Ready or not, here ICD-10 comes. We’ve landed at the very end of our transition timeline, and the next few days undoubtedly will have a huge impact on healthcare providers across the US. If you haven’t prepared, then hold onto your hats—because it’s going to be a bumpy ride. With that in mind, here are some last-minute things you need to know about ICD-10 that might help make things a little smoother:
The CMS Grace Period
The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) announced earlier this year that “…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.” So, what does this mean? It all boils down to the following:
- You still have to transition to ICD-10.
- You still must use a valid code from the right family of codes.
- This “grace period” only applies to Medicare. As of now, commercial insurances aren’t following suit.
Cheat sheets might sound like your fast-pass to claim payment. Unfortunately, the old adage “cheaters never prosper” still rings true when it comes to ICD-10. That’s because:
- General equivalence mappings (GEMs) typically form the basis for these cheat sheets. And that’s a huge problem, because these tools aren’t reliable when it comes to translating small sets of data (like those in patient documentation or claims).
- GEMs aren’t standardized; any entity can create and distribute them.
- For each ICD-9 code, there are potentially dozens—or even hundreds—of possible ICD-10 equivalents. According to a whitepaper from ICDLogic, there are “445 instances where a single ICD-9 code can map to more than 50 ICD-10 codes,” and there are “210 instances where a single ICD-9 can map to more than 100 ICD-10 codes.” In that same whitepaper, ICDLogic cites a UnitedHealthCare report indicating that only “about 5% of all codes will map accurately 1:1.”
In addition to steering clear of cheat sheets, beware of vendors claiming to offer a one-to-one mapping of ICD-9 codes to their ICD-10 equivalents. Clinical judgement is a crucial part of proving medical necessity through both documentation and proper ICD-10 code selection—and software can’t account for that.
Yes, it’s true that you don’t have much—if any—time left to prepare for October 1. But, going forward, here are a few key tips to keep in mind:
- Submit ICD-10 codes (rather than ICD-9) based on date of service, not claim submission date.
- Identify which current patients you’ll treat through the transition.
- Identify the ICD-9 codes you’re frequently using, and determine their possible ICD-10 equivalents. Furthemore, find the ICD-10 codes that most accurately match the conditions you treat most often. (But, remember, each patient case is unique, and a blanket code won’t work in every situation).
- Clean up your claims and try to submit as many claims as possible before the transition. That way, you’ll have a clean slate on October 1.
- Contact your non-HIPAA covered entities and find out which ones are making the transition. Remember that some non-traditional payers might require that you still submit ICD-9 codes, so be aware of this throughout the transition.
If you don’t already have an EMR vendor to help you make the jump to ICD-10—or if you’re considering making a software switch—now’s the time to look at your options. WebPT’s intuitive, easy-to-use ICD-10 tool will simplify the code selection process, as you’ll be able to search by code number, condition, or anatomical site. The code builder also will automatically expand when greater specificity is possible (i.e., you’re working with a subset of codes that allows you to code for details like laterality or encounter type). Essentially, WebPT prompts you to select the most specific code to describe the patient’s diagnosis. Sound like a good fit for your practice? Contact WebPT to learn more.
Finally, I recently hosted an ICD-10 crash course webinar; watch it here to learn more about what to expect during this transitional period. I know there’s a lot of information to digest and a lot of changes to face. But, I hope this last-minute preparatory information helps you along this ICD-10 ride—as bumpy as it may be.
About the Author
Heidi Jannenga, PT, MPT, ATC/L, Founder and COO of WebPT As Chief Operating Officer, Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.
An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics.
Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a BS in Biological Sciences and Exercise Physiology, went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida, and recently obtained her DPT through EIM. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.