ICD-10 Redux | Questions & Answers
As your practice is preparing for the impending ICD-10 changes, you might have many questions concerning billing procedures and software requirements. To help you get the answers you need, we have compiled some common questions and answers. Feel free to add any new questions in the comment section below. Q: I have a question about the top 50 ICD-9 codes we use, and doing the crosswalk to ICD-10. Where is the best resource for being able to do that? A: CMS GEMS would be one website that you can use; that’s CMS’s GEMS System, which is the General Equivalent System that they use — the General Equivalent Mapping System that they use to translate ICD-9 to ICD-10. Another good site for you is AAPC.com. Click on their ICD-10 link and they have a feature where you type in our ICD-9 and it returns the equivalent ICD-10 code. GEMS prompts you to choose the lateralities and origins, whereas AAPC is more one-to-one, but GEMS is really what most systems are basing their crosswalk from, and GEMS is built and maintained by CMS, the CDC, and AMA. Q: I’ve done all my conversions from ICD-9 to ICD-10 and I’ve done the left and right conversions. We’ve changed some of our documentation so it’s more specific about mechanism of injury — the when, where, the why and the how. What else is there really to do? A: You really want to make sure that how the practice is supposed to document the guidelines for documentation are clearly outlined in your policies and procedures manual. And that means adding in specificity and laterality. The manual should also have references as to where you seek the information; your reference point would be to CMS. Q: If I want to take a coding course to get certified, do I need to be certified on ICD-9 and ICD-10? A: Right now, you have to certify for both, but after October 1, 2015, you only have to certify for ICD-10. Q: Are you able to come out and help us train our staff? A: We can give you the tools that you need in order to train your practice. They can also take external classes — specifically from the AAPC, because their classes on physician documentation are extraordinary. In terms of crosswalking, we will work with you. Q: Where can I find CMS guidelines in written form? A: On CMS.gov, click on the Medicare link and you will find a link for both local and national coverage determinations. Q: When can I start finding ICD-10 codes within your software and submitting them? A: Our software already has all of the ICD-10 codes listed; we are building the crosswalk now. We recently completed ICD-10 testing with Medicare, and were successful with our front-end edits. We are looking to have this available to practices by June, to really start testing and crosswalking. At this point, payers are not accepting claims in ICD-10; they are not coming over until October 1, 2015, but we are testing with payers and clearinghouses directly. Q: Will you install products well before the October 1, 2015, deadline, so I can begin testing them now? A: We began crosswalking for ICD-10 in February 2014 and completed the process in April. Speak with your coach about testing for the new coding system. Q: When will you update my current products and applications for ICD-10? A: Our products are continuously update in accordance with new regulations and policies, so the ICD-10 changeover will be virtually seamless. Q: Will there be a charge for these updates? A: We do not charge for updates. Q: Will I need new hardware to accommodate ICD-10-related software changes? A: No. Our software, being cloud-based, will continue to run on your current hardware. Q: What are the costs associated with maintaining new products? A: There are no additional costs.
ICD-10 Strikes Back
Believe it or not, there is a method to the madness of ICD-10. The system was developed by the World Health Organization (WHO) as a means of standardizing the categorization of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Officially known as the International Statistical Classification of Diseases and Related Health Problems, ICD is the standard international diagnostic tool for epidemiology, health management and clinical purposes. This system is designed to map health conditions to corresponding generic categories together with specific variations, assigning for these a designated code, up to six characters long. Thus, major categories are designed to include a set of similar diseases. ICD-6, adopted in 1949, was the first version of ICD that was deemed suitable for morbidity reporting. The combined code section for injuries and their associated accidents was split into two: a chapter for injuries, and a chapter for their external causes. With use for morbidity there was a need for coding mental conditions, and for the first time a section on mental disorders was added. Work on ICD-10 — the tenth revision of the system — began in 1983. It was officially copyrighted by WHO in 1990, though it wasn’t actually completed until 1992. It was then adopted relatively quickly by many countries of the world, starting with Australia in 1998. Today, ICD-10 is the most widely used statistical classification system for diseases in the world. For numerous reasons, but particularly due to the special interest groups that affect policy, the United States wasn’t able to get on board until August 2008. At that time, the Department of Health and Human Services proposed that ICD-10 be adopted in America — a move that was formalized in January 2009, establishing ICD-10 as the new national coding standard, with an implementation date of October 1, 2013. And if the prospect of changing over to ICD-10 wasn’t imposing enough, ICD-11 is “scheduled” to become the new standard in 2017 — though with the numerous delays in getting ICD-10 onto the books, it’s likely that ICD-11 will be pushed back for at least a few years.
