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.
Note-Worthy
Staff and Office personnel have to work together to make transition easier. Can Ben’s self-improvement plans cause trouble for his staff? Pam looked up as Ben bustled into the office. “You’re energetic today!” “I’m feeling inspired,” smiled Ben. “We’ve made some smart changes in the practice, and we have more coming up, so I think I’m ready to tackle changes in documentation.” “I’m impressed,” said Pam, “but I hope you’re not going to make too many changes. I feel like I’ve had just about all the change I can stand.” Ben was surprised. “I don’t think this is going to be a problem, Pam. We know that the new ICD-10 codes that go into effect in October are going to require more detailed documentation. I’m just going to get a handle on the new requirements.” “I understand that,” Pam sniffed, “but I feel like I have just gotten to where I can completely understand your notes and pick out the important keywords for coding. If I have to get used to a whole new system… well, if it’s not essential, I’d rather we didn’t make any more changes, that’s all.” Ben took a seat. “You know there are a lot more codes in the ICD-10 system than with ICD-9 codes–” “Don’t I know it! Almost 70,000 total.” “And one of the reasons there are so many more is that the codes have to be a lot more specific. If you don’t have very specific clinical documentation, it’ll be easy to get the codes wrong.” Pam said nothing. “If we have too many coding errors, or inaccurate documentation, it becomes a compliance issue.” Pam frowned. “I see what you’re saying. We could face non-payment issues, or even be audited. That would be a lot more trouble than getting used to a new style in documentation.” “Exactly.” Ben stood and stretched. “Tell you what, I’ll work on my handwriting and punctuation at the same time.” Pam laughed — or, thought Ben, maybe it was a snort. Either way, he was ready to get on top of the new demands for documentation. It felt good to have a clear goal. Can Ben’s self-improvement plans cause trouble for his staff? See our ICD-10 page for more information and more blogs on the diagnosis codes.
Play Time’s Over
By Kathleen Casbarro Clinicians need to keep coming coding changes in mind How can Ben get on track for the ICD-10 changeover when it comes to clinical documentation? “Ben!” called Carmen, “You’re going to be late for work!” Ben swung Jonathan down to the floor and settled him with crayons and paper. The time he spent with his son in the mornings helped him start his day in a great mood, but it was easy to lose track of time. “Thanks!” he said to his wife, taking the strong, hot coffee she offered. “You don’t have to go in to the restaurant at all today?” “I have an actual day off,” she beamed. “It’s kids’ clinic at your place today, isn’t it?” “Yes, it is, and I think it’s my favorite day of the month.” Ben’s chiropractic office provided monthly well kid checkups for patients, and it worked out best to bunch all those appointments together. “Unless we have an emergency, it’s all happy, healthy kids.” “You can just write ‘Great kid!’ on each chart and skip the paperwork,” Carmen said with a smile. Ben finished his coffee quickly and headed to the clinic, with Carmen’s words ringing in his ears. He had been focusing on getting billing and scheduling systems in place in preparation for the ICD-10 changeover in October, but he knew he was also going to have to make changes in his clinical documentation. What changes, though? Once again, Ben thought, he was facing a possible problem without knowing just what he was up against. He knew he did a good job with clinical documentation, but he also knew that the documentation would be key to success with ICD-10. There would be different codes for the two sides of the body, for various levels of severity of each condition, and more — and payment decisions would be riding on making the right choices. Ben added “clinical documentation” to his list of issues to think about. The list never seemed to get any shorter, but he felt fairly sure that he had no choice with this issue. How can Ben get on track for the ICD-10 changeover when it comes to clinical documentation? See all of our information on ICD-10 on our ICD-10 page.
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?