Make your final plans
The Oct. 1 deadline looms, so ensure your implementation is a success.
By Jeff Grant
If your plan to implement ICD-10 is to cross your fingers and hope that the implementation deadline is extended, then you’ll be in very bad place on Oct. 1. ICD-10, the replacement for the current ICD-9 code set mandated by HIPAA, should not be taken lightly, but do not fear. If you properly prepare, you should easily be at 85% to 95% proficiency by the deadline.
This article will help to ensure that your practice is prepared to implement ICD-10.
ICD-10 includes far more codes than ICD-9, but don’t let the number of codes scare you. ICD-10 codes indicate laterality, which is very important in ophthalmology. This means that one ICD-9 code often has four codes in ICD-10 (RT, LT, Bilateral, Unspecified). Note: not all codes require laterality.
The codes indicate the following:
• RT = 1
• LT = 2
• Both = 3
• Unspecified = 4
Other ICD-10 coding basics
When coding for ICD-10, keep in mind the following guidelines:
1. Use “X” as a placeholder when omitting a code in one of the seven spaces (the “X” can be either upper- or lower-case). For example, T15.02XD – Foreign Body in the cornea, LT eye, Subsequent Encounter.
2. Most ophthalmology codes are in the H00-H59 Section (Chapter 7 – eye and adnexa), but you’ll also use “E” (Chapter 4 — endocrine), “T” (Chapter 19 — injuries or trauma) and “V” (Chapter 20 — external causes of morbidity).
3. Combination codes are very helpful in ophthalmology. A number of ophthalmology coding scenarios require two or three ICD-9 codes but only require one ICD-10 code. A common example is a diabetic patient with moderate nonproliferative diabetic retinopathy and diabetic macular edema:
• ICD-9 — 250.50, 362.05 and 362.07
• ICD-10 — E11.331
4. General Equivalency Mappings (GEMs) can help convert an ICD-9 code to one or more ICD-10 codes, and should be part of all EHRs and billing applications. An online GEM is located on the American Academy of Professional Coders’ website (http://www.aapc.com/icd-10/codes).
5. The seventh position on an ICD-10 code is used in different ways depending on the code. For an injury or trauma (a “T” code), you’ll need to add one of several “encounter codes” in the seventh position. You’ll commonly use:
• A = Initial Encounter. Used while the patient is receiving active treatment. Example: Corneal abrasion, initial encounter = S05.01XA.
• D = Subsequent Encounter. Used after active treatment when the patient is receiving routine care. Example: You’re no longer actively treating the corneal abrasion and the patient has returned several weeks or months later = S05.01XD.
• S = Sequelae. Used for complications or conditions that arise as a direct result of an injury. Example: A recurrent erosion caused by the corneal abrasion = S05.01XS.
• To indicate severity (on the codes that require this), you’ll enter a “severity code” in the seventh position:
1 = Mild
2 = Moderate
3 = Severe
4 = Indeterminate (“I can’t tell”)
0 = Unspecified (“I don’t know”)
For example: H40.2322 & H40.2311 = A patient has bilateral intermittent angle-closure glaucoma; mild stage in the right, moderate stage in the left.
PREPARE AND TRAIN YOUR STAFF
Now that you have a basic understanding of the ICD-10 elements most important to ophthalmology, you must prepare your clinical and billing teams. Take these measures to ensure that you’re ready for the Oct. 1 deadline.
Install an in-house ICD-10 expert.
Invest in online training resources and send your “expert” to coding seminars. Also, if your practice has more than one physician, you might want to have two in-house experts: one from the billing team and one from the clinical team.
Are payers ready?
CMS conducted several rounds of ICD-10 end-to-end testing (the last of which was scheduled for late June). The results have been very good.
Here’s a summary of the results from the end-to-end testing completed between April 27 through May 1, 2015. (For more, visit: http://tinyurl.com/ouo3u3c.)
• Almost 23,000 claims submitted.
• 50% Professional
• 43% Institutional
• 7% Supplier
• CMS accepted 88% of test claims.
