Workers Compensation and ICD-10

While healthcare providers and physicians may be scrambling to get ready for ICD-10, workers’ compensation practitioners are not required to switch to the new codes, according to the Workgroup for Electronic Data Interchange (WEDI), an advisor to the Department of Health and Human Services.

Approximately one-half of the Workers compensation claims systems are ready to switch to ICD-10 on October 1. About one-half, or 26 states will continue to use ICD-9 codes after Oct. 1 2015. Therefore your PM system will have to support switching between ICD-9 and ICD-10. Plus you staff has to be well-trained to avoid any confusion.

[Also: ICD-10 checklist: AHA releases step-by-step preparation guide]

WEDI has released data on worker’s compensation readiness by state. Twenty-one states have adopted ICD-10 billing for physicians, hospital inpatients and outpatients, according to WEDI.

ICD-10 ready: Alabama, California, Florida, Georgia, Hawaii, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, South Dakota, Texas and Washington.

Three states have adopted ICD-10 codes for hospital inpatient billing only: Indiana, Maine and South Carolina.

[Also: With ICD-10 about a month away, healthcare providers say ‘bring it on’]

Continue with ICD-9: Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Hawaii, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Wisconsin and Wyoming.

If you hear anything different please email me at ecf@eyecodingforum.com and we will update this post.

August 21 ICD-10 Questions for ophthalmology and optometry

Prepare for Oct 1 by working the 12 attached coding questions.

Aug 21 questions

The answers are made available to our ECF ICD-10 clients (4-page form or comprehensive course).

We will package all ICD-10 questions for Eyecare shortly with the answer key.

Quick LCD list with ICD-10 Codes

WPS Medicare now offers their LCD’s with either ICD-9 or ICD-10 codes. You can compare and contrast both lists. Click here for a complete list.

 

 

 

 

Aug 21ICD-10 Coding Exercises for Eyecare

See the link below to download the PDF file of 12 questions for August 21 2015.

AUG 21 update coding exercises

Answers are provided to ICD-10 course, 4-page ICD-10 list, and all Site License EyeCodingForum clients.

Thanks for your support!

August 7 ICD-10 Coding Exercises for Eyecare

August 7 2015 list of 12 ICD-10 coding exercises for optometry and ophthalmology. These follow our comprehensive, six-hour ICD-10 training program and our 4-page ICD-10 code list (aka “cheat sheet. Click on the link below to download the PDF.

Aug 7 Weekly ICD-10 coding examples for Eyecare Questions

The answer key and explanations will be supplied to all EyeCodingForum ICD-10 recorded training, 4-page ICD-10 code list and Site License customers. The EyeCodingForum staff has spent hundreds of hours preparing and educating thousands of Eyecare clinics nationwide. Let us worry about ICD-10 so you don’t have to. If you are not on our e-mail list enter your contact information here.

Click Here to Order EyeCodingForum Services.

Jeffrey Restuccio, CPC, CPC.
jeff@eyecodingforum.com
(901) 517-1705

ICD-10 Updates and Clarifications July 2015

Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities

JPR: The information below is from the Medicare document above.

As stated in the CMS’ Guidance, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family of codes. However, they are subject to specific LCD or NCD requirements.

JPR: I can think of few unspecified eye codes: ARMD, ectropion, scleritis, or amblyopia that would cause a denial. Most LCD’s for Eyecare include ranges of codes and do not exclude the “unspecified code.” As a certified coder, I am taught that the most specific codes and the group of codes that most accurately reflect the encounter, based on coding guidelines is the proper way to report the service.

For one, unspecific codes inform the world that the provider “does not know what is wrong with the patient.” Both the clinic manager and the provider should want to avoid this impression. While most won’t be able to be in the top ten-percent of clinics in terms of coding accuracy–you don’t want to be in the bottom 50% and certainly not the bottom 10-percent. Being specific, accurate, and following all coding guidelines is the best strategy to get paid, every time, and in all situations, by all carriers. Lastly, if the providers ever wanted to practice medicine because they wanted to help people, here is their opportunity. We need the specificity and additional status codes for research. Universities  worldwide are waiting on more specific data to help prevent and cure diseases. As I stated earlier, improve your diagnosis reporting because it’s the right thing to do.

In another example, a patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus). Use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) instead of the correct code, G43.711, would not be cause for an audit under the audit flexibilities occurring for 12 months after ICD-10 implementation, since they are all in the same family of codes.

JPR: Most in Eyecare use the unspecific headache codes. I recommend, in my ICD-10 training that the provider report the headache more specifically as tension, migraine, ocular, retinal, etc…There is no way for the carrier to know which type of migraine the patient has and the auditor would actually have to review the notes and compare them to the specific code reported. Not all auditors do this so this would be a rare phenomenon.

