Every time a person seeks medical treatment, healthcare professionals are required to use a specific code for billing and tracking purposes. The International Classification of Diseases, Revision 10 (ICD-10), was launched Oct. 1, 2015 — after 20 years of delays.
The new ICD-10 codes multiply the medical coding options available by a factor of five, jumping from roughly 13,000 diagnostics codes under the ICD-9 to more than 69,000 with ICD-10.
ICD-10 attempts to label every possible diagnostic scenario imaginable. Whether you’ve had an initial encounter with an orca whale (W56.21XA, W56.22XA or W56.29XA) or an unlikely repeat orca encounter (W56.21XD, W56.22XD or W56.29XD), been injured by a brass musical instrument (Y93.J4), or walked into a wall (W22.01XA, W22.01XD or W22.01XS), believe it or not ICD-10 has a classification for it.
Don’t believe us? Take a peak for yourself. Check out the ICD-10 Code Lookup Database or you can just look at the entertaining graphic below provided by Quill.com. The graphic illustrates 14 funny examples of ways people injure themselves and how ICD-10 classifies them.
A personal favorite? It has to be V91.07XA: Burn because of to water skis on fire, initial encounter. It’s easy to wonder how this happens once, let alone more than once, V91.07XD: Burn because of water skis on fire, subsequent encounter.
Take a look at the following graphic depicting some of the most bizarre ICD-10 codes, thanks to and provided by Quill.com. What will these codes, when aggregated over the next few years, say about us as a people? That we’re likely into, and injured by, some pretty weird stuff! Perhaps I’ll write a book.
It’s here. The day has arrived. The biggest thing to happen to the administration of healthcare in decades is upon us: Today is ICD-10 conversion day.
It’s been a long and winding road. But we’re here. The trip has certainly not been easy and there have been multiple detours. But, the destination has arrived. “Momma, are we there yet?”
Yes.
Take a breath. Stretch your legs and try to find some joy in the tumultuous trip. You’ve earned it. It’s been a long ride.
But the trip is not over yet. Like all road trips, there’s the way back. And that, too, is a long road ahead. There’s still much to see and do, and much to prepare. Much to look forward to on the road ahead.
For a minute, though, on perhaps the most important day, why not take a moment to reflect on the journey and congratulate yourself on a job done well, which you’ve done with integrity and professionalism, in which you have been filled with excitement and glib, where you’ve experienced pain, pressure and perhaps even a little joy as you pushed yourself to the max.
Many of us never thought this day would come. Some of you hoped it never would.
Now, thankfully, we can move on to a new goal, a new destination.
Though ICD-10 is upon us and there is little, if anything, that can be done at this point other than wringing your hands in disbelief or praying for peace with the patience of a saint (depending on your religious worldview and personality), we wait for the storm to hit, then pass and roll on a bit for a time. And it will pass. The storm will dissipate.
For some reason, when I think of the current state of ICD-10 and its impact to healthcare I’m reminded of a hurricane. The analogy of a hurricane seems like an apt example of the phase healthcare currently is in in regard to ICD-10.
The road here has been long – there has been much fear and anticipation of the coming storm. Surges of energy, wind and waves have met us and battled at the banks of the beach. The wind and thunder has been loud, the elements seem to have shaken the very foundation of our lives and our “homes.” Pain, fear, struggle and stress have been the order of the day. But at last we’re here. The storm is upon us, in fact it is half over, and we stand in its eye, one of the most beautiful and peaceful times one can ever experience.
Peace, calm expectation and a subtle excitement of the storm’s beauty are in the eye, as is anxiety of the anticipation of what’s to come — the second half of the storm. Having personally stood in the eye of one of the largest hurricanes on US record, and having survived one of the most terrifying storms of my life, I can tell you that the eye of the storm is a brilliant, calm and peaceful place in what is actually an extremely deadly and dangerous place to be.
However, when the eye passes, the storm rages again, even more fierce than the penetrating force of the first half of the storm. Again, there’s more fear; more stress; more panic. Finally, the storm passes, slowly and subtly. The wind disappears, the sun breaks free and among the chaos, birds sing with striking clarify and beauty. It’s as if their songs are the only remaining sound because the storm has sucked all else away. Their song is an encouragement as you assess your losses and determine the first steps required to put your life back together.
