Top Ten Misconceptions about ICD-10

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. 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 stricter 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 efficienthealthcare  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:

  1. Aid in the development of fee schedules and pricing schemes.
  2. Help in managing the utilization review process.
  3. Provide an opportunity for greater measurement of the quality and efficacy of medical care.
  4. Background for research.
  5. 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
Coding Consultant
ICD-10 and Eyecare

Dec 18 Webinar: 2015 Coding Changes for optometry and ophthalmology

This 50-minute Webinar will cover everything and anything that will help you plan properly for 2015. It will save you time and money, condensing about 8-hours worth of research into 50 minutes. It will be recorded so if you cannot attend live, sign up and watch it at your leisure.

This webinar is at a special price–only $25. Competing Webinars cost much more–often $200 or more. I should know. I teach a lot of them for other companies. The usual price is only $49 and the EyeCodingForum offers bundles of 4 or 8 Webinars at $99 and $199 respectively.

Help me keep our costs low and tell your friends.

Topics covered include:

  1. CPT changes
  2. Preparing for ICD-10
  3. OIG Work Plan
  4. Medicare changes
  5. Medicare conversion factor
  6. PQRI program
  7. Auditing
  8. Medicaid
  9. Compliance
  10. Attendee Questions

click here Order menu button to order.

Jeffrey Restuccio, CPC, CPC-H, MBA

Specializing in coding, billing and documentation for Eyecare

 

Nov 20 Webinar: How to Maximize Revenue through accurate coding

This 50-minute Nov 20, 2014 Webinar is recorded and available anytime on demand. It can be watched multiple times for 180 days. Live presentation is Thursday, at noon, central time.

We will discuss the following:

  1. Why not understanding anatomy and medical terminology can cost you money.
  2. Multiple ways to increase your medical business.
  3. How to use codes 99050 and 99058 to increase revenue.
  4. How to get paid on 92015 even when the patient does not have vision insurance.
  5. How to confidently report level IV visits every time
  6. How to perform screenings for a wide variety of medications and conditions
  7. How to ensure your medical necessity is accurate.
  8. How to use modifiers effectively
  9. Understanding carrier-specific rules
  10. Tips on appeals
  11. Your Questions!

The Webinar is $49.00 or purchase a block of 4 Webinars for only $99. Click on this link to Order EyeCodingForum Services

Jeffrey Restuccio, CPC, CPC-H, MBA
jeff@eyecodingforum.com
http://www.eyecodingforum.com
(901) 517-1705

Oct 23 Webinar: Coding and Billing for Glaucoma Patients

This is a shortened version of the 90-minute presentation presented Nov 7 at the 2014 California Optometric Association Conference in Monterey CA.

On Thursday, October 23, noon, Central Time, the EyeCodingForum will present a 50-minute Webinar on everything related to coding and billing for glaucoma patients. You will learn important tips and tricks that will help you get paid correctly, the first time. This Webinar will be recorded so you can order and view the video anytime. This fee is per clinic, not per person. Click on this link to Order EyeCodingForum Services. It is the first item on the list. If you do not see this Webinar, then select the Recorded Webinars option and send us the month and year and we will send you the link. We will discuss the following:

  1. Ways to increase your revenue.
  2. Top documentation errors
  3. Report 992xx E & M codes or 920xx eye exam codes for glaucoma?
  4. Medical necessity
  5. Common diagnostic procedures.
  6. Coding for glaucoma patients in ICD-10
  7. Medicare and glaucoma patients
  8. Coding and Billing with other services
  9. Coding and Billing with other diseases
  10. Understanding carrier-specific rules
  11. MOD-59 and why you need to know this modifier
  12. Tips on appeals
  13. Your Questions!

The Webinar is $49.00 or purchase a block of 4 Webinars for only $99. At only $25 per webinar just one tip could return your investment in just one week! Click on this link to Order EyeCodingForum Services. Click on the EyeCodingForum link at the bottom to learn more about our services.

www.eyecodingforum.com

Does the chief complaint “lock you in?”

This is from a national Medicare Regulations and Guidance Transmittal dated August 8 2014. [The original link is here].

