What Does ICD-10 Mean for Gastroenterologists?
The move from ICD-9 to ICD-10 is a nuanced transition, but the foremost issue is the jump in the number of diagnosis codes. ICD-10 will demand a higher level of documentation and coding detail. Ms. Pyrdol demonstrates the increased need for specificity by comparing the ICD-9 code for Internal Hemorrhoids without Mention of Complication (455.0) with the corresponding ICD-10 codes, which include:
• K64.0: 1st Degree Hemorrhoids
• K64.1: 2nd Degree Hemorrhoids
• K64.2: 3rd Degree Hemorrhoids
• K64.3: 4th Degree Hemorrhoids
• K64.4: Residual Hemorrhoidal Skin Tags
• K64.5: Perianal Venous Thrombosis
• K64.8: Other Hemorrhoids
• K64.9: Unspecified Hemorrhoids
Creating a budget
The American Medical Association released a study predicting the switch to ICD-10 will cost from $56,639 to $8 million, depending on the size of the physician practice. Such a significant investment requires a carefully laid out financial plan. Ms. Pyrdol suggests creating a budget that includes:
• Expense of new EHR and practice management software, if the current systems are not ICD-10 compatible. "If their system is compatible, then they may have to consider the expense of a system upgrade," she says.
• Office and clinical form updates to include restocking HCFA 1500 claim forms. "CMS HCFA 02/12 forms were available for use as of January 2014, but are required for use on April 1," she says.
• Training time and paid consultant seminars for physicians and staff
In the case of gastroenterology, a large portion of ICD-9 codes will cleanly translate to the ICD-10-CM code set, according to an American Society of Gastrointestinal Endoscopy report. "Analyze the top 50 ICD-10 codes by utilization numbers and crosswalk to ICD-10 codes," says Ms. Pyrdol.
The first step in creating that bridge is to ensure that a practice's EHR and billing and scheduling software is updated for the ICD-10 code set. "Most EHR programs will have two diagnosis code files: one file for ICD book descriptor and another file to be customized by the provider for his or her favorites," says Ms. Pyrdol. "Once the top diagnoses have been selected, determine how the physician wants ICD-10 customized in the EHR." The top 50 ICD-9 codes matched with the corresponding ICD-10 codes will serve as a type of "cheat sheet" as gastroenterologists delve into the new code set.
GI staff preparation
ICD-10 preparation is a practice-wide commitment. "All office personnel should review their internal workflow policies to determine how this change will impact daily workflow processes," says Ms. Pyrdol.
• Nurses and medical assistants will be in charge of analyzing clinical forms for ICD-10 diagnosis changes. "Determine whether there will be medical necessity changes for prior authorization of the most popular medications by contacting the different payers," says Ms. Pyrdol.
• Practice managers will look through administrative forms, such as superbills, ABNs and waivers, for coding changes. They will also determine whether or not the practice management system is prepared to handle ICD-10 coding or if it will need to be updated. "If using a billing vendor, confirm the vendor is knowledgeable about ICD-10 and their computer software is updated to allow for billing of these codes," says Ms.Pyrdol. Practice managers will also spearhead the organization of training sessions for staff and physicians.
• Billers and coders have the responsibility of reaching out to commercial payers to determine which payers the practice will be able to test with and which payers will not be prepared for the implementation deadline. Increased knowledge of GI anatomy will be necessary to meet the specificity demands of the new code set, says Ms. Pyrdol.
Pause before the plunge
ICD-10 is causing ripples of unease, and even protest, throughout the healthcare industry. It is undeniably a substantial undertaking, but if approached properly preparation can make it a manageable task. "Do not focus on the 91,000 ICD-10 codes identified as of Jan. 1, 2013," says Ms. Pyrdol. "Save your time and effort by concentrating on those diagnosis codes that directly impact GI coding." Break down the preparation into phases, create a timeline, assign tasks and work towards efficient execution of the plan. Below, Ms. Pyrdol illustrates a sample of timeline form.
|Phase||Task||Responsible Person||Start Date||Percent Completed||Task Finalized|
Implementation and beyond
After Oct. 1, physician practice staff will be straddling two different code sets, ICD-10 for billing services rendered after Oct. 1 and ICD-9 for billing appeals of services rendered prior to that date. "Recognize that coding and billing for procedures will be impacted and this process will take more time to complete," says Ms. Pyrdol. "For the first six months or so, payments will be compromised as payers struggle to confirm their adjudication systems are fully compliant."
The immediacy of implementation dominates the ICD-10 conversation, but healthcare, and the field of GI, will feel its effects beyond the initial shock. The increased specificity of the code set allows for more detailed physician reporting on patients' healthcare conditions.
"There will be improved documentation sharing, audit capabilities and reimbursement agreements based on quality of care rather than types of procedures performed," says Ms. Pyrdol. "There will be better clinical reporting options, which will in turn allow for increased GI disease research."
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