Politicians offer unspecified ideas for a smoother ICD-10 transition
When it comes to politics, anything can happen. That includes another delay of ICD-10 implementation.
Yes, everything seems to moving smoothly. Not smooth enough to declare that ICD-10 implementation is inevitable. I agree with John Lynn's assessment that an ICD-10 delay can be added to healthcare legislation going through Congress. But he also hit the nail on the head:
"However, if I were a betting man, I’d put my money down on ICD-10 not being delayed any more. The advocates for no more ICD-10 delay are much better organized this year and I think their message is getting across to the right people in Washington."
Which makes another ICD-10 delay very unlikely.
What's more likely is an ICD-10 twist.
I can see Oct. 1 being the first day that U.S. healthcare organizations use ICD-10 codes. Maybe they will have the option of using ICD-9 codes also.
OK, I'm not betting on that. But I want to see the odds on the "unspecified" option.
For example the “Increasing Clarity for Doctors by Transitioning Effectively Now Act” calls for at least 18 months of unspecified or incorrect ICD-10 coding. Because physicians shouldn't have to be penalized for honest mistakes.
This week, Rep. Kevin Brady, Texas, wrote a letter to Centers for Medicare and Medicaid Services acting administrator Andy Slavitt listing several conditions that need to be considered to make the ICD-10 transition easier for physicians. Tucked in there was this:
"Indicate whether claims must include the ICD-10 diagnosis code with the highest level of specificity immediately upon the Oct. 1, 2105 effective date, or whether a clinically accurate but less granular code will be accepted. A period during which less specific codes are accepted while providers get accustomed to the new systems would be appropriate."
This unspecified period is catching traction on Capitol Hill. I wouldn't bet against it.
CMS reported that its latest round of end-to-end ICD-10 testing was a success with 88 percent acceptance rate:
- 23,138 test claims received
- 20,306 test claims accepted
- 2% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code
- <1% of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code
The non-ICD-10 reasons for rejections included:
- Incorrect NPI, Health Insurance Claim Number, or Submitter ID
- Dates of service outside the range valid for testing
- Invalid HCPCS codes
- Invalid place of service
CMS sees this as an improvement over the last end-to-end testing period.
The Coalition takes on The Heritage Foundation's assertion that we need separate code sets for billing and data reporting:
"And how would developing another diagnosis coding system decrease costs, burden, or complexity? After all, it would require that providers use two coding systems instead of one—ICD for research purposes to fulfill international disease reporting requirements, and a different system for capturing diagnostic information for reimbursement purposes."
- Updating the superbill with ICD-10 codes may not be feasible. "There are other solutions, such as the use of EHR, which would better assist physicians in selecting appropriate codes."
- The superbill is not all the clinical documentation needed for coding.
- There are more forms that will need ICD-10 coding updating.
- Medical practices need to create claims with ICD-10 codes.
- Use a crosswalk to get the ICD-9 codes.
- Compare the diagnosis groupings of both claims.
- ICD-10 training for medical coders at physician practices isn't a priority.
- Physicians are reluctant to undergo ICD-10 training themselves.
Seven tips for physician practice coders:
- "Become an ICD-10 super-user."
- "Start small to avoid becoming overwhelmed."
- "Advocate for 1-2 hours of practice time per week."
- "Network with other coders."
- "Identify a physician champion in mid- to large-size practices."
- "Provide input into template design."
- "Open lines of communication."
- Coding error rate is expected to at least double to 6 percent to 10 percent.
- Medical coders are reporting needing an extra 18 minutes to code each ICD-10 claim.
- Physicians will need to become more involved in denials management.
Albert Oriol, vice president and CIO of San Diego's Rady Children's Hospital, makes the case for granular data leading to better patient outcomes.
This week I had a little bit of fun with a Star Wars reference. And David Berky answered the headline's question in the comments:
"I'd code carbon freezing with "T69.9XXA - Effect of reduced temperature, unspecified, initial encounter". In fact, if you search for T69.9XXA on findacode.com you'll see an Easter Egg at the top right corner. Click it and it plays that scene in Start Wars: Empire Strikes Back."
Who says ICD-10 codes are out of date? (ICD10 Watch)