I’ve been asked, many times over the years, regarding the guidelines concerning the chief complaint for an Evaluation and Management office visit. While the specific example below does not refer to Eyecare, it is an official position on whether the provider can use a confirmed diagnosis when the patient presents with only signs and symptoms.

“For outpatient claims, providers report the full diagnosis code for the diagnosis shown to be chiefly responsible for the outpatient services. For instance, if a patient is seen on an outpatient basis for an evaluation of a symptom (e.g., cough) for which a definitive diagnosis is not made, the symptom is reported.  If, during the course of the outpatient evaluation and treatment, a definitive diagnosis is made (e.g., acute bronchitis), the definitive diagnosis is reported.”

Jeffrey Restuccio, CPC, CPC-H, MBA

EyeCodingForum.com

jeff@eyecodingforum.com

 

Status of ICD-10 for ophthalmology and optometry July 31 2014

To all Eyecare professionals, ophthalmologists, optometrists, coders, billers, and managers, the new due date for ICD-10 has been confirmed by Medicare: October 1 2015.

Do not wait until August or September of 2015 to begin your training. Most clinics are spending at least six hours reviewing their current codes and working on improving documentation now to prepare for ICD-10. Implementing ICD-10 is not a clerical function–it is mostly about documentation. Learning the actual codes is about 30% of the training. Translating the documentation to the codes is the other 70%. The EyeCodingForum offers a comprehensive, six-hour ICD-10 training course specifically for Eyecare.

A copy of the CMS Medicare Press Release is below.

Press release: Deadline for ICD-10 allows health care industry ample time to prepare for change

Date2014-07-31TitleDeadline for ICD-10 allows health care industry ample time to prepare for changeFor Immediate ReleaseThursday, July 31, 2014Contactpress@cms.hhs.gov
Deadline for ICD-10 allows health care industry ample time to prepare for change
Deadline set for October 1, 2015

The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services. The code set’s granularity will improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and provide detailed data to enhance health care delivery. Health care providers and specialty groups in the United States provided extensive input into the development of ICD-10, which includes more detailed codes for the conditions they treat and reflects advances in medicine and medical technology.

“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services (CMS). “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”

Using ICD-10, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM. Moreover, the level of detail that is provided for by ICD-10 means researchers and public health officials can better track diseases and health outcomes. ICD-10 reflects improved diagnosis of chronic illness and identifies underlying causes, complications of disease, and conditions that contribute to the complexity of a disease. Additionally, ICD-10 captures the severity and stage of diseases such as chronic kidney disease, diabetes, and asthma.

The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology and preventive services.

ICD-10 represents a significant change that impacts the entire health care community. As such, much of the industry has already invested resources toward the implementation of ICD-10. CMS has implemented a comprehensive testing approach, including end-to-end testing in 2015, to help ensure providers are ready. While many providers, including physicians, hospitals, and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and this rule ensure all providers are ready.

For additional information about ICD-10, please visit: http://www.cms.gov/ICD10

Here is the link to the Medicare website.

Wednesday July 30 EyecodingForum Webinar: Medicare for Eyecare

This noon, Central Time, 50-minute Webinar will focus on everything related to Medicare for both optometry and ophthalmology.  Note the live Webinar is Wednesday and not the usual Thursday. It will be recorded so you order and view anytime. We will discuss:

  1. Common diagnostic procedures
  2. The Basics (LCDs, E & M Guidelines, Incident-To Rules)
  3. How to work with Medicare
  4. Why Medicare is not just one, single  agency (jurisdictions)
  5. Co-Management
  6. Understand carrier-specific rules
  7. Office visits (both E & M and 920xx codes)
  8. Documentation requirements
  9. How to Appeal denied claims
  10. Preparing for ICD-10 in 2015.

Nationally, about 75 to 85% of Medicare rules and guidelines are the same. However, there are 12 Jurisdictions in the United States and each one has slightly different rules. Our goal will be to provide both a sound foundation and discuss new information from all of them and help you get paid correctly, the first time.

The Webinar is $49.00 for one or purchase a block of 4 for only $99. Click on this link to Order EyeCodingForum Services.

