Problems with ICD-10 Implementation? Check Out These Tips…

Ready or not, tomorrow is the day. While the Medical Association has been and remains an opponent of the forced switch to ICD-10, we fought it and in 2014 got a one-year delay. We continued fighting the mandated changeover in 2015, but when it became evident it would be implemented, we worked diligently to soften the landing as much as possible.

Dr. Buddy Smith on ICD-10: “This should be a wake-up call … to be an advocate”

Medical Association President Buddy Smith, M.D., has had it with government mandates in medicine, likening ICD-10 to the proverbial “straw that broke the camel’s back.”

“It has gotten to the point of absurdity. We need more of the ‘practice’ of medicine and less of the ‘process’ of delivering medical care. We are forced to jump through hoops checking boxes that don’t do the first thing to improve patient care,” Dr. Smith said.

In his opinion, forced adoption of ICD-10 tops the list of practice aggravations and only adds to the frustrations an already overburdened physician workforce is having with their chosen profession.

Seeing the negative effect it would have on its members, over the past few years the Association worked with Congressman Gary Palmer (R-AL06) and the Alabama Delegation on legislation putting off ICD-10 adoption. The Association also worked with state media to raise awareness of the problems with ICD-10 and even the Legislature, ushering through a bipartisan resolution by Alabama’s two physician-Senators Tim Melson and Larry Stutts this spring urging Congress to either delay ICD-10 or find a way to offset the cost to medical practices. In the end, however, medicine was unfortunately unsuccessful, and the full effects will not be known for some time.

“We gave it our best, but with hospitals, insurance companies and the entire health care data and technology industry on the other side, the voices of physicians – like my dear friend the late Dr. Jeff Terry – were drowned out,” Dr. Smith said.

A silver lining, Dr. Smith says, was the Medical Association’s success in petitioning Blue Cross Blue Shield of Alabama and VIVA HEALTH along with Alabama Medicaid to implement “grace periods” for physician coding errors made under ICD-10 as is being allowed under Medicare Part B. Few other states have any commercial payors implementing any type of “grace period.”

“Most of our colleagues in other states will have zero leeway if they miscode for anyone other than a Medicare patient,” Dr. Smith said, “and even though we must still code under ICD-10 we are better off than most physicians in this country.”

In his rural Clay County medical practice, Dr. Smith tries to focus on the positive when there is bad news to deliver to patients. For physicians, ICD-10 implementation certainly fits that description. But there is hope, Dr. Smith believes, pointing to medicine’s successes on the state level as not only proof that doctors can be effective advocates for their patients and professions but also to using those successes as a blueprint for future battle plans.

“When you look at the multitude of proposed standards of care, trial lawyer tricks and threats to medicine our Medical Association and its members have fought off over the years, it’s truly remarkable,” he says. “We can succeed, but we all have to be in this together.”

Engaging more doctors and expanding the influence of organized medicine, he says, is the key to learning from the losses we’ve encountered while expanding on our successes. After losses on the Affordable Care Act and now ICD-10, while many in Washington are saying “organized medicine is dead” Dr. Smith believes the opposite is true. He thinks ICD-10 will instead be a turning point where physicians finally stand up and say enough is enough.

“This should be a wake-up call to my colleagues, not just in Alabama but around the nation, that non-physicians are dictating the future of our profession and you can’t afford not to be an advocate for the profession,” he said. “You are most vulnerable to giving up after you’ve suffered a loss – and ICD-10 was a loss for medicine – but we cannot abdicate the remainder of our profession without fighting every inch of the way.”

What You Said…about ICD-10

During the launch of ICD-10 on Oct. 1, we wanted to know how the day was going for our physicians and their staff, so we asked them. Below are a few responses we received about the implementation of the new billing system. Keep in mind the true test of the implementation of ICD-10 won’t be fully realized for some time:

“I think the whole thing is unworkable, a waste of time and will make my office much less efficient. I am not sure why doctors continue to tolerate these ridiculous mandates.”
— Sen. Larry Stutts, M.D., OB/GYN from Sheffield

“Much anticipated arrival of ICD-10 today that passed smoothly for patients and practitioners alike; the final grade is now left with our billing service.”
— Maartin Wybenga, M.D., family physician from Prattville

“We have been working to prepare for years with lots of study, classes and tests. It is disappointing on Day One that 100% of our claims have been rejected. It appears our clearing house is not ready. I’m glad I have put money in a savings account to be prepared. It should be made clear to EVERYONE that we are the only country in the world that uses ICD-10 for payment. It was designed to allow statisticians to monitor disease. This is ALL about Big Brother keeping track of what we do. I am struck by the idiocy of the bureaucrat many years ago that was once reported to say that the expense to doctors would be nothing more than ‘printing’ fees for a few new superbills.”
— Allen Meadows, M.D., allergist from Montgomery

