As someone who has been teaching ICD-10 to doctors, coders, billers, and managers for over two years, I would like to dispel some of the most common misconceptions.
ICD-10 training will cost me lots of money. Most of the estimates are widely-inflated full absorption cost accounting techniques where they add up every minute you spend reviewing your coding. Most small clinics can learn ICD-10 in 6-12 hours, update their fee ticket, and coding practices for less than a tenth of the $87,000 amount bandied about.
All medical practices need to get a line of credit because most of the insurance companies will not be ready and will deny a majority of their claims. This is another example of selling fear. Most insurance companies are ready now. Firstcoast, the Medicare carrier in Florida, has already updated (Dec. 2014) all Local Coverage Determination’s (LCD’s) to ICD-10. While some small self-funded plans may have some growing pains, if everyone in the clinic is properly trained, this should not be a problem.
ICD-10 is primarily an administrative function. Send the billers and coders to trading so they can take care of everything. This is incorrect. ICD-10 is primarily a documentation issue–that means more specific documentation by the providers. All providers need 6-12 hours of training; most of the training will be basic coding and documentation instruction that they may never have learned in the first place. The goal of ICD-10 is improved documentation and reporting the complete story of the visit.
I don’t have time to write a book! This is the either/or fallacy and asking the provider to document controlled versus uncontrolled diabetes is not asking for a book–it’s good clinical care and documentation. If the providers are currently using a look-up program, fee ticket, or ICD-9 cheat sheet with numerous unspecific codes, then, yes, they will need to improve the accuracy and specificity of their documentation, but this is something that they should have been doing all along. There is a difference between wet and dry age-related macular degeneration (ARMD), internal and external ophthalmoplegia, and myopia and degenerative myopia. Monthly audits and phasing-in improved specificity over a period of months is the best strategy.
ICD-10 is a conspiracy by the insurance companies to not pay me. Understanding basic coding and billing guidelines and applying them is another task that requires a minimal amount of training. I have been teaching coding and billing for over 20 years and still learn something new every day. All providers need to understand the significance of “carrier-specific” rules and the concept of medical necessity. Some carriers will very likely be more strict with claim edits and deny claims when two codes are required and not just one (secondary glaucoma for example). It will not be consistent, but gathering data to improve healthcare, manage costs, and determine what is most efficient healthcare is the reason for ICD-10–not to deny your claim.
My practice management software vendor told me they would handle everything and I do not have to go to any training. There are ways you can test this. One is to submit two codes where the second one is an “Excludes 1” code. Was it rejected? Another is to report codes that require a second code (code also, code additional, code the underlying cause, code first). These guidelines are in the manual and if you don’t use the manual for all your coding it’s easy to miss these. Last, search for PVD or “posterior vitreous detachment”. These terms are not in ICD-9 nor ICD-10. Did your software find them? There are additional codes that do not have a crosswalk. What does your software recommend? Lookup capability does not substitute for proper training in guidelines and documentation.
There are hundreds of new, specific disease codes in ICD-10. Actually, there are less than a dozen new codes in ICD-10 for Eyecare. Yes, that is not a typo. In some specialties, such as infectious diseases, OB/GYN, and orthopedics, there are many new codes, new code combinations, and additional reporting requirements. In Eyecare there is now laterality; you must report most conditions as either right, left, or bilateral eyes. That will increase the number of codes approximately 4X. The other major changes relevant to Eyecare are: diabetes and diabetic retinopathies (now one combination code); glaucoma codes (stage codes and laterality are now one combination code); and accidents (now must be reported as initial, subsequent, or sequela). Most of the specificity is already in ICD-9.
I’ll wait until a month before the implementation date of Oct. 1 2015: Over 95% of an ICD-10 class is reviewing basic coding concepts, guidelines, anatomy and terminology. All of this can be used now. The doctors need to learn and focus on documentation requirements and the concepts. The coders and billers need to learn as much about the diseases as possible so they can effectively translate the doctor’s documentation into accurate codes. The two most common examples are: late effects and reporting both the location and reason for an accident. Most optometrists do not document or report these. A late effect is the subsequent effect from an prior injury or event. The statement “chronic conjunctivitis due to burns to the eye five years prior” requires two codes, not one. One for the chronic conjunctivitis and another to indicate that this is a “late effect.” In ICD-10 a late effect becomes a sequela and is coded with an “S” 7-th digit extension code. Concerning accidents, every patient with a corneal abrasion or foreign body in their eye should be asked where they were when it happened and what were they doing? If they were in a factory and working on a metal-working machine, then two additional codes should always be reported to indicate the location and reason. These concepts have been around for decades. They are nothing new but many clinics are not documenting or reporting them today.
ICD-10 is going to reduce my revenue. You can use ICD-10 to increase the profitability of your practice–particularly in optometry. Increasing the number of medical patients by 10, 25 or 50% will have a significant increase in income per patient. Increasing the suite of diseases you manage and implementing a long-range marketing and education program concerning diabetes, high-risk drugs that can affect the eyes, hypertension, ARMD, glaucoma, and collagen vascular disorders, will reap results in higher level codes, more procedures, and more reference for medical patients. I like to think of ICD-10 training as “spring cleaning” where the doctor, the coder/biller, and the manager learn what each one needs to know to do their job effectively. Most all clinics have errors in their fee ticket, are missing documentation, or use codes improperly; errors that can be fixed in less than 30 minutes with a simple audit. Use ICD-10 to update everything in your clinic. You will be surprised how little time it takes and how much it can improve the bottom line, not decrease it.
The insurance companies don’t need all this detail. Remember, the data you send does not stop at the insurance carrier. It is further analyzed by the World Health Organization (WHO), the Center for Disease Control (CDC) and used worldwide for research to improve healthcare. The data is used to:
- Aid in the development of fee schedules and pricing schemes.
- Help in managing the utilization review process.
- Provide an opportunity for greater measurement of the quality and efficacy of medical care.
- Background for research.
- Allow additional codes for some categories (infectious diseases) that have run out of room for new codes.
ICD-10 is the “right thing to do.” If any provider, at any time, has said they became a medical professional because they wanted to help people, then that is yet another reason to implement ICD-10. It will help people. The data gathered will be used to fund research and improve healthcare worldwide.
Do not delay your ICD-10 training. Do note that some training is a lot better than others. If possible find specialty training that explains the diseases and conditions for all non-clinical staff. Also, there are numerous exceptions or “gotchas” as I call them. ICD-10 training should include at least a dozen; if not then they have not really done their homework. The EyeCodingForum has a complete, six-hour recorded ICD-10 training course for ophthalmology and optometry.
Jeffrey Restuccio, CPC, CPC-H, MBA
ICD-10 and Eyecare