ORLANDO — The transition to using ICD-10 billing codes is one of the biggest issues facing physician practices this year.
The number of diagnostic codes will increase from nearly 14,000 to around 69,000. The number of procedure codes will jump from around 3,000 to roughly 87,000.
Handling this jump can understandably be daunting for physicians, but obstacles can be overcome with a few strategies.
MedPage Today spoke to several people during this week’s Healthcare Information and Management Systems Society (HIMSS) annual conference in Orlando. Here’s the advice they gave.
1. Break Out Codes You Use Most
While there are several tens of thousands of codes, most practices won’t use but a small slice of those. Find what ones are most applicable to your practice and focus on those.
ZirMed has software that will scan your claims data and find which ICD-10 codes you will use the most. It will also tell you where documentation is lacking. ICD-10 is infamous for its granularity that may not be documented by clinicians including differentiation between left and right, trimesters for pregnancies, and severity of diabetes.
“That gives you an idea where the impact is and what you need to home in on,” said Betty Gomez, head of regulatory strategy at the health informatics firm ZirMed.
2. Consider Coding Software That Can Help
Technology exists that will scan a patient’s record and find the appropriate ICD-10 code.
Such software is becoming increasingly complex. For example, ChartWise 2.0 contains more than 1,300 pages of unique rules about ICD along with inputted knowledge about medicine and clinical documentation to help find the most accurate code, founder and Chief Executive Jon Elion, MD, told MedPage Today.
That information helps the software translate “doctor speech” into codes.
3. Use Dual Coding
While insurers are only accepting ICD-9 codes today, that’s not stopping providers from gaining familiarity with ICD-10 codes by beginning to pepper them into their work.
Develop a process where you use both the familiar ICD-9 code and learn the appropriate ICD-10 code. It might take more time initially, but it will help you gain an appreciation for coding in ICD-10.
4. Train and Educate Yourself and Others
Appoint a leader in your practice to start managing the ICD-10 transition now.
Rex Stanley, health consultant and chief executive of Alpha II, told MedPage Today that if practices haven’t started work on making the ICD-10 transition by now, they’re probably too late.
5. Test, Test, Test
CMS has announced a couple of instances in which it will test ICD-10 code submission.
The agency will test “front-end” submissions between Medicare and Medicare Administrative Contractors (MACs) and providers between March 3 and 7. It will also conduct end-to-end testing of submissions with a limited number of providers this summer.
Take advantage of this.
6. Stockpile Cash
Practices should start escrowing money now to have on hand in case a practice or its payers run into trouble submitting codes or processing claims.
“If everything goes smooth, you have extra money,” Stanley said. “If everything doesn’t go smooth, you’re gonna need that money.”
Most practices don’t have the ability to operate more than a month without claims being processed. While some will have the ability to borrow money if needed this fall, Rex said interest rates won’t be friendly.
7. Don’t Wait for More Delays
Despite repeated calls from groups like the American Medical Association, most people familiar with the issue believe that the switch to ICD-10 will finally come on Oct. 1. The Centers for Medicare and Medicaid Services (CMS) has delayed the start date before but has been saying for months that there will be no more delay.
8. Remember That Help May Be on the Way
Despite little chance for another delay, there may be some assistance this fall from payers, including CMS.
Gomez said she doesn’t expect big health insurers to be hard on providers right away. They will expect doctors to likely have problems with coding initially.
CMS will also have contingency plans and is offering help to providers having struggles.