ICD-10 | Five Building Blocks | Q&A from Webinar
ICD-10 Questions and Answers ICD-10 is coming soon. As you get your practice ready for the ICD-9 to 10 changeover, you are bound to have questions regarding documentation and compliance. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar “ICD-10 | Five Building Blocks,” along with the presenter’s responses. Feel free to add any new questions in the comment section below. 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 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 cross-walking. At this point, payers are not accepting claims with these new codes; they are not coming over until October 1, but we are testing with payers and clearinghouses directly. You will be able to see which ICD-9 codes correspond to the appropriate diagnosis 10 codes, side-by-side right in the travel card.
ICD-10 | 100x More Complicated | Q&A
As your practice is preparing for the impending ICD-10 changes, you might have many questions concerning chiropractic billing procedures and software requirements. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar ‘ICD-10 | 100 Times More Complicated,’ along with the presenter’s responses. 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 chiropractic 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 chiropractic 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, 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. For chiropractic documentation, have them listen to our webinar in March, but 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. View our ICD-10 page that has a collection of information about ICD-10.
Billing Updates | G-Codes and C-modifiers for chiropractors working with PTs
Genesis’ Vericle billing platform has been updated with G-Codes and C-modifiers to improve compliance for all clients who work with a physical therapist in their chiropractic clinics. Medicare is now requiring that G-Codes and C-modifiers are included on your physical therapy claims and documentation. This change is very complex and can not be done from memory alone. If these requirements are not met, providers will not get paid by Medicare and these claims will be denied. The G-Codes are used on your Initial Evaluations, Progress notes/Re-evals and Discharge visits to track the patient’s progress in reaching their goals. These codes are used to demonstrate medical necessity and ensure that the patient is getting better. In addition to billing out these G-Codes, providers also have to add C-modifiers depending on the severity of the patient’s condition. Providers also need to use these codes in their documentation and ensure that it is supported with functional testing (e.g., Dash, Tinetti, etc). Any claims submitted after July 1, 2013 that do not have G-Codes on the required visits will be denied. If these findings are not documented, the audit risk increases significantly. G-Codes and C-modifiers have been added to all procedures for clinicians with the PT, OT, and/or SLP specialty code. These can be found in the Procedures list on the Billing and EHR screen. We have put in several validations that will flag any claim missing the G-Codes and C-modifiers. These claims will be sent back to your provider workbench for review. We have also created a new XDoc template that allows providers to document the Initial Evaluation, Progress Note, and Discharge Summary all in one XDoc template so they will be able to track the overall progress of the patient. This template also has the Functional Assessment Tools (e.g., Dash, Tinetti, etc) complete with automatic calculations to support your G-Code and C-Modifier reporting. To add this XDoc template to your account, please open a Vericle ticket to your SPOC. We have held two G-codes webinars on these updates this month and will be publishing a downloadable version in the next couple weeks. If you have any questions or concerns regarding these new requirements, please do not hesitate to open a Vericle ticket to your Coach.