Certainly, ICD-10 is not deadly, nor is it as dramatic as surviving a killer storm, but the process has been stressful, and painful and chaotic for millions. We’re in the eye, half way between beginning and end. Much has happened, but there is still a great deal more to come. I image that’s how many of you are feeling today; trying to ride out the storm — in peace, in fear or maybe a combination of the two. So, on this occasion, as we wait, I thought I’d provide a few final thoughts about ICD-10 from those working alongside you, in the trenches, who are also weathering the storm. Hopefully these insights provide you some peace, and help you get through this stressful time.
With the transition to ICD-10, we expect three types of industry disruption occurring at different times. First, starting in the first few days after the Oct. 1, 2015 cutover, when providers start transmitting claims containing ICD-10 codes (between 10/3 and 10/10), we predict that providers that chose to ignore the ICD-10 mandate will receive a monumental wake-up call when clearinghouses and payers immediately reject their ICD-9 coded claims as non-clean HIPAA transactions. We believe that most of the nonconformists will be smaller, rural professional providers and small practices. They will scramble to get ready in short order if they wish to be paid for their services.
Second, by mid- to late-October, providers will start receiving payments based on claims submitted using ICD-10 codes. Most professional claims are reimbursed based on the CPT/HCPCS codes and therefore are not susceptible to payment shifts. Institutional claims are paid via a wide range of reimbursement mechanisms, mainly due to combinations of both ICD-10 diagnosis as well as procedure codes. ICD-10 testing between providers and payers illustrates that four out of five payment disputes are because of poor coding accuracy from the provider. We see an increase in phone calls to payers and an elongated revenue cycle collection timeframe.
Third, throughout 2016, we see overall data quality issues emerging as the industry stabilizes and acclimates to the new code set. Although CMS relaxed coding accuracy requirements for Medicare fee for service claims, commercial payers have not followed suit. Be prepared for an increase in chart reviews and ongoing adjustments to previously paid claims.
Coastal Orthopedics has been serving the coastal South Carolina region for more than 30 years, and has helped countless members of our community regain and maintain a full quality of life. In those years of serving our community, ICD-10 has without a doubt been one of the biggest challenges that our practice has faced to date. With major overhauls to our practice workflow and ultimately our ability to provide the best care to our patients on the horizon, we set out early to meet the demands of the ICD-10 transition proactively.
The success of our transition to ICD-10 has been two-fold. One: our software partners (SRS Soft EHR and Allscripts Practice Management) have continued to deliver exceptional tools that have allowed our practice to leverage the power of healthcare information technology to expand our ability to provide exceptional care exponentially. Two: The dedicated staff and physicians of our practice, who truly love getting to be a part of helping our patients live their best life, have invested countless hours of preparation into being sure that our patients continue to receive only the best care. After months of updating our office systems/processes, working with care partners across the community, working with our software partners to fine tune our systems, and working with insurance companies to ensure that our patients get the most of their benefits, we’re ready to take ICD-10 head-on.
October 1st will be just another day of providing exceptional orthopedic care to our community for Coastal Orthopedics.
The day before, the day of and the day after ICD-10 goes live, it will be too late. But, as we get closer to ICD-10 go live, there are some final preparations that you can do before it does, and some remediation that can be done post go live. Physician practices and hospitals can focus on the procedures and visit types that drive their practices. We call this focus, the Codes that Matter. A very small percentage of procedures and visit types drive 95 percent of revenue so focus on those key areas to protect your revenue.
In addition, the physicians and hospitals need to take a snap shot of financial and revenue cycle performance prior to going live. This is especially critical at this point. The hospitals and physician practices have to know where they are today so they can effectively evaluate their financial and revenue cycle performance post go live. Financial “fire drills” need to be conducted to practice and prepare for revenue cycle impacts. How to prevent 10 percent to 15 percent revenue hits? If we see those issues arising, how do we quickly address and how do we rapidly deploy teams to close the issues. Waiting until the day before, similar to cramming for the test will not work well for the October go-live. There are a couple of things listed above that can still make a difference so the time is now before the die is cast.
