The Clock's Ticking

ICD-10 Coming in 2014 

 Texas Medicine Logo 

Practice Management Feature – January 2013 

 By Crystal Conde 
Associate Editor 

Tex Med. 2013;109(1):37-40.

Thanks to objections from the Texas Medical Association and others, the U.S. Department of Health and Human Services (HHS) last year granted physicians a reprieve from switching to the ICD-10 coding system, moving the deadline from Oct. 1, 2013, to Oct. 1, 2014.

TMA delegates convinced the American Medical Association House of Delegates in November 2011 to go on record opposing ICD-10. At TMA's insistence, AMA adopted a resolution urging the Centers for Medicare & Medicaid Services (CMS) not to adopt ICD-10 because of its "bureaucratic and financial burden on physicians." The resolution also warned ICD-10 would force many physicians in small practices out of business. 

But CMS was only willing to delay implementation for a year, thus, barring some unforeseen circumstances, ICD-10 will become a reality in 2014.

Austin colon and rectal surgeon David Fleeger, MD, past chair of the TMA Council on Practice Management Services, is concerned about the time, cost, and "an inefficiency that goes on forever" associated with the ICD-10 conversion.

"It's the private practice doctor in small groups who's going to have the biggest problem implementing ICD-10," he said.

AMA is not giving up, though. At the AMA House of Delegates meeting in November 2012, delegates adopted a resolution reaffirming its opposition to ICD-10. The resolution said "in order to alleviate the increasing bureaucratic and financial burden on physicians, our [AMA will] vigorously advocate that the [CMS] eliminate the implementation of ICD-10 and instead wait for the adoption of ICD-11 … [and] immediately reiterate to the [CMS] that the burdens imposed by ICD-10 will force many physicians in small practices out of business."

Although TMA opposes the transition to ICD-10, it is committed to helping physicians get ready for the new coding system, should CMS persist in its current trajectory. TMA, AMA, and coding experts recommend physicians plan now, as ICD-10 promises to affect every aspect of their medical practices.

Edinburg pediatrician Martin Garza, MD, a member of the TMA Council on Practice Management Services, spent 2012 completing Stage 1 electronic health record (EHR) meaningful use requirements and meeting Health Insurance Portability and Accountability Act 5010 electronic claims standards. (See "Ready for 5010?" in November 2011 Texas Medicine.)

"Now it's time to turn our attention to ICD-10. Working to achieve meaningful use and transitioning to HIPAA 5010 last year taught me and my staff that we shouldn't underestimate the amount of time we need to allot for ICD-10 implementation," he said.

Arming physicians with tools for a successful ICD-10 implementation while alleviating documentation and coding hassles is a TMA priority. (See "Coding Help From TMA.")

The association collaborated with Louisiana-based Complete Practice Resources (CPR) to develop web-based tools that help physicians successfully transition to ICD-10 and help ensure they continue receiving payments after Oct. 1, 2014.  

CPR President Denny Flint says physicians need to know the significant impact ICD-10 will have on documentation.

"Physicians are ultimately the cornerstone for ICD-10 implementation success. Physicians can have the clearest communication plan, most thorough impact assessment, and the best implementation plan. But at the end of the day, if physicians don't document, coders can't code, billers can't submit claims, and the entire implementation process was time and money wasted," he said.

Use TMA's Tools 

Manually converting ICD-9 codes to ICD-10 can take hours, even days. To help reduce the conversion time frame, CPR developed the Simple Solutions ICD-10 Transition Software. It's available from TMA for $129.

The software can generate a medical practice's top 50 codes in a matter of minutes. It can also create coding flash cards of most commonly used diagnoses that physicians can share with their staff members. 

It allows physicians and office staff members to search ICD-9 and ICD-10 by code, description, and key word; create and save a list of commonly used codes; and develop and print quick-reference conversion lists.

The software illustrates the new code structure's dramatic differences in specificity and chart documentation. For example, when "fracture of the patella" is typed into the transition software, ICD-10 may require additional documentation, such as asking physicians to specify laterality, type of encounter, and degree of healing. Search results for fracture of the patella list two codes in ICD-9 and 480 in ICD-10.

To make the code search more manageable and to hone in on the appropriate ICD-10 code, physicians can type in additional key words from the patient's chart. Physicians and staff members can also use the software to convert their super bills or EHR problem lists to ICD-10 with just a click of the mouse.

At press time, TMA was working with CPR to finalize the Simple Solutions ICD-10 Tool Kit, which includes the software. Contact the TMA Knowledge Center at (800) 880-7955 to inquire about product availability.

Mr. Flint says the tool kit helps physicians organize, assess, and track all elements of ICD-10 implementation.

"Without a logical, measured, and organized approach to implementation, important pieces will be missed. Everywhere a diagnosis code touches the practice, impact must be addressed. The tool kit provides the means to do this in a truly turn-key, all-inclusive way with every piece of the ICD-10 puzzle accounted for."

The tool kit allows automatic importation of data elements and features instructional videos for each phase of ICD-10 implementation. It also includes a 50-page guide book, timelines, and important deadlines.

Budget for the Switch 

Transitioning to ICD-10 won't be cheap. A 2008 report by a Maryland-based consulting firm, Nachimson Advisors, LLC, says it could cost a three-physician practice up to $83,000. A 100-physician group could pay more than $2 million to convert to the new system. The American Academy of Orthopaedic Surgeons and 11 other health care organizations commissioned the report.

