Now that CMS has officially issued another delay in the implementation date for ICD-10 to October 1, 2014, you may be tempted to relax and wait. Instead you should consider this new delay a gift…a gift of extra time to prepare for the transition.
Mapping is the Key
The easiest way to learn how ICD-10 will impact your practice is to look at mapping first. Mapping is the process of converting ICD-9 codes to ICD-10 codes and vice versa. Mapping from ICD-10 back to ICD-9 codes is referred to as backward mapping. Mapping from ICD-9 codes to ICD-10 codes is referred to as forward mapping. Looking at mapping first will help you visualize the transition based on ICD-9 codes you already use.
The coding guidelines for ICD-10 are almost identical to the ICD-9 guidelines. The process of coding is the same, i.e. you look up a word or phrase in the index, go to the appropriate tabular section and pick the code. You already know how to do that. But what do the new codes look like? How do the ICD-10 and ICD-9 codes relate to each other? How many of the 65,000+ ICD-10 codes apply to your practice?
ICD-10 mapping will answer those questions and serve as an introduction to the ICD-10 coding system. You can use mapping resources to:
• Convert ICD-9-CM codes to ICD-10-CM
• Convert ICD-10-CM codes to ICD-9-CM
• Update diagnostic coding databases
• Revise your billing forms
• Create common code lists for training purposes
Who Can Use Mapping?
Mapping can be used by anyone who wants to convert coded data including: all payers; all providers; medical researchers; informatics professionals; coding professionals; software vendors; organizations needing to create mappings that suit their internal purposes; and others who use coded data.
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced Monday, April 9th, a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
THE PROPOSED RULE DELAYS THE IMPLEMENTATION OF ICD-10 BY ONE FULL YEAR.
The new compliance date is October 1, 2014. Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.
View the proposed rule
ICD-9-CM 2012 & 2013 NOW MORE IMPORTANT
This delay means all provides must continue to use ICD-9-CM codes from October 1, 2011 through September 30, 2014. The revisions to ICD-9-CM for 2013 are likely to be more extensive due to this delay. If you are not already using ICD-9-CM 2012 and/or ordered ICD-9-CM 2013 you should do so immediately to protect yourself from potential payment and compliance problems.
The American Medical Association (AMA) House of Delegates voted on November 15th at the semi-annual policy making meeting in New Orleans to work vigorously to stop implementation of ICD-10 (The International Classification of Diseases and Related Health Problems, 10th Revision), a new code set for medical diagnoses.
ICD-10-CM has about 69,000 codes and will replace the 14,000 ICD-9-CM diagnosis codes currently in use. “The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients’ care,” said Peter W. Carmel, M.D., AMA president. At a time when we are working to get the be value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions.
The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be – on their patients.”
A 2008 study found that a small three-physician practice would need to spend $83,290 to implement ICD-10, and a 10-physician practice would spend $285,195 to make the coding change.
ICD-10 is scheduled to replace ICD-9 effective for all health insurance claims filed on or after October 1, 2013.
Few people play such an important role in the reimbursement process as the professional coder. Using a combination of training, experience, intuition and insight, these hard working, under-appreciated and frequently underpaid people have to be eight parts coder, two parts nag, and four parts detective to get their jobs done.
From simply trying to get basic information to code in the first place, to making critical coding decisions which affect the profitability of the medical practice, the coder must keep track of an impossible number of frequently changing rules, regulations, policies and procedures. Add to that dealing with the black holes of insurance carriers and their likewise underpaid, under-appreciated claims examiners, and you can see that the medical office coder certainly deserves a purple heart and a medal of valor for sticking with it under duress.
In most businesses, employees who are able to increase revenues and/or profits are considered very valuable to the company and are frequently rewarded with raises, bonuses and promotions. Unfortunately, that’s not always the case in the medical office. Many of you don’t even get a “thank you for a job well done” or any acknowledgement…you deserve better than that.
The forthcoming transition from ICD-9 to ICD-10 in 2013 is an example of a major change that will require the training, knowledge and experience of medical coders. While others may plan the computer systems, training classes and conversion processes, at the end of the day, it will be coders that make the transition a success.
I’ve been in the health care industry for over 40 years and I have had the good fortune to know and work with many professional medical coders. I am constantly impressed by their knowledge, dedication and hard work, often in an adversarial environment. We know what you do and how hard you work. We know that it’s really you who are our customers, and we try our best to find ways to make your job easier. Even though there may never be an official day honoring all of you hard-working medical coders, at PMIC everyday is National Coders Appreciation Day.
As you know, the majority of the citizens of our country do not want health care reform as it was passed. Most believe that the Health Care Reform Act of 2010 will have negative consequences for physicians, their employees, and patients. But what do physicians think?
