ICD-10 now 1 year away, many ODs unprepared

October 22, 2014

The International Classification of Diseases, 10th Edition (ICD-10) code is scheduled for implementation in the U.S. on Oct. 1, 2015-less than a year from now. Many optometric practices will likely be unprepared and therefore at risk for serious claim-filing and cash flow problems, according to Rebecca Wartman, OD, the American Optometric Association's (AOA) point person on ICD-10.

The International Classification of Diseases, 10th Edition (ICD-10) code is scheduled for implementation in the U.S. on Oct. 1, 2015-less than a year from now. Many optometric practices will likely be unprepared and therefore at risk for serious claim-filing and cash flow problems, according to Rebecca Wartman, OD, the American Optometric Association's (AOA) point person on ICD-10.

“I do not think that ODs have spent enough time on ICD-10 yet,” Dr. Wartman told Optometry Times. “Most practices do not have a formal plan for transition. And many ODs are totally relying on their staff to do this for them or their EHRs to handle ICD-10-both not great ideas.”

Medicare fee cut, ICD-10 delayed for 1 year

While healthcare institutions will be required to use both sections of the ICD-10 coding system-the ICD-10 Clinical Modification (CM) codes for diagnoses and the ICD-10 Procedure Coding System for procedures-healthcare practitioners will be required to use the ICD-10-CM only beginning next October and will continuing to use the American Medical Association's Current Procedural Terminology (CPT) to report services.

Changing the way ECPs do business

However, the transition will still represent a major change in the way small healthcare practitioners do business, Dr. Wartman said.

The ICD-10 code set is far larger and more complex than the ICD-9 coding it will replace. It is designed to provide much more highly detailed reporting-the ICD-10 code set has roughly 68,000 codes and is designed to allow for the introduction of additional codes. By comparison, the ICD-9 system has 13,000 codes and limited space for additions. ICD-10 codes are longer, in many cases, than ICD-9s, with a digit-seven extension used when necessary to provide additional detail. ICD-10 supports the use of combination codes that can be used to classify such things as multiple diagnoses or a diagnosis with a complication. Eyecare practitioners will notice that the use of ICD-10 codes requires specifying whether a condition pertains to the right, left, or both eyes.

While ICD-10 codes are similar to ICD-9 in some respects, coding will be somewhat different than before, Dr. Wartman warns. The U.S. Centers for Medicare & Medicaid Services (CMS) has prepared general equivalency maps providing “crossover charts” for common conditions. Most EHRs provide assistance in ICD-10 selection. However, the additional specificity of the ICD-10 will mean practitioners and their coders will need to understand how to effectively search for and select the proper code, Wartman said.

“ODs seem to have the most trouble with coding the more complicated encounters, particularly injuries, that require a lot of different codes to fully describe,” Dr. Wartman said. “While the ‘extra’ codes are not required federally, I think that workers’ comp and some states will require the full coding for injuries.”

ICD-10 coding will be required of all health care providers covered under the federal Health Insurance Portability and Accountability Act (HIPAA) Security Rule, per CMS. That includes providers who submit claims to commercial and employer-based insurance plans, as well as Medicare, Medicaid, and other public health insurance programs, the agency says.

 

ICD-10 action plans

Although many healthcare practitioners may not yet be actively readying their practices for the new coding system, the Oct. 1, 2015 “deadline for ICD-10 allows healthcare industry ample time to prepare for change,” CMS asserted in a July statement on the transition.

Under its new Road to 10 program (www.roadto10.org), the agency recommends healthcare practitioners adopt a formal, four-phase ICD-10 “action plan” encompassing:

• Planning

• Assessment

• Implementation

• Testing

It should include checking with technology and service partners-including EHR and practice management system vendors, as well as billing services and clearinghouses-to assess readiness to properly use ICD-10s. Practitioners should also contact all third-party payers-including commercial insurance plans, Medicare carriers, state Medicaid programs, and military health plans-to establish a “bridge to readiness” with each, the agency says.

The CMS Road to 10 website offers a primer on ICD-10 coding as well as examples of ICD-10 codes that will be commonly used by various healthcare specialties. However, the website provides no information specific to primary eye care.

Specialized information on ICD-10 coding for optometry is available through the AOA, which offers its members a series of 10 webinars on the coding system. Most major national and state optometric meetings have offered ICD-10 education over the past year or will do so in the coming months, Dr. Wartman said. However, she fears many practitioners and optometric office managers are not taking advantage the educational opportunities offered them. Moreover, “many may not yet be putting the information they have on ICD-10 codes to the test,” she fears.

“Practice is extremely important in mastering the proper use of the ICD-10 codes,” Dr. Wartman said. Both Dr. Wartman and CMS officials urge practitioners to phase-in the utilization of ICD-10 codes over time by completing a gradually increasing number of test claims each month.

“Practice coding the encounters you have in your office every week-especially the more complicated and unusual encounters,” Dr. Wartman said.

Practitioners should then work with payers to see if their test claims will be accepted or would be paid, Dr. Wartman says. Medicare carriers will offer practitioners a series of frontend ICD-10 system test weeks, beginning this month.

 

Don’t get caught off guard

CMS has twice postponed ICD-10 implementation; however, the agency now insists it Oct. 1, 2015 deadline is firm. Implementation of updated ICD coding in the U.S. is required under an agreement with the World Health Organization (WHO). ICD-10 codes are already used for claims and reimbursement in 25 nations. The CMS sees ICD-10 as critical to not only improving healthcare record keeping in the U.S. but implementation of a planned value-oriented reimbursement system.

Nevertheless, some groups, including the American Medical Association, are still urging the CMS to again delay ICD-10 implementation or skip it entirely and implement the WHO's more advanced ICD-11 coding system.

However, most coding experts who spoke with Optometry Times believe an update of the nation's healthcare-coding system is inevitable. And when it occurs, well-prepared practitioners will be at an advantage, while those caught off guard could risk severe disruption in their practices, they say.

In addition to practicing ICD-10 coding and test filing claims, some practice management consultants suggest healthcare practitioners arrange lines of credits for working capital, in case the transitions results in substantial claims denials or payment delays in their practices.

Medical Economics: ICD-10 Training: Start with a plan