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.
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?
Appreciating the Layers
By Kathleen Casbarro ICD-10 changeover represents a multi-level issue for practice owners What makes the ICD-10 changeover so challenging? “You just have to know your onions,” said Carmen, waving a wooden spoon. Ben snatched a mushroom from a prep bowl. It was always fun to visit his wife’s pizzeria, even when he was worrying about his chiropractic practice. “I don’t usually envy you,” he said, “but just for the moment I wish onions were all I had to worry about.” “See,” Carmen continued, spreading onions over the sauce and cheese on a pizza with a practiced hand, “not everyone likes onions sliced and on the pizza, but everyone wants them in the sauce, where they don’t even notice them. Tomatoes, cheese, sausage — that’s the stuff people think is key to a pizza, but the onions are really essential. Without onions carefully chosen, chopped, and simmered in the sauce, you won’t have the flavor.” “Down-home philosophy based on pizza,” Ben laughed. “Just what I need today.” “I know this whole changeover in the insurance reporting is bothering you a lot.” “True. Payments from insurance companies are a very large part of the profit at the clinic. If I don’t make the changeover correctly, I could lose out in a very big way.” “So the codes are like onions,” said Carmen. “It’s not something everybody knows about and notices, but it’s very important. When someone says you know your onions, it means you’re really knowledgeable and experienced, not just on the surface.” “I’m not sure they’re really talking about pizza.” “Come with me on this,” Carmen laughed, pushing the pizza into the big oven. “The codes are changing, and you would like that to be a small thing, something your office staff can take care of, but it’s really important, the way onions are important. Just because your clients don’t notice it doesn’t mean it’s a small thing. It’s worth an investment of time and money if that’s what it takes.” “I think it will take time and money,” Ben admitted. “The ICD-9 set has 14,567 codes, while new ICD-10 has 69,832 codes.” Carmen turned away from her workstation to stare at her husband. “Did you make those numbers up?” “No,” said Ben, “I have them stored right here on my phone.” He showed her the note. “I’m not sure why I’m saving these numbers, but I guess they seem to explain the reason this is such a big deal. It’s not just about changing a few numbers. Things for which we’ve been using just one code will now need to be divided up into a lot of different codes depending on lots of new criteria, including which side of the body is involved and how the patient got the injury — there’s a special code for turtle bites, and I am not making that up.” Carmen cupped Ben’s face with her hands, leaving his cheeks dusted with flour. “You’re a great chiropractor and you can do this. I’m just saying, accept that it’s a big deal. It’s complicated, it’s urgent, and it requires an investment.” She suddenly sniffed the air, whirled, and pulled the pizza out of the oven. “See,” Ben said, “you caught that just at the right moment — because you know your onions when it comes to pizza.” He hoped his knowledge of chiropractic would be enough to bring his practice through the reporting changes successfully. Sometimes it seemed as though the business side of the practice was overwhelming. What makes the ICD-10 changeover so challenging? Go to our ICD-10 page to see everything we have on ICD-10 diagnosis codes.
Trouble Brewing
By Kathleen Casbarro ICD-10 spells a major adjustment What will Ben’s chiropractic office face with the changes in insurance reporting? Carmen sat on the sofa next to her husband and pulled her feet up under her. “Ben,” she said, taking his hands, “I want to know what’s going on. You picked at my homemade manicotti, you provided no challenge at Wii Bowling, and you didn’t even do the voices for Jonathan’s bedtime story.” Ben smiled ruefully. “You’re right. I’ve got something on my mind,” he admitted. “Remember I told you about the new codes for insurance reporting?”“ICD-10 codes?” Carmen thought back to the previous week, when Ben had told her some government changes would affect his chiropractic clinic. “I remember you didn’t seem to know just how they would affect you.” “Ignorance might have been bliss! I just found out that the effects are going to be significant. The AMA estimates that complying with the changes will cost a practice like mine in the neighborhood of $83,000.” “That’s not a neighborhood we’d feel comfortable in,” Carmen protested. “Things have been rough with the practice already–” “I know,” Ben agreed. “It’s already so stressful dealing with uneven cash flow, I don’t know where I’m supposed to come up with the funds to cover this kind of investment, but it’s not optional. We have to complete these changes by October 1, 2014, or we won’t get paid at all.” Carmen frowned. “Are you sure it has to cost that much? I’m pretty good at pinching pennies.” “I know you are, but this isn’t like negotiating with your suppliers at the pizzeria. I can’t negotiate with the government, and the the new ICD book has 1,107 pages of non-negotiable changes. We’ll need software upgrades, changes in billing practices, training for all the staff… that’s all going to cost.”Carmen and Ben both stared glumly ahead. “Even if you figured out some way to do everything yourself, you’ll have some opportunity costs,” Carmen said. “You’d have to cut down on the patients you see or the other work your team is doing. I’m at your place a lot and I never see people sitting around doing nothing. You’re already running efficiently, so extra time is the same as extra money.” “Exactly. Plus, any change increases the risk that we’ll be audited or that the insurance companies won’t pay claims. We don’t yet know what will be considered medically necessary under the new system, but we’ve heard that there’ll be opportunities for cherry picking. That means that our choice of words in the notes we write up could affect whether or not we get paid.” Carmen shook her head. “You’re already dealing with non-payment of claims, aren’t you?” Ben nodded. “I just don’t see how we’re going to get through this.” “Things are good at the restaurant. And, as I said, I’m good at pinching pennies.” Ben forced a smile. He was lucky to have Carmen, and he knew she’d do what she could, but the stress was getting to him. This was definitely not what he had dreamed of when he had set up his practice. What will Ben’s chiropractic office face with the changes in insurance reporting? Visit our ICD-10 page to see everything we’ve published about ICD-10 diagnosis codes.
