3 Specialties Facing Important ICD-10 Code Changes

ICD-10 implementation is confirmed to take place on October 1. Any remaining hopes for further postponing of the new coding system have completely vanished by now. While this may appear as good news to some people, October 1 is actually a deadline for all physicians and medical practices to complete the training and testing phase of their ICD-10 conversion plan, in order to avoid Penalties from CMS. 

ICD-10 training and testing is not all that medical practices must prepare for before October 1.

Physicians must be ready to face some major drawbacks of ICD-10 that will hit Medical Practices hard in the first few months like slowed productivity, reimbursement in capabilities and stalled cash flow. ICD-10 codes transition is another important negative aspect that will affect practice Revenue Cycle Management of various medical specialties. Some medical specialties will be facing more difficulty in transition as compared to others, not just because of the increase in number of codes but other variations in the coding structure as well. Some of these specialties are as follows:

1. Cardiology

Cardiologists will not only have to trouble themselves with learning additional and specified codes for every diagnosis, but also interpret the actual definition of the statement. Some diagnoses have undergone definition changes in the new coding system. For example, the acute phase of myocardial infarction originally lasts for 8 weeks in ICD-9, but is being reduced to 4 weeks in ICD-10. Some diagnoses of ICD-9 are not mentioned in ICD-10 either. Like for example, the ICD-9 code 410.00 of “an unspecified episode of care” for AMI of the anterolateral wall, when converted to ICD-10 becomes I21.09, which does not address episode of care at all. Similarly, some diagnosis that required two separate ICD-9 codes, have been converted to one ICD-10 code. These changes make it all the more difficult for cardiologists to be Ready for ICD-10 before the deadline.

2. Neurology

The neurologists are in no better situation. According to the American Academy of Neurology, neurology diagnosis codes have entered a whole other level of complexity in ICD-10 coding system. For example, the new ICD-10 code for Alzheimer’s disease is G30.9, when converted from ICD-9 code 331.0. After that, ICD-10 further specifies Alzheimer’s disease in 3 different ICD-10 codes: G30.0 for Alzheimer’s disease with early onset, G30.1 for Alzheimer’s disease with late onset and G30.8 for Other Alzheimer’s disease. Similarly, CMS provides 10 addition ICD-10 codes for Migraines, which originally had only one ICD-9 code, 346.90.

3. Pediatrics

Like the former two medical specialties, pediatricians must also be prepared to deal with an upcoming large collection of complex codes for various specified diagnosis. In ICD-9, bronchiolitis has only one code (466.11) while in ICD-10 it is specified in two different diagnoses, RSV (J21.0) and human metapneumovirus (J21.1). A common ICD-9 code 774.6 (for unspecified neonatal jaundice) when converted through the ICD-9 to ICD-10 converter, will become P59.9. This is a code for a specified jaundice diagnosis.

The new complicated variations in ICD-10 coding system will be quite a challenge for physicians to learn in such a short time. Even if physicians and billers do manage to adjust to the new coding system, the probability of them making errors in patient documentation and claim processing will still be very high in the first few months post ICD-10 Implementation. The new coding system regulations make it compulsory for physicians to mention the specified diagnosis in their documentation and not to miss any detail, because according to the popular ICD-10 phrase; “If it isn’t documented, it didn’t happen!” 

What impact will ICD-10 have on your practice?

ICD-10 is expected to be implemented on 1^st October, 2015. Despite how far it sounds, providers are running short of time to prepare their practices for the new coding system. In contrast to the existing ICD-9 coding system, ICD-10 is much bigger.

All the coding experts who are well versed with ICD-9 codes will have to go through training for the new coding system from scratch. The latest version of ICD-10 contains over 68,000 codes, as compared to the 13,000 ICD-9 codes. However, it is not necessary to memorize all these codes, especially for small and medium sized physician groups, who should only be concerned with codes related to their particular practices. The major impact of ICD-10 will be on the following key areas:

1.     Financial sustainability

CMS experts are of the view that a decrease in cash flow and revenue will follow the implementation of ICD-10. They have predicted that claim denial rates could increase by 100 to 200 percent and revenue of healthcare organizations could witness declining payments for at least two years post implementation. Pershing Yoakley & Associates, P.C (PYA) identified seven key areas of the continuum of revenue cycle management that organizations must focus on to Prepare for ICD-10. These include updating and testing IT software, adjusting account receivable reserves, preparing for future delayed payments, and keeping track of expected denials.

2.     Workforce

Arrival of ICD-10 will not only be troublesome for coders, but for office staff as well. Preparation for ICD-10 can indirectly affect front-end tasks like patient scheduling, pre-certification, pre-registration and case management functionality. So other than coders, office staff must also be well-educated and trained to deal with the new coding procedures. 

3.     Provider and Vendor Readiness

Although the implementation date for ICD-10 was announced a long time ago, some providers are still stuck in the planning and strategy implementation phase of ICD-10. Moreover, there are others who have not yet established their ICD-10 budgets. Vendors on the other hand are also exposed to a high level of risk when it comes to ICD-10. Providers must ensure that their vendors have upgraded their IT systems and trained their workforce to be ICD-10 ready. Failure of vendors to be prepared for the new coding system is an indication that providers need to look for a new vendor who is capable of meeting their needs.

With so many issues, you’re probably wondering ; why go through the hassle of implementing ICD-10 for your practice? Michael Wilson, Chief Executive of Healthcare information Management (HIM), said that the new ICD-10 diagnosis and procedural codes will lead to accurate payment of new and better procedures, improved administrative performance and enhanced patient care. Other benefits for providers after the twoyear trouble post ICD-10 implementation will be greater efficiency, fewer fraudulent claims and more accurate reimbursements. 

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