IN THIS ISSUE
In the News
ICD-10 BOOT CAMPS
Green Bay 8/18
Grand Rapids 9/15
This e-Newsletter offers the most up-to-date and essential news and information about the transition to ICD-10. If you would prefer not to receive these monthly updates, you can change your email preferences in your account.
by Jo-Anne Sheehan, CPC
Preparedness within the health care industry should always be a priority, yet many providers depend on their office administration, IT support, or software vendors to keep them current with annual updates directly affecting their practice.
In the past, internal problems that may have developed due to negligence required minimal adjustments to get the workplace flowing again. However, implementation of Version 5010 and the transition from ICD-9-CM to ICD-10-CM will not be an easy fix should a provider assume a wait-and-see attitude toward these significant changes slated for October 1, 2013. The "go live" date for 5010 is much closer, at January 1, 2012.
For some providers, 2013 is too far into the future to contemplate. For others, Version 5010 is an issue, as it is a concept which is not clearly understood, resulting in deficient planning. Unlike previous changes that have occurred in health care, there will be no grace period with the transition to Version 5010. Without preparation, practices will experience unrecoverable financial loss, particularly with health plans that impose filing limits.
To understand Version 5010 and its relationship within a medical practice, review the following electronic transactions that most providers utilize. Keep in mind that 5010 is the only version that will accommodate ICD-10-CM's size of 3 to 7 alpha-numeric character spaces and its complexities for submission standards.
- Electronic Claim Submissions and Remittances
- Electronic Referrals and Authorizations
- Electronic Eligibility Inquiries
- Claim Status Inquiries and Claim Adjustments
- Coordination of Benefits
- Clearinghouse Communication
- Practice Management Software
- Electronic Medical Records Utilization and Interaction with Practice Management Software
Providers may not comprehend the internal improvements with the transition from Version 4010 to Version 5010, but planning ahead and budgeting for the future now is the only solution to health care's upcoming changes.
It is only by working hand in hand with our vendors and testing often and early that we can identify any issues we may have and take the necessary actions to be sure our revenue is not interrupted. The Centers for Medicare & Medicaid Services (CMS) are declaring the week of August 22 as a national testing week; be sure to join in and test with your vendors.
IN THE NEWS
CMS, in conjunction with the Medicare Fee-for-Service Program, announces a National 5010 Testing Week from August 22 - 26. National 5010 Testing Week is an opportunity for trading partners to come together and test compliance efforts that are already underway with the added benefit of real-time help desk support and direct and immediate access to Medicare Administrative Contractors (MACs).
While walking to her car from her house, pulling two suitcases, the patient fell in her driveway. She landed on her left knee, striking her left shoulder. Patient states she heard a pop type sound of her right foot. Patient's right foot is swollen, bruised, and sore to the touch. X-ray of the right foot reveals a fracture of the 5th metatarsal at the proximal site. Patient was placed in a walking boot and will return in two weeks to evaluate the healing process. If there has been no progress then the patient will be scheduled for surgery to place a screw at the fracture site.
- 825.25 Fracture of metatarsal bone(s) closed
- E888.8 Other accidental fall
- E001.0 Activities involving walking, marching and hiking
- E849.0 Home accidents
- S92.354A Nondisplaced fracture of fifth metatarsal bone, right foot, initial encounter for closed fracture
- W18.30XA Fall on same level, unspecified, initial encounter
- Y93.01 Activity, walking, marching and hiking
- Y92.014 Private driveway to single-family (private) house as the place of occurrence of the external cause
Rationale: In ICD-10-CM, certain code sets, like fractures, include laterality. In the case above, we show that it is the right foot that has been fractured, whereas in ICD-9-CM, that information is not available to append on a claim. According to the ICD-10-CM Draft Official Guidelines for fractures (C.19.c), a fracture not indicated as open or closed should be coded to closed. While not specifically stated in the note, this is a nondisplaced fracture. With nondisplaced fractures, the bone cracks either part or all of the way through, but does move, maintains its proper alignment, and does not have to be reset. In the case above, no realignment was necessary. The patient's foot was placed in a boot and no other treatment was performed at the time.
ICD-10 Implementation Strategies
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
If you are dependent on a vendor for your 5010 conversion, you need to have increased communication with them on their 5010 timeline, including their testing schedule. With less than six months until implementation, you want to ensure that the vendor is on schedule to convert. Depending on your practice, you may need to check with: practice management software vendors, your IT department, billing services, clearing houses, and payors. Ask them what they are doing, how long have they been testing, and if they are having any issues. You will want to make sure that you have ample time to test with your trading partners (e.g., clearing houses, payers) to avoid transaction rejections and the revenue impacts that will follow.
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