ICD-10 and Version 5010
The Ninth Revision (ICD-9) coding system for reporting diagnoses and procedures will officially be replaced with two new codes in October 2013: the ICD-10 Clinical Modification (ICD-10-CM) for diagnoses and the ICD-10 Procedure Coding System (ICD-10-PCS) for procedures. From the conception of ICD-10 and the 5010 HIPAA standards, our Academy has worked tirelessly to stave off implementation before preparation is complete. The changes seem to do no more than add to the layers of bureaucracy, further challenging our ability to do what we do best—provide quality care for our patients. The previous snail’s pace of government information related to ICD-10 and 5010 seems like a bullet now. Many of my colleagues are already reporting holdups in reimbursement, increased bureaucracy, and severe challenges in meeting the requirements of the new 5010 HIPAA standards, which took effect January 1, 2012, and will be actively enforced by the Office of E-Health Standards and Services (OESS), starting July 1. Although the Department of Health and Human Services (HHS) has announced its intent to delay the date, the current deadline for implementing ICD-10-CM is October 2013. The Academy has disseminated this information in many formats, including mail, the Bulletin, email, tweets, Facebook, conferences, and more, but I suspect many of us are still unaware of these changes. The ICD change affects all of us. There are many more ICD-10 diagnosis codes (70,000 ICD-10-CM and 70,000 ICD-10 PCS) than ICD-9 codes (17,000), with ICD-10 codes having a maximum length of seven characters compared to five characters under ICD-9. In the case of acute sinusitis, for example, there are 14 ICD-10 diagnosis codes compared to only six under ICD-9. While amusing to some, my immediate response to seeing some of these codes was a wave of nausea. In order to fully comprehend the extraneous burden of ICD-10, you will have to review a few extreme examples of these codes: W61.11XA = injury related to macaws and V91.07XA = injury from water skis on fire. I used to water ski quite a bit, but I am hard pressed to remember the last time the skis were on fire! Another example of a new code is Y93.F4 = injury from playing brass instruments. Perhaps more interesting to zoologists, there are 312 animal codes compared to nine in the previous version. There are separate codes for “bitten by a turtle” and “struck by a turtle.” Likewise, a poorly healed fracture can now fall into one of 2,595 different codes. With 10- to 15-minute patient visits, it seems virtually impossible for a physician to code properly. While the physician or an administrator can research the appropriate code, it is important to consider that this requires extensive time away from the patient and may detract from a physician’s ability to provide expert and compassionate patient care. The AAO-HNS is advocating continuously on our behalf. The reporting and coding undoubtedly requires increased physician documentation for hospitals to take full advantage of ICD-10-PCS, which applies only to care provided in the inpatient hospital setting. The impact analysis accompanying the proposed rule seemingly ignores the impact of the increased documentation requirements that are permanently required to permit the fullest use of ICD-10. The AAO-HNS has seriously questioned how “super-bills” can be effective. ICD-10, if fully utilized, will likely require that the bills be many pages (instead of today’s convenient one-pager), and be converted to electronic format at an additional cost to affected physician practices. For example, a study by Nachimson Advisors, LLC, noted that one software firm currently offers an electronic “super-bill” add-on to their practice management system for $995 per user. At the very least, the impact of ICD-10 on the use of “super-bills” will, in turn, have significant consequences for physician office procedures and productivity. The HHS agrees that implementation of ICD-10 code sets may cause serious cash flow problems for providers, but argues that these could be addressed through mechanisms such as periodic interim payments. However, these mechanisms are neither automatic nor problem-free, and AAO-HNS believes their use should rarely be required. Thus, HHS should begin by adopting a reasonable compliance date to minimize cash flow and other problems, and should listen carefully to the physicians, vendors, and payers who will be affected by changes in the code standards. An Academy member reached out to me in early January regarding a billing issue related to the switch. She learned that the system she was using was sold to another company, and decided that this switch would be the best way to transition EMR to EHR. Her practice made the change last April and spent countless hours to prepare for 5010. Despite their best efforts and intentions, they received communication on January 6, 2012, informing them to expect payment delays. She found it difficult to believe that EMR vendors and large insurance companies, such as BlueCross, Aetna, Cigna, and Medicare, were not ready for the 5010 transition. Karen Zupko & Associates suggested establishing several lines of credit and having them readily accessible for the disruption, which is expected to last at least three to six months. Requirements that force the physician community to incur new loans and accumulate interest against their practices just to survive ICD-10 are, quite frankly, intolerable. ICD-10 should not be implemented until it can run without significant financial hardship or demand absurd implementation deadline requirements. New signs will need to be created for our waiting rooms and here are just a few suggestions: Watch out for falling turtles! Beware angry macaws! Fire-throwing mountain bikes ahead! And yes, there are codes for most of these.
