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ICD-10 — IT’S FINALLY HERE

THE IMPENDING DEADLINE ARRIVES NOT WITH A BANG, BUT A WHIMPER

I WOULD ESTIMATE that over the past 2 years, I have spoken about 300 times on the impending arrival of the ICD-10 system; well it is finally here. Oct. 1 marks the U.S.’s entry into a system that the rest of the world has been using for 20 years. And guess what: It is not going to be the apocalypse that some have predicted – more like Y2K.

My mantra with the ICD-10 has been, it is not difficult, but it will take more time. The average practice can expect a drop in productivity of about 15-20 percent, depending on where your baseline was prior to implementation. What everyone needs to understand is that the most difficult thing about the ICD-10 system is learning how to create a more detailed medical record that will support the new detailed diagnoses that you will be using. Converting the code from an ICD-9 to an ICD-10 will not be difficult if you are using good technology that allows you to perform contextual searches and accurate bidirectional conversion; in fact that may be the easiest piece of the puzzle.

KEY POINTS

A couple of key points to remember about the deadline:

1. CMS has announced that while they encourage practitioners to code cause of injury, place of injury and activity being performed while the injury was sustained, they will not require it to be coded on Oct. 1. (Other third party carriers may not adopt the same policy, please check with them.)



2. CMS also has announced they will neither withhold payment nor will it have an adverse effect on quality scores if the specificity to the right of the decimal is not perfect as long as the category of the disease is correct. The leniency period on this goes through Sept. 30, 2016.

3. ICD-9 codes are not going away. Let me be clear, for all claims where dates of service are on or after Oct. 1, you will be using ICD-10 codes for your claims. However if you are billing for services where the date of service was prior to Oct. 1, but you are submitting the claim after Oct. 1, then the ICD-9 codes must be used. If a service that you are providing, for example a comanagement of a cataract extraction, spans the Oct. 1 implementation date then use the date of surgery as your guide to which system you would use.

TEST RESULTS

CMS has released its results from the end-to-end testing that occurred in July and it is impressive. The claim acceptance rate for July was similar to the rates CMS obtained in January and April, but with an increase in the number of testers and test claims submitted.

• 29,286 test claims received

• 25,646 test claims accepted

• 87% acceptance rate

• 1.8% of test claims were rejected because of invalid submission of ICD-10 diagnosis or procedure code

• 2.6% of test claims were rejected because of invalid submission of ICD-9 diagnosis or procedure code

So here’s the deal: Don’t panic. In my opinion, the ICD-10 is more logical, more organized, easier to understand and much more searchable using technology than the ICD-9 system has been. It will be different — not harder — just different. None of us were born with the inherent knowledge of ICD-9 codes, we learned them and they became easy for us to use because of repetition. I have a high degree of confidence that within a very short period of time, we will have the same level of familiarity with the ICD-10 codes as well. Apocalypse? Hardly. OM

JOHN RUMPAKIS, O.D., M.B.A. is founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com, or visit tinyurl.com/OMcomment to comment on this article.