Question 4: What should I do if my claim is rejected? Will I know whether it was rejected because it is not a valid code versus denied due to a lack of specificity required for a NCD or LCD or other claim edit?

Answer 4: Yes, submitters will know that it was rejected because it was not a valid code versus a denial for lack of specificity required for a NCD or LCD or other claim edit. Submitters should follow existing procedures for correcting and resubmitting rejected claims and issues related to denied claims.

Question 5: What is meant by a family of codes? (Revised 7/31/15)

Answer 5: “Family of codes” is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters.

One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

The three official CMS documents are available to download below:

Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement

AMA-CMS-press-release-letterhead-07-05-15

MedicareProviderICD-10_July_7_2015

July 31 2015 ICD-10 Coding Exercises for Eyecare

July 31 2015 list of ICD-10 coding exercises for optometry and ophthalmology. These follow our comprehensive, six-hour ICD-10 training program and our 4-page ICD-10 code list (aka “cheat sheet. Click on the link below to download the PDF.

July 31 2015 12 coding exercises

The answer key and explanations will be supplied to all EyeCodingForum ICD-10 recorded training, 4-page ICD-10 code list and Site License customers. The EyeCodingForum staff has spent hundreds of hours preparing and educating thousands of Eyecare clinics nationwide. Let us worry about ICD-10 so you don’t have to. If you are not on our e-mail list enter your contact information here.

Click Here to Order EyeCodingForum Services.

Jeffrey Restuccio, CPC, CPC.

Exercise List is below:

Code for a benign neoplasm of left conjunctiva
Report DM type 1 with high A1C (greater than 8)
Report a blepharospasm
Code for allergic conjunctivitis of both eyes
Code simple episcleritis of the right eye
Report an after-cataract that is not obscuring vision, right eye
Report drusen of the macula, right eye
Code a glaucoma suspect, bilateral
Report myopia of both eyes:
Report a routine exam of the eyes for a vision plan w/o abnormal findings.
Code for a screening for long term plaquenil use:
On the fee ticket, the provider documents “cataract.”

2015 example of a GEMS ICD-9 to ICD-10 conversion

for ophthalmology and optometry. If you want your codes converted, create a report from your practice management system sorted by quantity (so we can determine your top 100 codes.)

Sample $500 ICD-9 to ICD-10 conversion list

 

ICD-10 Implementation Plan for Eyecare

This free, three-page implementation is a succinct outline of an action plan for preparing for the October 1 ICD-10 deadline.

It is suitable for optometry and ophthalmology offices. It includes:

  1. Overview
  2. Action Items
  3. New to ICD-10 Concepts
  4. What to review starting now
  5. Data entry practice recomendations
  6. Basics
  7. ICD-10 concept review
  8. Reporting 2 codes when required (this is covered in detail in my ICD_10 training course)
  9. Documentation issues pertaining to specific diseases (covered in my online, recorded course)
  10. Injury coding
  11. Top 10 codes/code groups most clinics omit.
  12. List of six actual omitted codes
  13. 42 questions posted separately on the EyeCodingForum

Click on this link to enter  your information and download the free, three-page implementation form.

Click Here to Order EyeCodingForum Services

Four-Page ICD-10 Code Sheet for Eyecare

This form would be suitable for most ophthalmology and optometry offices that report a considerable number of medical diagnoses. For best results we recommend ordering it with our comprehensive ICD-10 training.

Click Here to Order

The form is $150 per copy and will be mailed to you so be sure to include your mailing address. It will be printed on 11X17 paper and folded in half, and includes just over 500 codes–more than any comparable form.

Form Features.

  1. Sorted by Type/Category and then alphabetically.
  2. The laterality codes sort properly in numeric order.
  3. We aggregated over a dozen actual clinics codes to create this form.
  4. Over 100 specific disease codes.
  5. Reviewed by the certified coders at the EyeCodingForum.
  6. Diabetic retinopathy codes (all of them) are available as a separate one-page form.
  7. This form took well over two weeks (80) hours to create. Plus it requires knowledge of both GEMS and MS Access database.
  8. Customization is available. This form can be customized for your clinic. We can change the order or format.
  9. We can add your codes. We can subtract codes.

If interested please order now as the deadline approaches our inquiries are increasing exponentially every month. The customization service is a minimum of $350 extra (essentially the same as the ICD-9 to ICD-10 code conversion service.) This upgrade includes up to 5 hours of custom conversion services. Additional formatting is billed at $65 per hour.

The sample is “watermarked” with red type. Your will be printed professional on card-stock paper.

June 6 SUN 4 page Cheat Sheet WM ICD-10 for Eyecare