Medicare Compliance & Reimbursement

Tip: ICD-10 codes’ more detailed information will simplify claims in the long run.

Make sure your transition to ICD-10 is on track or you could find yourself running scared as the conversion date draws nearer. The Centers for Medicare & Medicaid Services (CMS) recently confirmed that the ICD-10 implementation date of Oct. 1, 2014 “is firm,” while busting some myths related to it. 

To make the transition easier, CMS has started offering free training sessions to practices via phone and the web, and plans to offer an online ICD-10 tool within the next few weeks, said CMS’s Denesecia Green during an Aug. 27 CMS Open Door 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, MD in an ICD-10 webinar published by CMS on Aug. 28. “Physicians deal in diagnoses, not codes,” Duvall said. “Coders, and physicians when they code their own claims, 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

Right now, you should be confirming that your software can handle ICD-10, Duvall said. Next spring, your physicians and coders should develop your 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, practices that have been fearful of nearly going bankrupt due to the ICD-10 conversion should take heart, Duvall said. If you’ve heard that your new IT costs will be sky-high, you could be in for a pleasant surprise, since most of those IT costs were already incurred by your practice to convert to using the new 5010 transaction standard. “Going forward with ICD-10 does not add to that cost — it may help you reap the benefits,” Duvall added. 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 noted:

• 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. “If you don’t currently write down whether you treated the right or the left leg, you will need to change that.” Otherwise, however, coders should easily be able to select codes based on the doctor’s documentation.