Billing > Billing
ICD-10 Begins
RichardP:
Here we go. Good luck everybody.
Within the last week we have had clients new to us insist that, for the next year, using ICD-10 is optional. Or, they have been told by other providers that - where one ICD-09 code translates approximately to multiple ICD-10 codes - the provider must use each and every one of the multiple ICD-10 codes or the claim won't get paid.
These are highly-paid doctors in Beverly Hills. I wouldn't have believed it if I hadn't heard it myself. Fortunately for them, we set the new clients straight. Hopefully, they are passing the correct information back to those they heard the incorrect information from.
This next year is going to be interesting.
For one last time, for those who might need it, here is a resource that is quite good.
http://www.icd10data.com/Convert
Converter
http://www.icd10data.com/ICD10CM/Codes
ICD-10 Diagnosis Codes
http://www.icd9data.com/
Main Page
Michele:
We have also heard some similar crazy information as well. Someone actually said on Monday "they may delay it again right?" :)
I'm not anticipating any big issues for us, just a few bumps, but it will be interesting to see how we all do! I told a couple of my doctors "it's like Y2K, tomorrow we will all wake up and everything will be ok". Unfortunately there are vulture companies out there trying to get money out of everybody using fear tactics. One of our smaller clients (one doctor chiropractor who is semi retired) had someone offer to translate all of their patients' diagnosis for them for $2500 down, and the rest of the bill due upon completion.
Let's keep each other posted.
kristin:
At my office, everything has been business as usual. I made a few extra tweaks to my ICD-10 superbill today, but that was it. That said...
I already see a fairly large problem with my remote billing jobs, in that the various EMR/PM systems I use for them are converting the ICD-9 codes over to ICD-10 codes, and they are all converting to unspecified codes, if multiple more specific codes exist. While I know that there is a one year grace period with CMS for this use of unspecified codes, I don't want the providers to start off on the wrong foot by simply letting the EMR assign an unspecified code, when they should actually be looking for the specific code they need in the system.
I am also surprised all over again at how unprepared/uninformed so many providers/coders/billers were yesterday, based on what I was reading on various forums. I am talking about very basic stuff, that nobody seemed to understand.
One other thing...for the last two years I have been reading articles about how much money it would cost a 1-3 provider practice to make the transition to ICD-10. At one point, I think the high figure was like $50,000. I could never understand why the dollar amount was so high, and in the end, it was crazily inflated. We transitioned for under $1500. Upgraded software, and a mapping book, that was all that was needed. I really hope people didn't get scammed by companies like Michele mentioned in her post.
All in all for me, ICD-10 turned out like Y2K. Much ado about nothing. Now if the insurance companies delay payments, that will be a different story, and remains to be seen.
RichardP:
--- Quote from: kristin on October 02, 2015, 07:10:57 PM ---... the various EMR/PM systems I use for them are converting the ICD-9 codes over to ICD-10 codes ...
--- End quote ---
Kristin - can you provide a bit more detail on that statement please. re. the remote systems:
1. Are you the one putting in the diagnosis codes?
2. Or are you talking about a situation where the doctor is placing the codes into the EMR, and the EMR is sending the codes to the PM side?
3. If Point 2 is the correct answer, are the doctors still using the ICD-9 codes, and letting the EMR translate from 9 to 10 on the fly?
One of our new clients is using the AthenaHealth system. He puts the codes into the EMR, AthenaHealth's black box does its thing with his codes, and then he has to do the follow-up. Did the insurance pay? If yes, was it correctly posted to the proper patient? Was the correct amount posted? Does the claim need to be appealed? He has no desire or expertise to do this work and so he has hired us to do it. Plus oversee his transition to ICD-10.
AthenaHealth gave us an Excel spreadsheet that we could download which lists the doctor's most frequently-used diagnosis codes, and the ICD-10 code(s) they had translated them to. We verified that they were all correct. But also noted a significant number of the codes had translated to unspecified. That is because the ICD-09 codes were also for unspecified.
Our primary goal was to be as certain as possible that our client could see patients on 10-1 and be confident that the ICD-10 codes he picked would pass through the AthenaHealth system and on to the payors. We assured him that this would happen, but that we would need to fine-tune his codes over the next few months. Kristin, it seems you will need to do that also with your remote clients. Medicare has said that, for the next year, they won't reject codes so long as they are in the correct family of codes, so we have some time to do this.
For all of our clients, over the next few months, we are going to make certain that the ICD-10 unspecified codes remain only in those instances where it is actually the correct choice. That will be a simple task for the Internal Medicine folks. Not so easy for the specialists.
The other class of codes we need to tighten up are the ones that have a left/right or top/bottom choice. For now, Medicare at least will pay on codes that don't specify where on the body. In 12 months, they will probably reject claims that contain codes that should specify where on the body and don't. When this happens, I predict a good number of doctors will give up and join doctor's groups where they can just practice medicine and get paid, and leave the coding up to others.
kristin:
Richard, here is what I have figured out since I wrote my post, because I went into the EMR's, and did some further digging around(basically I am dealing with Point 2, to Point 3)
Each EMR was upgraded to include every ICD-10 code available. However, the mapping that was done automatically most frequently maps to an unspecified code, because as you say, the ICD-9 codes were unspecified to begin with. Because I bill only for specialists, there are very few codes that have an equivalent mapping available. 99% of them need laterality, A,D,S, or causation factors listed. Gout, for example, went from two codes basically, to over fifty codes. Same with diabetes, ulcers, etc.
The provider enters the superbill through the EMR, and chooses CPT and ICD-10 codes, and assigns them accordingly. I go in to the EMR, look at the superbill, and then transfer the charges manually to a completely separate PM software. But how the EMR superbill is set up is that the provider can just pull up the ICD-9 code that they have always used in the past, and the ICD-10 code that mapped to it is right next to it, so the provider assumes that they don't have to do anything further, the EMR did it for them. Should they want to, they CAN search for a more specific ICD-10 code, and use that one. But that isn't happening. The reason I think it isn't happening is because the providers were assured by the EMR people that "you just need to code ICD-9, and it will convert for you!". In fact, one of the EMR's I use says this on the log-in page:
"Transition to ICD-10 without having to know a single code with our streamlined diagnosis selection". Yeah, great. That just encourages providers to think they will never have to actually learn the codes in any way, because the EMR will handle it. :-\
So I am now looking at billings that almost exclusively have unspecified ICD-10 codes used, and now I have to talk to the providers, and the owners of the billing companies, and get everyone to understand that this isn't going to work, for the very reasons you stated...while claims won't reject during the grace period, that will change come Oct. 1, 2016. Which is why I want to nip this in the bud now, before the providers get too reliant on the EMR.
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