 

 

 

 

Webinar Bundle – Beginner

This group of six 50-minute Webinars is suitable for a beginner to intermediate coder/biller in an optometrist or ophthalmologist office. The list price for all six Webinars is $294 ($49 each). For a limited time only, the price is $125. That is nearly six hours of training, a per-clinic fee (not per person) plus you can watch anytime and multiple times.

  1. June 2014 Top Documentation Errors
  2. April 2014 Coding and Documentation for Office Visits (992xx and 920xx)
  3. Mar 2014: 35 key concepts every EyeCare professional should know.
  4. Jul 18, 2013: Eyecare Diagnostic Procedures Review
  5. March 2013: Medical Necessity. Linking ICD-9 codes to office visits and procedures
  6. NOV 2012: Optometry Coding and Billing Basics with specific Examples.

Click on this link to Order EyeCodingForum Services.

It is the top option.

Trizetto Introduction to ICD-10 Coding for Eyecare

The 55-minute webinar, conducted by Jeffrey Restuccio, CPC, CPC-H, MBA, (author and narrator of the EyeCodingForum content) is now posted to the Trizetto website. It is free to review.

http://www.gatewayedi.com/icd10/webinars/icd-10-webinar-for-eyecare-professionals/

The EyeCodingForum offers a 6-hour (plus) training program for ICD-10. It is recorded video format and can be viewed anytime, multiple times, until Oct 1 2014.

Click the link below to order the EyeCodingForum six-hour version of the ICD-10 coding for Eyecare.

http://www.eyecodingforum.com/amember/signup.php

 

 

 

GEMS on Steroids by the EyeCodingForum

With the looming deadline of October 1 2014 for ICD-10 implementation, there will be hundreds teaching ICD-10 and offering ICD-9 to ICD-10 conversion services. How do you determine who is qualified? How do you distinguish someone who is knowledgeable about ICD-10 coding? And lastly how do you determine is truly knowledgeable about your specialty and can discuss the diseases and diseases on more than a superficial level?

Most advise to use the GEMS (General Equivalency Mapping) tool to crosswalk ICD-9 to the correct ICD-10 codes. Some organizations are charging $2500 for this GEMS conversion. The GEMS conversion files are available on the Medicare website but it requires knowledge of database design and manipulation to actually make this work. Plus, as you will see there is a lot of information that is missing from GEMS.

Below is the list of the top 27 ICD-9 codes from a typical Eyecare clinic used in our example. The complete EyeCodingForum ICD-9 to ICD-10 service is explained here. I call the service. Send us your list of ICD-9 codes for a free analysis. The complete analysis is 21 pages and you can download it for free at this link GEMS on Steroids by the EyeCodingForum Dec 1 2013.

Rank

ICD-9

Description

1

36721

Regular Astigmatism

2

3671

Myopia

3

3674

Presbyopia

4

3670

Hypermetropia

5

36616

Senile nuclear sclerosis

6

36504

Ocular hypertension

7

36615

Cortical senile cataract

9

36511

Primary open angle glaucoma

9

36511

Primary open angle glaucoma

9

36511

Primary open angle glaucoma

9

36511

Primary open angle glaucoma

9

36511

Primary open angle glaucoma

10

37300

Blepharitis unspecified

11

2245

Benign neoplasm of retina

12

37200

Acute conjunctivitis unspecified

13

37272

Conjunctival hemorrhage

14

37311

Hordeolum externum

16

25000

Diabetes mellitus without complication type II or unspecified   type not stated as uncontrolled

17

36614

Posterior subcapsular polar senile cataract

19

37515

Tear film insufficiency unspecified

20

36250

Macular degeneration (senile) of retina unspecified

21

36257

Drusen (degenerative) of retina

22

36500

Preglaucoma unspecified

23

36502

Anatomical narrow angle borderline glaucoma

24

36510

Open-angle glaucoma unspecified

24

36510

Open-angle glaucoma unspecified

24

36510

Open-angle glaucoma unspecified

24

36510

Open-angle glaucoma unspecified

24

36510

Open-angle glaucoma unspecified

27

37210

Chronic conjunctivitis unspecified