Michael Seidman, MDThe Ninth Revision (ICD-9) coding system for reporting diagnoses and procedures will officially be replaced with two new codes in October 2013: the ICD-10 Clinical Modification (ICD-10-CM) for diagnoses and the ICD-10 Procedure Coding System (ICD-10-PCS) for procedures. From the conception of ICD-10 and the 5010 HIPAA standards, our Academy has worked tirelessly to stave off implementation before preparation is complete. The changes seem to do no more than add to the layers of bureaucracy, further challenging our ability to do what we do best—provide quality care for our patients.
The previous snail’s pace of government information related to ICD-10 and 5010 seems like a bullet now. Many of my colleagues are already reporting holdups in reimbursement, increased bureaucracy, and severe challenges in meeting the requirements of the new 5010 HIPAA standards, which took effect January 1, 2012, and will be actively enforced by the Office of E-Health Standards and Services (OESS), starting July 1. Although the Department of Health and Human Services (HHS) has announced its intent to delay the date, the current deadline for implementing ICD-10-CM is October 2013. The Academy has disseminated this information in many formats, including mail, the Bulletin, email, tweets, Facebook, conferences, and more, but I suspect many of us are still unaware of these changes.
The ICD change affects all of us. There are many more ICD-10 diagnosis codes (70,000 ICD-10-CM and 70,000 ICD-10 PCS) than ICD-9 codes (17,000), with ICD-10 codes having a maximum length of seven characters compared to five characters under ICD-9. In the case of acute sinusitis, for example, there are 14 ICD-10 diagnosis codes compared to only six under ICD-9. While amusing to some, my immediate response to seeing some of these codes was a wave of nausea. In order to fully comprehend the extraneous burden of ICD-10, you will have to review a few extreme examples of these codes: W61.11XA = injury related to macaws and V91.07XA = injury from water skis on fire. I used to water ski quite a bit, but I am hard pressed to remember the last time the skis were on fire! Another example of a new code is Y93.F4 = injury from playing brass instruments. Perhaps more interesting to zoologists, there are 312 animal codes compared to nine in the previous version. There are separate codes for “bitten by a turtle” and “struck by a turtle.”
Likewise, a poorly healed fracture can now fall into one of 2,595 different codes. With 10- to 15-minute patient visits, it seems virtually impossible for a physician to code properly. While the physician or an administrator can research the appropriate code, it is important to consider that this requires extensive time away from the patient and may detract from a physician’s ability to provide expert and compassionate patient care.
The AAO-HNS is advocating continuously on our behalf. The reporting and coding undoubtedly requires increased physician documentation for hospitals to take full advantage of ICD-10-PCS, which applies only to care provided in the inpatient hospital setting. The impact analysis accompanying the proposed rule seemingly ignores the impact of the increased documentation requirements that are permanently required to permit the fullest use of ICD-10.
The AAO-HNS has seriously questioned how “super-bills” can be effective. ICD-10, if fully utilized, will likely require that the bills be many pages (instead of today’s convenient one-pager), and be converted to electronic format at an additional cost to affected physician practices. For example, a study by Nachimson Advisors, LLC, noted that one software firm currently offers an electronic “super-bill” add-on to their practice management system for $995 per user. At the very least, the impact of ICD-10 on the use of “super-bills” will, in turn, have significant consequences for physician office procedures and productivity.
The HHS agrees that implementation of ICD-10 code sets may cause serious cash flow problems for providers, but argues that these could be addressed through mechanisms such as periodic interim payments. However, these mechanisms are neither automatic nor problem-free, and AAO-HNS believes their use should rarely be required. Thus, HHS should begin by adopting a reasonable compliance date to minimize cash flow and other problems, and should listen carefully to the physicians, vendors, and payers who will be affected by changes in the code standards.
An Academy member reached out to me in early January regarding a billing issue related to the switch. She learned that the system she was using was sold to another company, and decided that this switch would be the best way to transition EMR to EHR. Her practice made the change last April and spent countless hours to prepare for 5010. Despite their best efforts and intentions, they received communication on January 6, 2012, informing them to expect payment delays. She found it difficult to believe that EMR vendors and large insurance companies, such as BlueCross, Aetna, Cigna, and Medicare, were not ready for the 5010 transition.
Karen Zupko & Associates suggested establishing several lines of credit and having them readily accessible for the disruption, which is expected to last at least three to six months. Requirements that force the physician community to incur new loans and accumulate interest against their practices just to survive ICD-10 are, quite frankly, intolerable.
ICD-10 should not be implemented until it can run without significant financial hardship or demand absurd implementation deadline requirements. New signs will need to be created for our waiting rooms and here are just a few suggestions: Watch out for falling turtles! Beware angry macaws! Fire-throwing mountain bikes ahead! And yes, there are codes for most of these.