Michele Hibbert-Iacobacci, CMCO,CCS-P, vice president of information management support, Mitchell International.
Michele Hibbert-Iacobacci
With the October 1 implementation date for ICD-10 just around the corner, many providers are in need of a quick, at-a-glance refresher to their training. The implementation of ICD-10 has been delayed twice, so many providers that had solid plans for training in advance are not as prepared as they had intended to be.
Quick reference guides are in even higher demand considering the influx of codes required by ICD-10. Currently, ICD-9 includes 13,800 three to five digit, primarily numeric diagnostic codes. By contrast, the ICD-10 code set will contain roughly five times that number, totaling approximately 69,000 three to seven digit, alphanumeric codes.
To alleviate the last minute training scramble, ICD-10-focused readiness material and courses from widely accepted and well-known organizations may help ensure a smooth transition come October 1.
American Association of Professional Coders (AAPC) have go-at-your-own pace online courses for both ICD-10-CM and PCS.
Are you ready to transition to ICD-10? The countdown is on. As those of us in healthcare know, next week the industry in the United States will (finally) undergo a significant change as we transition from ICD-9 to ICD-10. ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and is used primarily to document diagnoses in a codified manner. The most recent revision has nearly five times more codes than its predecessor because of its increased complexity and specificity of ICD-10 codes.
Healthcare organizations in the U.S. have been preparing for the ICD-10 transition for nearly five years. Multiple delays, brought on by substantial lobbying efforts against the transition, led to elongated wait time, but the time has come and we’re ready to launch. Personally, I’m glad. I look forward to healthcare moving beyond this conversation; the infighting ICD-10 has caused among members and associations in the community has done us all a disservice. Perhaps, on October 2, the day after the implementation deadline, we can begin to move on to other issues — slowly, of course — so that the brilliant minds in healthcare can once again focus on more pressing, important issues than the dollars and cents of claims and the numbers needed for them to be paid by our payer partners.
As the transition date draws near, make sure you’ve got all your priorities and details in line. ICD-10 is no lightweight matter, as you have likely discovered. Cerner created the following video, “10 Things You Should Know to Get Ready for ICD-10,” that I’m posting here, with the company’s permission. Though my publishing it is a bit last minute, the video offers some tips that might help you prepare for “doomsday.”
This video reviews what Cerner considers the top 10 things you need to do to prepare for ICD-10; it also covers technical pieces related to Cerner’s Millennium solutions, as well as operational pieces to help with the transition. Overall, it’s a nice resource that may provide you a bit of last minute ICD-10 insight and comfort for the change again. Here’s to your ICD-10 health. Enjoy!
Errors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.
While many organizations have placed a priority on avoiding billing errors, they still occur. And with the upcoming transition to ICD-10, home health and hospice providers are under even more pressure to get billing right the first time, every time. By most accounts, providers can expect to see a spike in rejected claims during the first few months of ICD-10 implementation; some estimate that as many as 10 percent of all claims will be rejected as coders get used to the new procedures. That’s bound to have an effect on payments and cash flow, so it’s vital that agencies work with their billing offices to identify common errors now, and look for ways to overcome them.
Preparing for the Transition
Ideally, home health agencies should be in the final stages of preparing for the launch of ICD-10 now. August 3 marked the beginning of the 60-day episode period that would end on October 1, when ICD-10 goes into effect. This means that agencies that are beginning care episodes now are required to submit RAPs in ICD-9, but code them in both ICD-9 and ICD-10, so that when the final bill is submitted to Medicare, it will be in the correct format. In many ways, this gives home health providers an advantage, since they will have two months’ worth of practice with the new codes on almost every chart, where most other providers are only practicing dual coding on some charts.
Because of the dual coding requirements, most home health providers have already switched to an ICD-10 compliant software solution. Now is the time to identify gaps in training, and adjust intake procedures, forms and other resources that affect how services are billed. Mitigating potential obstacles now will prevent denied claims later, and smooth the transition.