• Reasons for rejection:
• <1%. Invalid submission of ICD-9 diagnosis or procedure code.
• 2%. Invalid submission of ICD-10 diagnosis or procedure code.
• >9%. Non-ICD-10 related errors, including issues setting up the test claims (e.g., incorrect NPI, Health Insurance Claim Number, Submitter ID, dates of service outside the range valid for testing, invalid HCPCS codes, invalid place of service).
It’s impossible to know if other payers are ready for ICD-10. So, you should have one to two months of overhead set aside in case some of your major payers have problems.
Make sure your EHR software is ready.
Check with your vendor(s) to determine their readiness for ICD-10. Also, make sure that you use all of the functions and training tools that your vendors offer. Many vendors have already released updates that provide excellent ICD-9-to-ICD-10 conversion tools and ICD-10 look-up tools. If your vendor provides training seminars or videos covering their ICD-10-related functions, then, at a minimum, your in-house experts should attend these sessions and present the information to the rest of your staff.
|Central ulcer in the right eye||370.03 (note a central corneal ulcer, ignoring laterality)||H16.011 (central corneal ulcer, right eye)|
|Uncontrolled, chronic open-angle glaucoma OU with severe visual field loss in both eyes||365.11 (primary open-angle glaucoma [POAG]) and 365.73 (severe glaucoma)||H40.11x3 (POAG, severe).
Note: POAG codes do not require you to indicate laterality, thus the placeholder in the sixth position and the staging code in the seventh position.
|Age-related nuclear cataracts in both eyes||366.16||H25.13 (the “3” indicates bilateral)|
|Exudative AMD in the right eye and non-exudative AMD in the left eye||362.51 & 362.52||H35.32 & H35.31. Note: AMD codes have no laterality.|
Provide formal, mandatory training.
Your billing and clinical teams must have a grasp of the basic concepts (laterality, severity, etc.) mentioned previously. So, schedule mandatory meetings in which you cover all of these basics. Use real encounters (perhaps from your EHR) to present examples of ICD-9-vs-ICD-10 coding, and gradually add more depth to these training sessions and present more complicated concepts.
Steadily increase your ICD-10 coding.
Practice your ICD-10 codes before the implementation deadline. To start, while coding encounters in ICD-9, make a note of the ICD-10 code that you’d select. This can be entered into a memo field in the EHR. If not, create a simple log sheet, where the patient account is listed, and have a field for the ICD-10 to be entered. Then, your in-house ICD-10 expert can audit this log sheet to help ensure accuracy and allow follow-up training for the coding staff.
As you get closer to the ICD-10 deadline, code a higher percentage of your encounters in both ICD-9 and ICD-10. Also, to grow accustomed to this system, code a sampling at the end of every clinic session. Randomly choose the encounters, and determine the ICD-10 code.
Meet at least weekly to discuss unique and difficult coding scenarios. Don’t make these meetings too long — usually 30 minutes is enough time to gather, to discuss difficult coding scenarios, and to go over pre-made and pre-printed scenarios.
Your in-house expert(s) should lead these meetings, but it’s a good idea to require various people to “get involved.” They can present examples or present a difficult coding scenario for the group to consider.
Use helpful resources.
Use one of the many free apps for smartphones or tablets as part of your training process and as a coding resource once the Oct. 1 deadline has passed. Our billers at HCMA use STAT ICD-10 and ICD LITE. Also, the World Health Organization has a free online resource to look up ICD-10 codes (http://apps.who.int/classifications/ICD-10/browse/2015/en). Keep in mind that this resource is not a replacement for an ICD-10 manual or a good ICD-10 online coding subscription.
Despite some obscure eye-related ICD-10 codes, most scenarios are straightforward and will be easy for you to code if you follow these suggestions.
You might not initially have the same level of coding competence that you have now with ICD-9, but you’ll be more than competent enough so that ICD-10 becomes nothing more than an inconvenience. OM
About the Author
Jeff Grant is founder of HCMA, Inc., which specializes in revenue cycle management services, as well as management & operations consulting for ophthalmology practices. E-mail him at email@example.com.