Don’t get denied! Prepare now

ICD-10 is a few months away. Here’s what you can do to prepare Uncertainty related to implementation was one of the main reasons many providers postponed preparing for ICD-10. Now that political uncertainty has been all but eliminated, electronic health record (EHR) vendors, clearinghouses, and health plans are all moving forward with preparation for the ICD-10 transition. Otolaryngologists in group or small practices must follow this lead and focus on preparation efforts to ensure that practice revenues will not be interrupted come October 1. ICD-10 is a few months away, what can I do to prepare? Communicate with your payers/vendors One of the most effective things you can do at this point is communicate with all payers and vendors to ensure they are prepared and ask them what you need to do to further prepare. Below is a sample list of questions to ask your payers/vendors to receive ICD-10 information that could be crucial to your practice’s workflow after October 1. (This list is just a sample and is in no way all-encompassing nor should it be interpreted as legal advice): Does our license with you include ICD-10 regulatory updates on a moving-forward basis after the ICD-10 go-live date of October 1? Who are the ICD-10 contact people and what is their contact information? What modifications to my EHR must be made to accommodate ICD-10? Will there be any additional fees charged as a result of the ICD-10 upgrade? When will system upgrades for ICD-10 go into effect? Will there be any additional training provided as a result of the ICD-10 upgrade? Is there a charge associated with any additional training that is required? Besides system upgrades, what additional documentation and forms changes (matrices, clickable templates, etc.) will you provide? When can we see updated policy/edit/prior authorization changes for ICD-10? Will system upgrades for ICD-10 require additional hardware to support the software modifications? How will your products and services accommodate both ICD-9 and ICD-10 as we work with claims for services provided both before and after the transition deadline for code sets? What does testing mean to your organization and when will we be able to test ICD-10 claims/transactions? What are your post-implementation contingency plans to ensure accurate provider reimbursement? (e.g., Will you grant “advance payments” in the form of paper checks for risk mitigation purposes?) Improve documentation practices While you cannot submit actual ICD-10 codes and receive payment until the deadline has arrived, you can submit detailed documentation for your claims as a form of practice in anticipation of the deadline. Several EMR vendors allow ICD-10 coding now, so patient problem lists are being populated with both ICD-9 and corresponding ICD-10 codes. This can help get a practice acquainted with doing the ICD-10 coding, and when the switch is flipped in October, several ICD-10 codes will already be associated with established patients. For a Microsoft Excel list of common ENT ICD-10 codes, visit the Academy website: www.entnet.org/content/icd-10-coding-resources. There are several factors to focus on when improving the specificity of your documentation. Some examples include (documentation elements will vary by different codes): Anatomy (e.g., attic, tympanum, mastoid, diffuse cholesteatosis) Anatomical Location (maxillary, frontal, ethmoidal, sphenoidal, pansinusitis) Disease Acuity (e.g., acute, subacute, chronic, recurrent) Localization/Laterality (e.g., right, left, bilateral) Infectious Agent (e.g., scarlet fever, influenza, measles) Type (e.g., open, closed) Episode (e.g., initial encounter, subsequent encounter, sequela) Manifestations (e.g., serous, mucoid, suppurative, non-suppurative, with/without spontaneous rupture of tympanic membranes) Circumstances (e.g., exposure to environmental tobacco smoke, history of tobacco use, occupational exposure to environmental tobacco smoke, tobacco dependence) Below is a sample of incorrect versus correct documentation under ICD-10 requirements: INCORRECT DOCUMENTATION UNDER ICD-10 CORRECT DOCUMENTATION UNDER ICD-10 A 3-year-old female presents with unilateral