The Most Common Errors
While the new coding procedures will undoubtedly be a learning curve for many providers, you can reduce the overall number of denied or delayed claims by paying close attention to the most common errors and taking steps to avoid them. These include:
For many practices, the focus this year has been on ICD-10 and preparing for an effective transition. As a result, a growing problem has been slipping under the radar—patient collections.
Today, patient due amounts make up 30 percent or more of practice accounts receivable. And the longer it takes the practice to collect from a patient, the less they get paid. According to Mary Pat Whaley, after 60 days the percentage collected drops to below 60 percent.
ICD-10 will likely remain a key focus for practices through the end of 2015 at least. But don’t let that stop you from taking some time to look at the state of your patient collections. This infographic shows how the landscape is changing and what practices can do to ensure they get paid.
Guest post by Daniel Schwartz, content strategist, CureMD.
Daniel Schwartz
On Oct. 1, 2015, the 10th revision of the International Classification of Diseases, or ICD-10, will go into full swing, requiring that all healthcare institutions and organizations covered by the Health Insurance Portability Accountability Act comply as such. This will mark a transition from the previous classification of diseases, called ICD-9. The Centers for Medicare and Medicaid Services (CMS) has already released several documents and other mediums of information to help answer questions and concerns about this upcoming change and to provide avenues of approach to handling the upgrade, and you might find that, if you’ve waited until now to begin preparation or even so much as to begin thinking about this major coding change, you’ve waited far too long.
In a recent survey done by the Workgroup for Electronic Data Interchange (WEDI), 25 per cent of physicians stated that they are not going to be ready when the ICD-10 compliance date arrives, and another twenty five per cent stated uncertainty. Marcia Frel lick, author of the article on Medscape that represents this statistic, writes that Robert Tennant, vice chair of the WEDI group, says that “the physician side of the provider community [is] really struggling,” and, judging by the numbers in their survey, he seems to be largely correct.
Exactly a year ago, Aug. 10, 2015, the first phase of the recommended transition process, suggested and published by aafp.org in early 2014, would be less than two months away. This debut entry into the process would begin October 1 and end in December, and would include necessary tasks such as scheduling hard-date meetings with committees and personnel, conducting large inventories of coding, becoming vastly familiar with the ICD-10 coding itself, budgeting for the transition, learning your implementation plan, and much more. After the completion of the first phase, the second phase would then begin in January of 2015 and last until April, demanding the passing of tasks like completing ICD-10 training on all levels, reviewing insurance contracts, evaluating your current cash flow, and determining the impact quality initiatives, such as PQRS and Electronic Health Records, had in 2014 for your institution. These are only two of the five total phases aafp.org suggests you complete, and if you’re just now starting to look over what needs to be done, you’ll be cramming all of this scheduling, monitoring, determining, and preparing while you’re already integrating ICD-10—specific workflow plans, processes, and claim submission resources; in other words, you’ll be doing far too much within a miniscule time period, leaving too much room for error, failure, and dissatisfaction.
ICD-10 will provide more than 14,400 distinctive code sets and the ability to track many new diagnoses for hospitals and other practices. Such a large database of higher-echelon information does not demand proper transition, but requires it. Since the current ICD-9 codes are being used in almost all current healthcare processes, rather significant and grandiose substitutions and reincarnations are going to have to take place. This large-scale implementation is required so as to ensure that the codes will be put into place and used correctly, because of the improvements they carry for features such as service reimbursement, coverage qualifications, population health management and reporting, and more.
If you’re already feeling concerned about waiting too long, there are other concerns you should be worried about that would have been your only concerns if the proper preparation-phasing would’ve taken place much earlier in the year. A lot are worried that the translations from the previous ICD-9 to the current ICD-10 will not be straightforward or easy to follow, and some of these translations are indeed not directly correspondent. They include disproportionate changes that go both ways, from ICD-9 to ICD-10 and vice versa. In spite of this, there have been tables and crosswalks published to make this transitional process more painless, but it’s going to take more study and observation in order to properly determine how the coding will completely change. Practices and institutions of healthcare that have not been preparing sufficiently for these new and complex implementations and upgrades ICD-10 will bring will be maniacally wishing they had when the date of compliance arrives.
Errors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.