“We had no problems today. We were slower in documentation trying to find the new codes. However, the jury is not in just yet, since we haven’t yet had time for any claims to be rejected. We are cautiously optimistic.”
— Beverly Jordan, M.D., FAAFP, family physician from Enterprise

“Since our EMR did not properly work pulling up the new codes as promised, we had a difficult day searching for codes online, ultimately slowing us down.”
— McCain Ashurst, M.D., OB/GYN from Montgomery

“There’s been a lot of comments about how specific ‪‎ICD-10‬ is, but I have been surprised by how many codes are even less specific than ICD-9.”
— Steven P. Furr, M.D., former president of the Medical Association and family physician from Jackson

“No problems here at all … I took the day off!”
— Tim Stewart, M.D., pediatrician from Huntsville

“Although today was a day I have been dreading for quite some time now, it has gone smoother than I ever expected it to. I believe the transition has gone as well as it has gone because of adequate preparation. My staff, my software vendor and IT support team prepared exceptionally well for the storm. My quick navigation tools were already in place, and my office had several ‘ICD-10 dummy days’ where we practiced entering patients/visits with the new ICD-10 codes. My software vendor also gave us the ability to convert to the new ICD-10 codes effortlessly from our old ICD-9 database. My staff and I also attended seminars by the Medical Association and Baptist Hospital, which helped immensely. As with any storm, your best chance of surviving is to be adequately prepared. We have had this forecast on the radar for quite some time now. For so long it appeared we were blowing a lot of hot air in an attempt to get the hurricane to go away or to change its course as opposed to just hunkering down, preparing, and allowing it to do would it was ultimately going to do. All storms, no matter how bad they are, will eventually blow over. What remains to be seen at this point is how well the change will affect my reimbursements and how much of a delay and additional expenses I will incur.”
— Jefferson Underwood III, M.D., internist from Montgomery

ICD-10 Is Here…Now What?

It’s been just more than a week since the debut of ICD-10, and reports of its implementation have been mixed. While some physicians and their staff had little trouble, others had a very long day of coding issues.

Keeping in mind the true test of ICD-10’s implementation won’t be realized for a few more weeks, we contacted Kim Huey, also known as Kim the Coder, to find out what physicians need to know next about this new billing and coding system:

• Practices will be able to use unspecified codes after this first year IF that is the only appropriate code. There has been much confusion about Medicare’s announcement that claims would not be denied for lack of specificity for the first year. That does not mean unspecified codes will be automatically denied on Oct. 1, 2016. In some cases, you don’t have any other choice. For example, with Vitamin D deficiency, the only options are rickets or unspecified. Obviously, not everyone with Vitamin D deficiency has rickets. Practices should focus on the specificity already documented or on specificity that would support a particular diagnostic test or course of treatment.
• Don’t rely completely on crosswalks built into your EMR. Many of these only take you to the most unspecified code available. Others don’t take into consideration Guidelines and Notes contained within the ICD-10-CM book. Some have chosen not to give their physicians any training – that is a huge mistake! Software simply cannot capture all the nuances in the new codes. For example, COPD with bronchitis with exacerbation is one code in ICD-9-CM. This takes three separate codes in ICD-10-CM. Does the software prompt you to enter the additional codes? EMRs vary widely in their search functions, in which some ask the additional questions necessary to choose the appropriate code, while others simply provide a crosswalk that may or may not be correct. When looking at the differences in coding between ICD-9-CM and ICD-10-CM, a practice needs to look up the code in ICD-10-CM to find the differences in the guidelines. This would not be apparent if just using the crosswalks.
• Everyone who touches a diagnosis code needs some amount of training. Training may vary from just an hour to several hours, whether it is a lab technician or clinical staff or a receptionist who calls in for pre-authorizations.
• There are some good things about the ICD-10-CM changes. Hypertension is no longer classified as benign or malignant. Some conditions, such as asthma can now be coded to capture severity that may support additional treatment or more expensive medications. There is now one code for vaccinations – Z23. There are more specific codes for patient refusal of treatment, underdosing of medication and other circumstances that may affect physician quality reporting.
• Identify the particular challenges in your practice. Coding for injuries is a huge change in ICD-10, but if you don’t see injuries, don’t sweat it. Coding for diabetes is another big change – walk through the coding guidelines to see the differences in information captured. For example, OB practices will now code for the trimester and weeks of gestation – that is almost always documented – and the practice needs to find a way to transfer that to a code on the claim.
• External Codes are not mandated. That is, you do not have to use them unless a particular payer requires it. We have all laughed about the External Cause codes such as burn from fire while on water skis, bitten by a duck, struck by debris from a spacecraft.

In response to a request from the Medical Association, Alabama Medicaid, Blue Cross Blue Shield of Alabama and VIVA HEALTH have said they will not penalize physicians for coding errors under ICD-10 as long as a valid ICD-10 code from the correct “family of codes” is used. This follows a similar policy by CMS for Medicare Part B claims announced in early July.

What You’re Saying about ICD-10, One Month Later

ICD-10 Grace Period Ends Oct. 1