PQRS | How These Four Letters Affect Your Practice | Webinar Q&A
Unless you are billing the right set of PQRS codes on 50 percent of your qualifying visits, then you will lose 2 percent of your allowed reimbursement in 2016 and forward. As a result, you may have concerns about the changes that this reporting system brings to your chiropractic clinic. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar “PQRS | How These Four Letters Affect Your Practice,’ along with the presenter’s responses. Feel free to add any new questions in the comment section below. Q: Is Genesis powered by Vericle an eligible registry? A: Right now, the only way to submit a PQRS code to CMS is claim-based. Vericle is working on becoming a registry. It’s a very long process. Right now, we are working on Stage Two Meaningful Use. This is another way for users to avoid the 2016 penalty. Q: Does pain and medication measure have to be reported on every visit? A: Whatever measurements you choose to report, the documentation has to be in your chart. Q: What is Genesis powered by Vericle doing to maintain compliance with Medicare? A: In terms of compliance with Medicare, Vericle does keep up on the rules. In some cases, if you need a different secondary diagnosis when you’re submitting your claims to Medicare, Vericle is C-CHIT. Vericle completed EHR Meaningful Use Stage One and is preparing for Stage Two, which is Medicare compliant. PQRS codes have been available in the Vericle system. Learn more with the PQRS webinar so you can see it and hear it. Does PQRS affect your chiropractic practice?
Something for the Pain
By Kathleen Casbarro Simplifying coding issues can relieve practice tension How can software make a difference in the ICD-10 changeover? “Doctor!” The box on Ben’s desk squawked. Pam always sounded professional, but Ben knew her well enough to hear the tension in her voice. Ben hesitated for just a moment over the stack of paperwork he’d been plowing through, but decided he should respond to Pam’s obvious stress. As he neared the front desk, he heard raised voices. “You’ve already been to the doctor!” a young woman shouted at an older man whose face was set in pain… or perhaps in stubbornness. “He’s already been to the doctor!” she repeated in Pam’s direction. “Maybe I can help,” Ben offered. “I was in a car accident–” the older man began. “My dad has been to the doctor and to the hospital,” the young woman said firmly, “and they told him it was back pain and it would get better in time. They gave him pain medication to take and he won’t take it. Now he’s insisting on coming here, and I don’t think his insurance will pay. I just want to take him home.” Family altercations weren’t as common in Ben’s chiropractic clinic as they were in hospitals, but he recognized the situation. The daughter was worried that her dad wouldn’t be able to pay, the old man was still in pain, and their worries were showing up as anger. “Let me take these good people back and have a little chat,” he said calmly to Pam. Getting the shouting out of his waiting room was the first priority. He’d get them calmed down, explain the situation, and then bring them back to Pam for intake, and the paperwork — well, it looked like he’d be working late again. It was hours later when Ben had a chance to discuss the event with Pam. “I’ve been thinking about the man who’d had a car accident,” she said. “We’re always careful to avoid using the ICD-9 code 724.5 for back pain because it tends not to get paid. We make sure to use the most specific code we can so the patient’s insurance will be able to pay.” Ben nodded. “I realized that I don’t have that knowledge about the new ICD-10 codes,” Pam continued. “We’re always focused on the people we treat, but the paperwork is what allows us to keep the doors open and take care of those people. I’m worrying that the new insurance reporting codes will get in the way.” “I think we may have a solution,” Ben said. “I’ve been talking with the people at Genesis — the new practice management software. They had a really sensible approach to it. Three things: assessment, documentation, and implementation. That’s better than focusing on the 70,000 new codes, right?” “It might be,” Pam said uncertainly, “If I knew just what that meant.” Ben laughed. “Fair enough,” he said. “What I get is that the software will cluster the codes into groups so we can drill down to the right one, instead of trying to memorize everything. We’ll be able to see the relevant ICD-9 and ICD-10 codes on the billing screen, along with which payers are using each set, and we’ll have a crosswalk that will let us learn and train before the deadline.” “All on the billing screen?” Pam sounded excited. “That sounds workable.” “Workable,” Ben repeated. “That’s it exactly. It’s like when we get a patient having a meltdown in the front office — we may feel a little stress, but we have workable systems in place to handle it, and it turns out well.” How can software make a difference in the ICD-10 changeover? View our ICD-10 page for everything we know about ICD-10.