Mr. Flint says physicians should budget for implementation costs, including hardware and software upgrades, training, and short-term loss of productivity.

"Physicians should be asking their IT vendors now who will pay for the ICD-10 hardware and software upgrades," he said.

Physicians using old practice management systems should consider an upgrade. He says the price of many EHR systems includes a companion practice management system.

He advises physicians to plan for an estimated 20-percent loss in productivity early in the transition to ICD-10 because they won't be able to see as many patients and will likely have increased claims denials due to a lack of familiarity with the new processes.

Mr. Flint encourages practices of all sizes to take ICD-10 implementation seriously and to develop a plan.

"While smaller practices may have fewer moving parts affected by ICD-10, they also typically have fewer resources to assist with the transition. Small to medium-sized practices should especially take advantage of TMA's expertise and resources," he said.

Get Started Now 

AMA published "ICD-10 Timeline: Meeting the Compliance Date" to help medical offices prioritize their preparations.

The timeline's nine critical steps take at least 22 months to complete, so medical practice staff should be working now to ensure that employees, office technology, and internal operations are ready to make the switch on Oct. 1, 2014. The nine steps, with expected minimum completion times in parenthesis, are:  

  1. Conduct an impact analysis on business practices and systems to determine how the switch will affect operations. Next, inventory all systems, both electronic and manual, that use ICD-9 codes. By conducting this review as early as possible, physicians fully understand the scope of work ahead and prioritize important tasks. (3 months)
  2. Contact vendors about the dates, expected costs, and other details of installing the ICD-10 upgrades on computer systems. (2 months)
  3. Contact payers, billing services, and clearinghouses to learn when their ICD-10 upgrades will be completed and when they'll be ready to begin testing transactions using the new codes. Likewise, doctors should let these groups know when they expect to have their office system upgrades installed. (2 months)
  4. Because the timing of system upgrades to a medical office is dependent upon the readiness of the vendors serving that office, it's important to talk to vendors about upgrades early on. This also may help reduce ICD-10 transition costs. Upgrade other systems, such as quality reporting and public health reporting tools, as well. (3 months)
  5. Once the upgrades are complete, conduct internal testing to ensure the upgraded systems can generate transactions with the ICD-10 codes. Practices should allow extra time for troubleshooting and working with vendors to address any obstacles. (2 months)
  6. Update internal processes that support coding. These include super bills, encounter forms, quality data collection forms, and public health data collection forms. Take this time to review clinical documentation to ensure it captures the necessary details of patient diagnoses. (2 months)
  7. Train every staff member. The training times should be staggered to prevent down time in the practice. Coding staff may want time to practice using the ICD-10 code set on sample claims, such as current claims, before the compliance date. (2 months)
  8. Conduct external testing with clearinghouses, billing services, and payers to make sure they can properly send and receive ICD-10 codes in transactions. (6 months)
  9. Switch to ICD-10 on Oct. 1, 2014. Payers will not accept claims with ICD-10 codes before Oct. 1 and will reject transactions that continue to use the ICD-9 codes after Oct. 1, 2014.

TMA urges physicians to start preparing for ICD-10 now.

"Waiting until the last minute or expecting CMS to postpone the implementation date sets a medical office up for loss of productivity and decreased revenue," Dr. Garza said.

Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email. 

 RELATED STORY  

Coding Help From TMA 

The Texas Medical Association can help your practice prepare for ICD-10. TMA Practice Consulting offers a variety of services to help ensure your reimbursement doesn't suffer during the transition. Don't delay in ICD-10 planning and implementation.

To inquire about any of the following services and resources, contact TMA Practice Consulting by telephone, (800) 523-8776, or by email. All services are available for a fee based on a practice's needs.

 ICD-10 Starts With Physicians: A Primer for Beginning the Process 

This TMA lunch-hour webinar on Jan. 30 will educate participants on the financial and operational impacts of ICD-10. TMA urges physicians to prepare now to ensure ICD-10 implementation is a gradual and systematic transition. Start off on the right foot with ICD-10, and register for the webinar.

 Coding and Documentation Customized Training 

TMA Practice Consulting offers on-site training for practices that need help understanding documentation guidelines or identifying inappropriate or inaccurate coding and weaknesses in medical record documentation. The two-hour session, customized to the practice specialty, covers a review of 1995 and 1997 evaluation and management (E&M) documentation guidelines, time-based coding, modifiers, and audit triggers, among other topics. It is approved for up to 2 AMA PRA Category 1 Credits™. 

Coding and Documentation Reviews 

Get a glimpse of your coding techniques with E&M coding and documentation reviews from TMA Practice Consulting. The reviews include a claims coding and medical record documentation analysis of 10 records per physician. An abbreviated checkup and a comprehensive review are available.

TMA Practice Consulting also can conduct a quarterly coding and documentation review to determine whether a medical practice is following payers' guidelines for appropriate billing year-round. Simplified reporting of the checkup findings allows physicians to step back from the details and realize the underlying trends that directly affect revenue through visual illustration.

Comprehensive Chart Audits 

Have your coding and documentation techniques thoroughly analyzed and the findings presented in a formal, written report that outlines opportunities for improvement. TMA Practice Consulting reviews a practice's documentation for accurate CPT coding; appropriate application of CPT coding guidelines; E&M coding guidelines; correct use of modifiers; encounter forms; claims; and corresponding explanations of benefits to ensure accurate billing and payment.

TMA Practice Consulting can perform audits monthly, annually, or quarterly. Audits are approved for 20 AMA PRA Category 1 Credits™.

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