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.