Doctors document a diagnosis so they can understand a patient’s problem and put together a treatment plan. And with some understanding of Latin and Greek languages, a lay person can make a pretty good guess at what the diagnosis is. But some time ago the WHO (World Health Organization) determined that Latin and Greek just wouldn't do, so they adopted a seemingly random (sorry, my bias is leaking) alpha numeric system to document diagnosis. Though originally it was for reporting mortality/morbidity, it evolved to broader purposes. I’m talking of course about the International Classification of Diseases (ICD) system.
I’m simplifying here, but in the United States doctors use the ICD documentation, e.g. 845.00, to justify treatment in order to receive private insurance or government insurance reimbursement for services rendered. Clinically, they still rely on the written word, e.g. ankle sprain.
In 1999, the world switched to ICD-10 (revision 10), but the United States just rambled on with ICD-9 (revision 9). But our time is running out and on October 1, 2013, we'll make the switch to ICD-10. I'll save you all the technical info on the switchover, as my head blows up if I think about it too much. But there are a few thoughts which have struck me as I delve deeper into the switchover.
1. Increase your cash-on-hand for Q4 2013 and Q1 2014. You may be documenting and coding perfectly for ICD-10, but don’t count on your colleagues to do the same. And don’t count on the payer reviewers either. I’m anticipating a large uptick in the number of claims which will be reviewed by payers, and therefore the time for payment to be extended for any reviewed claim. This is both due to claim issues, but also with reviewer issues. I know payers are preparing, but no one really knows what those first few months will look like.
2. Don't underestimate the number of your staff that will require retraining. I’m sure you have heard this enough already, but it’s true. The ICD-10 switch is not only a billing issue—it’s a medical record documentation issue, a billing issue, a training issue, and a business process issue. As someone who once thought of it as a billing issue only, please believe me on this.
3. This is a major impact on every practice, but not necessarily a major disruption for every practice. What do I mean? Think of it this way. ICD-10 is more specific than ICD-9. This will require more specific documentation and record keeping from virtually everyone who interacts with the patient. This may require processes or software which has different capabilities than what is currently in place. None of this is difficult to account for. But if it isn’t part of a planned, thoughtful process, then the impact could turn into disruption.
4. It doesn’t matter if you don’t like it, you must deal with it. Getting mad won’t make this issue go away. And waiting makes the inevitable changeover more stressful and disruptive (see Point 3 for more on disruption). And ignoring it means you won’t get paid. So unless you plan to run a completely cash-only practice and your patients won’t be asking for their PMH (personal medical history) to take to other providers, you must deal with it.
5. ICD-10 and ICD-9 will co-exist in your practice for a few years. Remember that outstanding claims submitted in ICD-9 will be adjudicated in ICD-9, not 10. Have pending litigation? If ICD-9 was used in the claim/chart, it will carry forward. Hiring a new biller? They will probably need to know 9 and 10.
If you have any thoughts, please share them with us. If you’d like help with your ICD-10 transition, you can contact me at bob@boboakleyconsults.com.
Straight ahead,
Bob
