Home Health ICD-9/ICD-10 Alert

Published on Wed Oct 16, 2013 PDF

Caps lock is one thing you won’t have to worry about under ICD-10.

If you’ve kept your fingers crossed in hopes the ICD-10 transition will be derailed at the last moment, it’s time to stop wishing and start preparing. The ICD-10 implementation date of Oct. 1, 2014 “is firm,” said the Center for Medicare & Medicaid Service’s Denesecia Green during a recent CMS Open Door Forum.

To make the transition easier, CMS has started offering free training sessions via phone and the web, Green said in the Aug. 27 forum. In addition, CMS representatives aimed to dispel several common misconceptions about the new diagnosis coding program.

CMS Likens New System To Cell Phone Transition

The ICD-10 transition may seem daunting, but shouldn’t be, said CMS’s Daniel J. Duvall in an ICD-10 webinar published by CMS. “Physicians deal in diagnoses, not codes,” Duvall said. “Coders … look up diagnoses and find the associated code. If the phone book changed from one land line per family to one cell phone per person, would you be afraid to use the phone book? That’s what’s happening in the ICD world,” he said.

To support that statement, Duvall aimed to ease coders’ fears by reminding them that “An index of diagnoses is still an index of diagnoses, and the good news is that just as cell phones spawned contact lists, speed dialing, internet lookups and circles of friends, ICD-10 is spawning a new generation of coding apps — inexpensive office aids that help you find the code for your diagnosis, and maybe simplify claim preparation at the same time.”

Check Your Software For Coding Change Readiness

Right now, you should be confirming that your software can handle ICD-10, Duvall said. Next spring, your clinicians and coders should develop ICD-10 coding skills, and by next summer you should be filling out sample claims with ICD-10 just to familiarize yourself with it, he added.

Contrary to popular belief, you won’t be expected to report a vast number of diagnosis codes on your claims once ICD-10 is implemented, said CMS’s Pat Brooks on the webinar. “The ICD-10 codes are more precise. Therefore, one ICD-10-CM code may provide more detailed information than one ICD-9-CM code.” For instance, Brooks said, a single ICD-10 code will capture a type of femur fracture and also the fact that it involves the left femur.

Upper/Lowercase is not important: Many coders have questioned whether the letters in ICD-10 (such as “x”) must be reported as either upper or lowercase characters, with some fearing that claims will be denied if the character is reported as the wrong case, but Brooks dispelled that myth. “It is not mandatory that the alpha characters be reported as either upper or lower case,” Brooks said. “Either is acceptable.”

Don’t Fear Costs

In addition, providers that have been fearing nearly bankrupting their organizations due to the ICD-10 conversion should take heart, Duvall said. Realistic IT costs for ICD-10 conversion when it comes to claims processing software will depend on your specific situation, with the following variables, Duvall claimed:

• If you use paper claims, there will be no IT cost;
• If you use a free claim entry software program, there will be no IT cost;
• If you use a third-party claim entry system, the software cost depends on your system, but those with subscription or leased services will already have the cost of annual updates built into your subscription;
• If you purchased a claim entry system, you will face additional costs if you have an older system, since you’ll need to upgrade it. “However, that cost is not necessarily large,” Duvall said. In addition, he said, the added benefits of automation inherent to the new system will help you reduce staff time in other areas and improve productivity.

Non-IT costs

You’ll also need to invest in new ICD-10 books and training for your staff members to streamline your ICD-10 conversion, Duvall said. He added that physicians who fear having to write reams of additional documentation to support ICD-10 codes needn’t worry. Only physicians who document poorly to begin with will have problems, he claimed. For example, docs who don’t currently write down whether they treated the right or the left leg “will need to change that,” he said. Otherwise, however, coders should easily be able to select codes based on the doctor’s documentation.

Breaking: Wondering which ICD-10 codes will be linked to LCDs? CMS has pledged to get you that information by April. “All ICD-10 local coverage decisions (LCDs) and associated ICD-10 articles will be published on the Medicare Coverage Database no later than April 10, 2014,” CMS says in MLN Matters article MM8348.

“All other LCDs and articles (i.e., those LCDs and articles that do not contain ICD-10 information, or articles not attached to an LCD) will be published no later than Sept. 4, 2014.”

Since the ICD-10 implementation date is Oct. 1, 2014, this should give you almost six months to nail down the LCD transition.

The MLN Matters article is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8348.pdf.