The 2011 National Physicians Survey recently published by Thomas Reuters/ HCPlexus provides some interesting answers to the question. In the survey physicians were asked questions about the quality and delivery of health care, reimbursement, and the impact on patients and physicians of the Health Care Reform Act of 2010 (HCRA). The report is based on the responses of almost 3,000 physicians, including primary care and specialists, from every state in the United States.
Quality of Health Care
When asked about the quality of health care, an overwhelming majority of physician respondents, 65%, believe that the quality of health care will deteriorate in the next five years as a result of the Health Care Reform Act. Only 18% of respondents believe the quality of
health care will improve in this country. This is significant to all of us, as we all are consumers of medical care at some time or other.
Who Will Be Taking Care of Patients?
Physicians were asked who will be treating the increased numbers of patients who will have health insurance because of the Health Care Reform Act. Respondents indicated that these patients will be cared for mostly by Primary Care physicians and Nurse Practitioners. Of
special interest is that physicians believe that these patients will be cared for in equal numbers by Primary Care physicians (44%) and Nurse Practitioners (44%).
What About Physician Reimbursement?
Not surprisingly, the great majority of physicians (74%) believe that reimbursement will be less fair due to the Health Care Reform Act. Of all specialities, surgeons, in particular Orthopedic Surgeons, took the most negative view, with 92% stating that reimbursement will be less. If reimbursement declines, physicians will have to find ways to cut practice costs, which will affect not only the physician but all those employed by physicians.
Impact on Patients
A majority of the physicians surveyed, 58%, believe that the Health Care Reform Act will have a negative patient impact. It is simply impossible to increase or maintain the quality of heath care, to a greater number of patients, and reduce costs. Something has to give.
Hopefully, the Health Care Reform Act will be repealed, and replaced by better legislation, before it can harm physicians, their practices, and their patients. To read the complete report, visit http://www.hcplexus.com/Survey.
Finding ways to reduce physician reimbursement and control billing fraud continues to be the focus of healthcare reform proposals. As shown by the recent GOP proposal, it doesn’t matter which political party is running the show when it comes to the issue of physician payment reform. Yet, in spite of the national furor over medical fees, virtually all medical practices are operated as discount businesses. When you accept insurance payment as payment in full, give up a portion of your bill to collection agencies, accept capitation or discounted payments from managed care organizations, participate in Medicare, provide services to Medicaid patients, and write off the rest of your bad debts, you are running a discount business.
Operating costs for the average medical practice have increased about nine percent per year for several years. But increases in fees haven’t kept pace, and Medicare fees continue to drop. The simple truth is that you can’t continue to be paid less and spend more and come out ahead.
Working with thousands of physicians over the past two decades has given me a unique perspective that politicians don’t have. I know that there is some billing fraud, committed by a few dishonest people. But I also know, for every physician that anyone can find who is committing any kind of billing fraud, I can find nine who aren’t charging what they should be. My advice is to take a hard look at your own fees, and make sure that they are at the proper level, while you still have some control over them.
If the health care reform being debated in Congress comes to pass, it will drastically affect providers, payers, and consumers. Most polls show that the majority of U.S. citizens are satisfied with their health insurance and medical care and do not favor the drastic reforms currently proposed. While some heath care industry groups have come out in favor of the proposals, the majority of physicians and other providers are vehemently against it.
While both providers and consumers recognize the need to make some changes, most want less, not more, government regulation. Most individuals want more, not less, control over decisions affecting their medical care. The current proposals will result in increased government control over the practice of medicine, reduced payments to providers, a reduction in the number of providers, and ultimately scarcity and rationing of medical care for consumers. Wherever these types of reforms have been tried, these are the results.
As a medical provider you need to be prepared for increased government scrutiny of your practice, an increase in the volume of forms, records and reports, along with significant decreases in reimbursement. Bottom line, you will have to work more for less while accepting government interference with your professional decisions.
As a consumer you need to be prepared for limitations in your choice of health care plans, choice of providers and treatment options. With fewer providers, coverage decisions made by government committees, and the increased cost of a government administered system; most of us at some point will face rationing of care based on age, diagnosis or other factors.
My Christmas wish would be for Congress to get out of the way, or even better reduce government interference in the health care industry, and let the free market determine our system. But that would require a Congress that truly cared about the desires and needs of medical providers and consumers. Bah! Humbug!
Every time I get a really bad cold or some stomach bug, which usually is over in a few days, I marvel at how our body can usually heal itself. But each year when we begin the process of revising the ICD-9-CM code books, and I see all the various diseases and accidents that can make us ill, hurt us, or kill us, I am amazed that any of us survives for very long.