otitis media with a ruptured tympanic membrane. A 3-year-old female presents with acute serous otitis media (L) ear with spontaneous 60% central ruptured tympanic membrane. Patient presents with adenotonsillitis, dyphagia, laryngitis, obesity. Patient presents with chronic adenotonsillitis with adenotonsillar hypertrophy, oropharyngeal dysphagia, acute obstructive laryngitis, morbid obesity with alveolar hypoventilation. Patient presents with hearing loss with history of high doses of IV antibiotics. Patient presents with bilateral hearing loss with a history of high doses of IV gentamicin. Hearing loss secondary to gentamicin.   Assess your claims for mapping risk Knowing your most frequent patient diagnoses and the optional ICD-10 codes will translate to help you assess which claims may be at risk for errors and their potential impact on revenues. See charts below for a few examples of risk levels. Low-risk claim with 1:1 translation ICD-9 Code Diagnosis ICD-10-CM Code Diagnosis 786.50 Chest pain unspecified R07.9 Chest pain, unspecified   Moderate-risk claim with 1:4 to translation ICD-9 Code Diagnosis ICD-10-CM Code Diagnosis 380.23 Chronic otitis externa NEC H60.60 Unspecified chronic otitis externa, unspecified ear H60.61 Unspecified chronic otitis externa, right ear H60.62 Unspecified chronic otitis externa, left ear H60.63 Unspecified chronic otitis externa, bilateral   Higher risk claim with 1: several translation ICD-9 Code Diagnosis ICD-10-CM Code Diagnosis 380.50 Other acute otitis externa H60.501 Unspecified acute noninfective otitis externa, right ear H60.502 Acquired stenosis of left external ear canal, unspecified H60.503 Acquired stenosis of external ear canal, unspecified, bilateral H60.509 Acquired stenosis of external ear canal, unspecified ear H60.511 Other acquired stenosis of right external ear canal H60.512 Other acquired stenosis of left external ear canal H60.513 Other acquired stenosis of external ear canal, bilateral H60.519 Other acquired stenosis of external ear canal H60.521 Acute chemical otitis externa, right ear H60.522 Acute chemical otitis externa, left ear H60.523 Acute chemical otitis externa, bilateral H60.529 Acute chemical otitis externa, unspecified ear H60.531 Acute contact otitis externa, right ear H60.532 Acute contact otitis externa, left ear H60.533 Acute contact otitis externa, bilateral H60.539 Acute contact otitis externa, unspecified ear H60.541 Acute eczematoid otitis externa, right ear H60.542 Acute eczematoid otitis externa, left ear H60.543 Acute eczematoid otitis externa, bilateral H60.549 Acute eczematoid otitis externa, unspecified ear H60.551 Acute reactive otitis externa, right ear H60.552 Acute reactive otitis externa, left ear H60.553 Acute reactive otitis externa, bilateral H60.559 Acute reactive otitis externa, unspecified ear H60.591 Other noninfective acute otitis externa, right ear H60.592 Other noninfective acute otitis externa, left ear H60.593 Other noninfective acute otitis externa, bilateral H60.599 Other noninfective acute otitis externa, unspecified ear   A longer list of common ENT ICD-9 codes and their relevant ICD-10 crosswalks can be downloaded online at www.entnet.org/ICD-10-Top-200-ENT-Diagnosis-Codes. Testing If you have not already, you should be testing claims with payers and/or Medicare Administrative Contractors (MACs). The Workgroup for Electronic Data Interchange (WEDI) has published a comprehensive guide on how to test your claims with ICD-10 at www.wedi.org/docs/resources/testing-for-small-providers-white-paper.pdf?sfvrsn=0. Your MAC should already have tested several claims by now. Request that your MAC share any testing results with you and check the CMS website for other published end-to-end testing results. Also remember, the closer you get to the deadline, the higher the likelihood that payer or MAC resources will be occupied by other physicians also trying to test. Test as soon as possible to beat the last-minute rush. Don’t get denied! The Academy’s ICD-10 website page has several resources, including a sample ENT ICD-10 Superbill that will assist your planning and preparation efforts. Visit the ICD-10 website for more at www.entnet.org/node/740.