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BUSINESS: coding strategy

The Countdown Resumes

Optometric Management November 1, 2014
BUSINESS

  coding strategy

The Countdown Resumes

Are you prepared for ICD-10?

JOHN RUMPAKIS, O.D., M.B.A.

The countdown for the ICD-10 officially hit the 12-month mark last month, racing toward the formal implementation date of October 1, 2015. Many have expressed significant doubt that it will ever be implemented based on the historical behavior of the government and its deal making. Nonetheless, you have roughly 11 months to prepare your practices for this event.

Third party carriers are prepared and ready to go; they have been performing their end-to-end testing since April 2014 and must demonstrate that they are capable of properly handling an ICD-10 claim. In addition, CMS released the “new” version of the CMS-1500 form adapted for the ICD-10 codes in January as well.

So, it seems that everyone is ready — except for the doctors.

ICD-9 vs. ICD-10

It is important to realize that the ICD-10 system is far beyond just converting an ICD-9 to an ICD-10. It is really a much more detailed method of medical record keeping and subsequent translation of that record into a code. Here are the basic differences between the two.

    ◦ ICD-9 Format

    ◦ ICD-10 Format

Prepare your practice

What’s your game plan for training and implementation? Here are nine steps to help you successfully integrate ICD-10 into your practice.

1. Print out “Top 30” ICD-9 codes from your EMR in descending order of frequency.

2. Separate into “Appropriate Categories”:

    - Refractive status

    - Adnexa and lids

    - Conjunctiva

    - Cornea

    - Iris

    - Ciliary body

    - Glaucoma

    - Vitreous

    - Retinal

    - Injury and trauma

    - Systemic

3. Using your conversion algorithm, begin creating a learning tool for each of your “Top 30.” For example, Myopia 367.1 (ICD-9) – H52.11, H52.12, H52.13, H52.10 (ICD-10). Create a timetable for each specific category that you created to provide adequate learning time.

4. Develop a testing system to ensure accuracy at all levels within the practice, physician or staff.

5. Contact your EMR vendor to ensure that it has the proper “end to end” testing completed and verified.

6. Contact your electronic billing “clearinghouse” to ensure that it is equipped to communicate the ICD-10s by Oct. 1, 2015.

7. Verify with your contracted carriers, both refractive and medical, that they are ready to accept ICD-10s by the deadline.

ICD-10 Structure

The ICD-10 format starts from left to right with increasing specificity, beginning with the systemic category and drilling down into specific structure detail. This is easy to see in the breakdown of diabetic retinopathy.

Structure of The ICD-10

    ◦ Diabetic Retinopathy ICD-10 E11.321 (Example)

8. Keep in mind that the ICD-9s are not going to go away until September 30, 2016, as they will need to be used to retroactively bill for dates of service prior to Oct. 1, 2015. So, be prepared to maintain both systems in parallel until 2016.

9. Develop an office strategy for change management. Remember, rules and requirements change frequently, so be sure to stay informed on the latest updates.

Get ready

Though this is not a comprehensive guide, it does provide you with some simple steps to help ready your practice for the switch to ICD-10. If you follow an organized method such as this, you will eliminate many of the “nice to knows” and focus on “need to knows” specific to your practice patterns. Let your practice history help direct where the learning needs should occur first. OM

DR. RUMPAKIS IS FOUNDER, PRESIDENT AND CEO OF PRACTICE RESOURCE MANAGEMENT, INC., A CONSULTING, APPRAISAL AND MANAGEMENT FIRM FOR HEALTHCARE PROFESSIONALS. E-MAIL HIM AT JOHN@PRMI.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.

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