The ICD-9-CM coding system provides specific codes for these injuries and diseases, but the addition of new codes and code groups reflects not only the discovery of new maladies and the advancement of medicine, but also reflects social, economic and political issues as well. Additions to ICD-9-CM in the past few years include a new section for HIV (042), codes for adult and child abuse (E9670-E967.9), accidents involving spacecraft (E845) and a host of codes related to terrorism by aircraft, biological, chemical and nuclear weapons (E979.0-E979.9). I wonder if letter bomber Ted Kaczynski knows there is an ICD-9-CM code for Assault by letter bomb (E95.7)?
But in addition to all of the ICD-9-CM codes for the really bad things that can happen to us, there are some codes that I have always found to be amusing by their descriptions (although I’m sure they’re not be funny to those afflicted.) One of my favorites has always been “black hairy tongue” (529.3) which conjures up some nasty images with little effort. Accidental fall from commode (E884.6) is another one I like. Until the mid-1990’s all versions of ICD-9-CM included a listing in the alphabetic section under “no” for “no room at the inn,” some government employee’s idea of a good joke no doubt.
In my opinion, training on a coding system you won’t be using for over three years (39 months) doesn’t make sense. Think about it. Do you really need to spend your valuable time and money learning something that has no immediate practical use?
Do you remember Y2K, when the world was supposed to end because computer systems would not be able to handle the date change from 1999 to 2000? Regrettably, health care organizations spent millions developing disaster plans for something that never happened. The same confusion and scare tactics are being used to sell you ICD-10-CM products, newsletters, seminars and training programs that you don’t yet need.
You already know that ICD-10-CM is different than ICD-9-CM. You know that it has more codes, has a letter in the first position, and may be 3-7 digits. Depending on what extensions you include, ICD-10-CM has 5-10 times as many codes as ICD-9-CM. But that doesn’t mean it’s harder to learn or to use, just that there are more choices. A professional coder will quickly get the look and feel of it. At this time, that’s really all you need to know.
In you’re skeptical, please Google and read the March 24, 2010 blog by Tom Sullivan at www.icd10watch.com, titled “CMS, AAPC, AHIMA all agree it’s too early to start ICD-10 training.” The blog states “All three, in fact, recommend that healthcare organizations should start training during the year of implementation, which means the first quarter of 2013, or perhaps 2012’s final quarter.” According to the AAPC and AHIMA experts quoted in the blog, “training coders, particularly those already proficient in ICD-9-CM, will require a mere matter of days.”
You have a choice. You can invest now in ICD-10 training that you don’t need, will forget, and will have to repeat later, or you can save your money and wait to start your training until late 2012 or early 2013, closer to the implementation date. When the right time comes, PMIC, home of the “Billion Dollar Biller”, will offer all of the ICD-10-CM products you need to make this transition.
The Centers for Medicare & Medicaid Services (CMS) released a final rule for replacing the 30-year-old ICD-9-CM code set with ICD-10-CM and ICD-10-PCS. The final rule outlines the the compliance date for as October 1, 2013 (four and one-half years from now).
ICD-10-CM includes five times more codes than the ICD-9-CM code set. The conversion will impact every aspect of business operations for physician practices and result in significant added costs. According to a recent study sponsored by several large medical associations and the MGMA, it will cost your practice about $28,000 per physician to convert to the ICD-10-CM coding system. According to the study:
- For a typical small practice, defined as three physicians and two impacted administrative staff , the estimated total cost impact of the ICD-10 mandate as $83,290.
- For a typical medium practice, defined as 10 providers, one full-time coder, and six impacted administrative staff, the estimated total cost impact of the ICD-10 mandate as $285,195.
- For a typical large practice, defined as 100 providers, with 64 coding staff comprised of 10 full-time coders and 54 impacted medical records staff , the total estimated cost impact of the ICD-10 mandate as more than $2.7 million.
These total cost estimates are based on an analysis of added costs in six key areas:
- Staff Education & Training Costs. will range from $2,405 for a small practice to $46,280 for a large practice.
- Business-Process Analysis of Health Plan Contracts, Coverage Determinations & Documentation. will range from $6,900 for a small practice to $48,000 for a large practice.
- Changes to Claim Form Software. will range from $2,985 for a small practice to $99,500 for a large practice.
- Computer System Changes. will range from $7,500 for a small practice to $100,000 for a large practice.
- Increased Documentation Costs. will range from $44,000 for a small practice to $1.785 million for a large practice.
- Cash Flow Disruption. will range from $19,500 for a typical small practice to $650,000 for a typical large practice.
Preparing for ICD-10
According to AHIMA, it would be impractical and a waste of resources and time to start training coders now on the specific updates to the code sets. AHIMA says coders should be trained much closer to the 2013 implementation date .
When the time comes, you can count on PMIC to provide the very best, innovative, high quality ICD-10-CM coding books, software and training materials. In the meantime, you can plan on continuing the use of ICD-9-CM for at least the next four and one-half years.