Are you prepared for ICD-10-CM?

As the implementation of ICD-10 is only six months away, now is the time to assess your readiness for the change and think about how this new system will affect your practice. Although we are all hoping and wishing for another delay, we believe the odds of that happening at this late date are remote.

Diagnosis Codes Only - CPT Stays the Same

Remember that only the diagnosis codes are changing, requirements for CPT coding remain the same. And though there are a greater number of codes in ICD-10-CM for diagnoses compared to ICD-9-CM, not all the codes will be used by every physician. Much of the increase in the number of codes is due to adding codes for the same condition on the right or left side of the body. For example in ICD-9-CM there is one code for acute conjunctivitis and in ICD-10-CM there are four codes: right eye, left eye, bilateral and unspecified. The added codes are also due to increased specificity. For example ICD-9-CM has one code to identify dermatitis due to drugs and medicines taken internally, while ICD-10-CM has two codes; one for generalized and the other for localized skin eruptions.

Documentation of many of these details is likely already included in medical records. For example the eye involved in conjunctivitis would be a part of the record, we simply are not coding to that level of detail now. How to be sure that all needed detail is included? If Electronic Health Records are used, often the documentation templates needed to assign ICD-10-CM codes are included and vendors may provide ICD-10 software upgrades as a part of their update packages.

Testing

Testing is important in assuring that claims processing will go smoothly on October 1st. Some of these testing activities can take place within the practice. From a coding standpoint, a certain percentage of cases can be dual coded using both ICD-9-CM and ICD-10-CM codes to identify areas where documentation or coding issues may arise.

Working with your biggest payers in end-to-end testing of claims processing will help to pinpoint areas that need adjustment before the implementation deadline. You may want to contact your billing company (if you use one), Practice Management Software vendor and/or clearinghouses to see what testing they’ve done with payers or one another. There are multiple entities that “touch” a claim from the time it is produced by the practice until it appears back to the practice in the form of an Electronic Remittance Advice (ERA). Testing needs to involve each of those entities so that if there is a breakdown, you can identify where in the chain the break occurred. AND when you receive the ERA, was it what you expected? In other words, did the test claim result in a “payment” that was what you expected to receive? Simply getting an ERA is not sufficient. The information in the ERA must be correct.

The Centers for Medicare and Medicaid Services (CMS) has been involved in testing activities and recently completed their first round of end-to-end testing with approximately 660 providers and billing companies for 15,000 test claims. Marilyn Tavenner, Administrator for CMS issued a news update on this testing that took place from January 26 to February 3, 2015 on ICD-10 claims. Overall these claims were successfully submitted with most errors occurring in areas unrelated to ICD-10. CMS plans additional testing and work on areas that need improvement.

Resources

There are many articles and tools available for physician transition to ICD-10-CM. The CMS offers a Road to ICD-10 tool and other resources. Other sources include Coalition for ICD-10 Guide to Physician ICD-10 Conversion and an article from the Physicians Practice on ICD-10 Prep for Small Practices.

Advocacy Council Educational Offerings

ACAAI’s Advocacy Council will also offer two webinars on ICD-10-CM. The first, scheduled for 11 a.m. CDT April 23, will be designed for office staff, (physicians are welcome also) focusing on the key differences in ICD-10 overall and in the areas of the classification specific to allergy, asthma and immunology. The second webinar, offered at 7:30 p.m. CDT on May 14, is designed for physicians (office staff are welcome also) and will include an overview of the ICD-10-CM system and major changes. Get more information and register today!‚Äč