Let’s Talk Turkey: What ICD-10 Looks Like Today

The end of October typically marks the beginning of the holiday season—a time of family fun for some and stress for others. But, the eager anticipation of eating turkey (or tofurkey) isn’t the only thing on the minds of busy therapists this time of year. That’s because, in addition to enjoying holiday feasts and other festivities, many practices are seeing increases in their caseloads as patients meet their deductibles, doctors schedule surgical procedures, and individuals push to get better before taking off for their holiday vacations. Faced with such crammed calendars, therapists are just trying to get through their days as they settle into the new ICD-10 world. So, what does that world really look like? Here’s what we’ve seen—and heard—so far:

Millions of Claims

A recent ICD-10 monitor article reveals that “America’s healthcare system has been submitting ICD-10 claims at the rate of 4.6 million daily since the conversion to the new coding set…” That’s a hefty number, and while providers haven’t had too much trouble selecting the right codes, they have encountered a handful of transitional hiccups. For example, we’ve heard that providers have experienced:

  • delays in their own productivity;

Beyond these small challenges, we’ve yet to really get a feel for what kind of fallout is on the horizon in terms of claim denials and payments. Even though it’s early in the game, some WebPT Members have reported receiving Medicare payment for ICD-10 claims, which is awesome. But we won’t have a full understanding of what’s getting paid or denied until we have a few more months under our belts. In other words, to continue with the holiday theme, we might not be able to gauge the success of the transition until we find ourselves buying chocolate for our valentines.

Hundreds of Questions

The bumps in the road have been few and far between, but there has been no shortage of questions. In fact, at WebPT, we’ve received so many that we had to create three separate FAQ documents. (Here are parts one, two, and three from the WebPT Blog). One of the biggest sources of lingering questions is the pesky seventh character:

  • When is the seventh character appropriate?
  • Do I have to include the seventh character for every visit?
  • What’s the difference between initial, subsequent, and sequela?
  • Do I really have to use this character?

The questions don’t stop there. We’ve also received a ton of detailed questions regarding:

And as the questions continued to roll in, I decided to host another ICD-10 webinar with coding and compliance expert Rick Gawenda. This time, we presented open forum-style, allowing plenty of time for audience Q&A—which included the questions I just mentioned. Curious about the answers? Watch the free webinar here.

A Few Adjustments

All in all, the ICD-10 transition seems to be going smoothly. Still, I urge providers to keep a few potential adjustments in mind:

  • Make sure you understand—and appropriately account for—the CMS “grace period.” As MedPage Today explains, “When it comes to Medicare claims, providers need to make sure they really understand the position of the Centers for Medicare and Medicaid Services.” That’s because CMS has clarified its grace period policy. CMS considers a “valid” code to be one that’s coded to the maximum level of specificity. So, as long as you’re applying a valid code from the right family of codes, it doesn’t matter if it’s the incorrect code—during this grace period, that is. That same MedPage article explains, “That’s a very different interpretation to what a lot of folks had.”
  • Audit your own workflows. Just because you’ve had some ICD-10 success doesn’t mean you can let your coding and collecting best practices fall by the wayside—especially if you find that your clinic has fallen into bad habits. Make sure you constantly evaluate your processes and systems to ensure you’re prepared for what lies ahead. If you make adjustments now, it’ll be much easier than trying to change gears when those bad behaviors have really set in.
  • Focus on preventing denials rather than managing them. If and when the denials start coming back to your practice, you’ll figure out the top reasons that they’re occurring. Then, you can educate your staff on how to avoid those pitfalls in the future—thus solidifying your plans for success moving forward.

After all that, you’ll definitely need some cranberry sauce to top off this ICD-10 feast. As an industry, we’ve done a great job navigating this transition so far—but it’s not over yet. So, enjoy your vacation, hug your family, and eat turkey and gravy to your heart’s content—but don’t forget to keep an eye on your claims and workflows as we move through the seasons. Oh, and save me a drumstick, will ya?