By ASMBS Insurance Committee Member, Tina Napora
and Are You Ready for ICD-10?
By ASMBS Insurance Committee Member, Tina Napora
Tina Napora, CPC
By now you should have received your 2014 Current Procedural Terminology (CPT) and International Classifications of Diseases 9 Edition Clinical Modifications (ICD-9-CM) manuals.
The joy for me comes when I peel off the cellophane, crack open the books and take a glimpse at all the new, deleted and revisions for the year.
This year includes changes to every chapter except anesthesia. However, few affect Bariatrics.
Evaluation and Management (E/M) has a new category with four new codes: Interprofessional Telephone/Internet Consultations (99446-99449). These codes describe situations where a specialist consults with a patient’s primary care physician to offer opinion or advice, but does not meet face to face with the patient. These time-based services are typically provided in complex and/or urgent situations where face to face services with a consultant may not be feasible. These codes include a review of patient medical records, test results, etc.
It is unlikely that CMS will recognize these for Medicare reimbursement because they are not face to face and Medicare does not cover/pay for consultation codes.
Other changes in the CPT are within the Digestive System, under Endoscopy. There are 13 new codes, descriptors, and revisions, including two new codes for Transnasal Endoscopy (43197-43198) 43197 – esophagoscopy, flexible, transnasal; diagnostic, includes collection of specimen(s) by brushing or washing, when performed (separate procedure) and 93198; with biopsy, single or multiple.
For additional additions, deletions and revisions, consult your CPT manual for a complete listing for 2014.
With the implementation of ICD-10 effective October 1, 2014, there are no new, revised or deleted diagnosis codes for volumes 1 & 2 for professional billing. This holds true for Volume 3 ICD-9-Procedure codes, as the system will no longer be a HIPAA standard. Only limited updates will be made to ICD-10 for new technology and new diseases. On October 1, 2015, regular updates to ICD-10 will begin.
Are you ready for ICD-10?
If your practice has not begun training, dual coding or reviewing of super bills/encounter forms, then you need to catch up. Did you know payers may start using the conversion to ICD-10 as another way to squeeze more money out of the reimbursement your practice should receive?
The countdown clock to ICD-10 implementation is ticking and CMS states this implementation date will not change.
The ICD-10 contains about 141,000 codes -- a huge jump from the 17,000 in the ICD-9-CM. This is due to the specificity and the expansion of code sets.
This year, code set standards will be used to identify diagnoses on medical claims. All codes will be based on specificity and medical necessity.
Accurate ICD-10 coding requires understanding criteria for different clinical conditions. Clinicians must document with clarity the precise conditions they are managing, and how a patient is responding to treatment to ensure proper diagnosis and that procedures are coded to the level of specificity ICD-10 permits.
For example: Diabetes documentation will need to include the following for ICD-10 code selection:
Due to drugs and chemicals
Due to underlying conditions
Other specified diabetes
Be More Specific
Improve code granularity allows for capturing more specific diagnoses. In this example, documentation following barium swallow may state, “dysphagia.” Under ICD-10 the clinician will have to provide enough details to distinguish among the following: (see ICD-10-CM tabular list of diseases and injuries 2014, chapter 19, injury, poisoning and certain other consequences of external causes)
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
In addition, more specificity will be required for anatomy, as ICD-10 codes point to exact anatomical locations.
Take this time to improve your documentation and prepare for increased payer audit scrutiny with pre- and post-payment audits.
ICD-10 will change every aspect of your practice – from the front desk to the back office, from policies and procedures to documentation and systems.
Unlike ICD-9, ICD-10 has alphanumeric categories rather than numeric categories. Some chapters have been rearranged, some titles have changed and conditions have been regrouped. ICD-10 has almost twice as many categories as ICD-9 and some fairly minor changes have been made in the coding of rules for mortality.
Coding and billing staff will need to not only learn ICD-10 and ICD-10 PCS, but prepare for increased clinical specificity required by the new code sets. Education and training for everyone in your practice is a must from physicians, physician extenders, nurses, and ancillary staff members.
For more resources on ICD-10 you can visit the American Medical Association (A.M.A.) website at www.ama-assn.org/go/ICD-10. Certified billers and coders can contact their professional associations for courses offered in anatomy and physiology and ICD-10 itself. You can also hire various consulting firms to do in-house training for all staff members. Those of you who work in hospital-based programs I’m sure have compliance officers who have already started implementation and training. In addition, there are many other online resources to get you started.
ICD-10 will bring significant benefits and challenges (perhaps more challenges in the early years). Well-prepared practices are those that recognize the obstacles and prepare for them early. They are also the ones who will reap the benefits of ICD-10, rather than suffer the consequences. So start your education and implementation today!