Last Minute ICD-10 Preparation
On October 1, 2015, reimbursement in the world of health care will change forever. Anyone who has not prepared adequately may be left behind. Just like it is impractical to expect to speak fluent Chinese after sitting through a one-day seminar, ICD-10 cannot be picked up in just a few concentrated hours of instruction, given at the last minute. Languages, like Chinese and ICD-10, are complex and real fluency can only be achieved over time, with practice. It will take a little planning and preparation to make sure it can be “spoken” as fluently as necessary in order to communicate properly when it takes effect on October 1, 2015.
Diagnosis codes are reported on claim forms to describe the reason for a health care encounter. Third parties use them to determine if the care provided was medically necessary and therefore, reimbursable. In the U.S., ICD-9 codes have been the standard for more than thirtyfive years, and, in that time, many of us have grown pretty comfortable with them. ICD-9 is a bit like that old, familiar t-shirt that gets worn every day. But if we take an honest look at it, we’ll notice that it is pretty worn out. It is stained and full of holes. It is time for a new shirt. It turns out that the federal government is going to take away the old shirt (i.e. ICD-9) on October 1, 2015 and we need to start wearing the new one (ICD-10), whether we want to or not.
Even though most experts agree that ICD-10 is a better code set than ICD-9, chiropractors, like most health care providers, would rather not spend time learning new codes. They want to work with patients and apply their clinical skills to a patient case. The ICD-10 code transition is just another administrative task that gets in the way of that. Short cuts and cheat sheets are appealing, but represent a flawed way of thinking because they can lead to mistakes which in turn result in claim denials. Short cuts are really only for those who are already fluent.
Even though DCs use relatively few ICD-9 codes, the short list of top ICD-10 codes is elusive. If all of the information provided by the Tabular List is considered, the idea of a cheat sheet becomes impractical. In reality, everyone who does business with ICD-10 codes should learn how to navigate the official guidelines and the Tabular List rather than looking for a much shorter list of the “best” codes. This requires an understanding of the structure of the chapters, blocks, and categories of codes, as well as the proper application of terms such as seventh character extensions, Not Elsewhere Classifiable (NEC), Not Otherwise Classified (NOS), Excludes1, and Excludes2. It is similar to learning the rules of grammar for Chinese before trying to speak the language.
Some providers have the mistaken impression that a simple translation tool, built into office software, or found on the internet, can take the place of actually learning the code set. Again, this is like using software to speak Chinese, rather than learning the language. Software can be helpful, but many practice management software programs have simply imported the General Equivalence Mappings (GEMs), which are only approximations, and frequently overlook more detailed code options. Cross-walking the common ICD-9 code 728.85 Spasm of muscle, with GEMs spits out only two codes. But, direct investigation of the code set leads to dozens more code possibilities, such as M62.830 Spasm of muscle of the back. This becomes evident when the exclusion notes for the M62 category (which contains spasms and contractures) is evaluated. In other words, the code chiropractors are most likely to use is not suggested by GEMs. It is only discovered if the Tabular List is used.
Software tools are not a substitute for the ability to navigate the Tabular List of codes in the official ICD-10 code set. The clinician and coder must be familiar with the codes and reliance on a third party tool may be unwise. A provider may want a simple list of the top codes, but an understanding of the Tabular List and its conventions are necessary to become prepared for ICD-10 implementation. This should minimize revenue interruption and improve code selection. In other words, by using the Tabular List, a chiropractic physician can learn to speak fluent ICD-10.
Dr. Evan Gwilliam is the Vice President of the ChiroCode Institute, which provides seminars, coding books, and online education for doctors of chiropractic. He is co-creator of UltimateICD10.com, which is a series of recorded ICD-10 training for the chiropractor. He is one of the few clinicians who is also a certified ICD-10 Instructor by the American Academy of Professional Coders, and he holds several other credentials in insurance coding and compliance. He can be reached at [email protected]
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Bruce Gundersen, DC, FACO
Stanley N. Bacso, DC, FACO, FCCO(C)
James Demetrious, DC, FACO
David Swensen, DC, FACO
Alicia Marie Yochum, R.N, D.C.