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The Only Constant is Change
by Cheryl Nash
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I am sure most everyone is still viewing ICD-10 as some vague requirement that will not happen until far in the future. Well, the future seems to be creeping in closer than we like to think. The current implementation date is October 1, 2014, a mere year and a half away. CMS (Medicare) is adamant that it will not be postponed again, and unless something changes, we need to operate under that assumption.
Why do you, the Physician, need to worry about this? Your Coders are the only ones affected right? Not necessarily. While there are some changes the coder will need to address and prepare for, the real burden falls to the Provider of Service.
The premise of ICD-10 is that there will no longer be non-specific diagnoses, and this will be directly reflected in the charting. The documentation will need to be much more specific than you are used to. In fact, there is a possibility of lowered reimbursement for services billed with unspecified codes. Let me provide an example. A commonly used code for diagnosing a patient with varicose veins is 454.8- varicose veins of LE with other complication (edema, pain, swelling). This code alone has 8 corresponding ICD-10 codes that require a more specific description. Is it on the right leg? Does that leg have pain only, or pain and swelling? Are both legs affected? Do they both have the same symptoms? If the right has pain and swelling and the left has pain only there will be 3 separate codes required to report this. Varicose Veins with Ulceration have more than 40 replacement codes to choose from. In order to ensure prompt claim submission and adjudication providers will have to learn how to meet these new requirements.
CMS has released a series of checklists and timelines on their website to help start an implementation plan. It can be found at www.cms.gov in the Medicare page, under the coding/ICD-10 link. Additionally CMS has released two free Mediscape Education modules that will provide CME credits for physicians that complete them. This is a great place to start. Another resource will be under the provider resources link directing you to multiple medical associations also providing information, such as AHIMA, and the AMA.
Whether ICD-10 moves forward at the scheduled date, or is again postponed, it is only a matter of time before it becomes a reality for all of us. Preparedness is the only way to ensure a smooth transition. It is recommended that providers, practice managers, and coding and billing staff all take part in an education and implementation program structured for your practice. CMS can help you do this.
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