This is Part 2 of our look at ICD-10 planning for the solo practice. Today we’ll take a look at what October 1, 2013 and the following months might look like.
October 1, 2013
When Dr. X documents a patient visit, Dr. X will need to
make sure the documentation supports the diagnosis. For example, for a patient with a follow up
visit for a left ankle sprain, the ICD-9 code of 845.00 is replaced with the
ICD-10 code of S93.402D. S93.40
represents ankle sprain of unspecified ligament, the 2 represents the left
ankle, and D represents a subsequent visit (as opposed to A for initial visit
or S for sequela visit). The encounter note
must document laterality and if the visit is for the initial evaluation or a
subsequent evaluation.
If the practice is using a paper super bill, then a revised super
bill will need to reflect the new code sequence. As a side note, our 845.0 code is replaced
with a universe of 9 possible ICD-10 codes.
Does your paper super bill have room?
If the practice is using an EMR, then someone will need to update
845.0 with the nine possible new ICD-10 codes.
Moving on from the doctor and other clinical staff who will
document the visit, let's look at the biller who will change this to a claim. The practice management software will need to
be updated to reflect the new codes. And
since the ICD-10 codes can go out to the 7th digit, this will probably require
a software uplift from the vendor. The
biller will also need to know what service (CPT code) is allowed for code
S93.402D so as not to submit a claim which will be denied.
November 15, 2013
The biller receives notice of denied claims. This notice contains denials with both ICD-9
and ICD-10 codes. This is because there
will be an overlap of time when both code sets will be in use as payers process
claims. So billers will need to be fluent
in both code systems. Practice management
software and EMR software also need be able to handle the dual code sets for a
period of time.
The biller has a denied claim with an ICD-9 code, and
another one with an ICD-10 code. She
looks at the encounter notes for supporting documentation, but both are
inconclusive. So she forwards both on to
Dr. X for clarification in order to resubmit the new claims. Dr. X and clinical staff will need to stay
fluent in ICD-9 until those claims are processed.
March 1, 2014
The biller receives notice of denied claims from a payer,
and there are many more than usual. After many hours, the biller determines the
almost all of the claims are correct. A
phone call to the payer makes it apparent they have a large backlog of denied claims
with the new code set and have had difficulty processing them. Some have been denied by mistake, and there
are also a large number of valid denials because many practices are struggling
with ICD-10. The end result is the payer
says the backlog will result in a delay in payments as they wade through
everything to get back up to speed. This
results in the practice experiencing reduced cash flow.
April 1, 2014
A patient previously diagnosed with controlled hypertension
returns for a scheduled 6 month follow up visit. During the visit, Dr. X will need to change
the ICD-9 code to it’s ICD-10 equivalent in either the EMR or paper chart.
May 1, 2014
The practices billing clerk has retired and the practice
has hired a new billing clerk. However,
he is only fluent with ICD-10, so any legacy ICD-9 claims need to be
processed by the office manager.
Next time, we’ll look at how we can prepare for these
situations. We’ll start making our to-do
list. In following posts we’ll start
putting together a timeline and goals.
