the meantime, try to encourage doctors and staff in your practice to concentrate on current challenges and worry less about ICD-10.

Our prediction is that when Oct. 1, 2014, arrives, you will be very happy you did not obsess over ICD-10 and you didn’t drop tons of money on training and preparations for the “big day”!

Available ICD-10 resources

The CMS website offers many resources to prepare your practice for ICD-10. The following links include useful tools to guide your practice and prepare the transition to ICD-10:

  • CMS Provider Resources http://cms.gov/Medicare/Coding/ICD10/ProviderResources.html
  • FAQ: ICD-10 Transition Basics
  • ICD-10 Transition: An Introduction Fact Sheet
  • ICD-10 Basics for Medical Practices
  • ICD-10 Basics for Payers
  • The ICD-10 Transition: Focus on Non-Covered Entities
  • Checklists, Timelines, and Implementation
  • Implementation Planning
  • Communicating About ICD-10
  • Medscape Education: Webinar and Articles Available
  • American Association of Professional Coders (www.aapc.com)
  • American Health Information Management Association (www.ahima.org).

The views expressed are those of the authors and do not necessarily reflect the views of the AOA.

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