Published: August 31, 2015

Get ready for ICD-10

In July, the Centers for Medicare & Medicaid Services (CMS) announced efforts to limit the burden on providers for the ICD-10 transition slated for October 1. What are the effects on the average otolaryngology practice, and should you alter your own “go-live” plan?

Robert R. Lorenz, MD, MBARobert R. Lorenz, MD, MBA

By Robert R. Lorenz, MD, MBA, coordinator for Practice Affairs and Physician Payment Policy (3P) Workgroup co-chair

In July, the Centers for Medicare & Medicaid Services (CMS) announced efforts to limit the burden on providers for the ICD-10 transition slated for October 1. What are the effects on the average otolaryngology practice, and should you alter your own “go-live” plan?

This course alteration by CMS was done to make the effort less burdensome on smaller practices having to deal with the cost of the ICD-10 transition. Denials for coding inaccuracies will be suspended for 12 months for Part B Medicare claims, as long as the physician uses a “valid code from the right family.”

getreadyI don’t know about your practice, but the incidence of Medicare denials for inaccurate specificity of codes has been minimal in our experience at the Cleveland Clinic, and it doesn’t change the fact that CMS will not be accepting ICD-9 codes starting October 1. We do have an issue with one of our Medicaid HMO’s denying payment based upon diagnosis code specificity through the Local Coverage Determinants, but it is still rare, and almost never occurs with our commercial payers.

Setting up an ombudsman to “help receive and triage physician and provider issues” is a positive step, but the ease of use and effectiveness of this service is to be determined. And clearly, the last two changes—lack of PQRS, VPM, and MU penalties due to the additional specificity of ICD-10 codes and assurance of payment in the case of contractor system malfunction or implementation problems through an advance payment option—are good signs. This also suggests that CMS realizes that “things can go wrong” (think, and the provider community will not be at as much risk from the government’s deficits, especially in respect to maintenance of cash flow.

In summary, the CMS announcement doesn’t relieve your need to go live with ICD-10 on October 1. It may make the transition a bit more palatable, but I’d strongly recommend you prepare for the October 1 date and don’t take too much solace from CMS’s recent announcement.

See FAQs about the CMS efforts at Read more about the transition at

*Dr. Lorenz is primarily responsible for private payer issues, including coverage, coding, and payment policies. He also provides oversight on the development and maintenance of programs that support the services our physicians provide to patients, including the Academy’s Position Statements, Clinical Indicators, and ICD-10 educational efforts.

**Please note: These superbills are designed solely as an exercise in demonstrating the process of transitioning to the new ICD-10-CM coding system. They do not represent an endorsement by the Academy of the use of superbills or either particular superbill format.



More from September 2015 - Vol. 34 No. 08

Products from the new AcademyU® Learning Platform
Foundation copublishes two books with Thieme As part of an ongoing agreement with Thieme Publishers, the Foundation has just added two more titles to its book and eBook collection. The first book, Otolaryngology Lifelong Learning Manual (OLLM), is an update to the Maintenance Manual for Lifelong Learning. Through the hard work of the eight education committees, under the leadership of Education Coordinator Sonya Malekzadeh, MD, this will become a valuable resource for all otolaryngology clinicians. OLLM serves as a great resident resource and certification study guide. Practicing physicians can use it for a refresher on a topic and for recertification through MOC. Nonphysician clinicians will also benefit from the comprehensive scope of the book. The second book, Geriatric Otolaryngology, was edited by Robert T. Sataloff, MD, Michael M. Johns III, MD, and Karen Kost, MD. This book is much more than a revision to the previous book of the same title. It is a comprehensive and timely discussion of the otolaryngology concerns of the elderly population. Both books are available in print and eBook formats and can be ordered through the Thieme website at You can search by specialty or title. The AAO-HNS Foundation is proud to have worked with Thieme on these two essential otolaryngology publications and looks forward to continuing its copublishing partnership. AcademyQ® CME: otolaryngology knowledge self-assessment tool AcademyQ® CME offers learners the opportunity to hone their knowledge skills through a series of otolaryngology-head and neck surgery-specific self-assessment questions. Derived from the 800 knowledge assessment questions available in the AcademyQ® app for Apple and Android, this activity provides the opportunity to enhance knowledge of otolaryngology-head and neck surgery with hundreds of study questions to test recall, interpretation, and problem-solving skills while earning CME credit. Drawing on the same questions released on the Academy® app in 2012 and 2014, nine modules contain 50 questions specific to each specialty. The physician learner will read and analyze otolaryngology-specific questions and rationales developed by otolaryngology experts. Included in each module is thorough feedback for each question, additional reading references, and appropriate images and videos to enhance the learning experience. Pediatric Otolaryngology eLectures Pediatric Otolaryngology eLectures, coproduced by the American Society of Pediatric Otolaryngology (ASPO) and AAO-HNSF, offer learners education opportunities designed to address pressing patient care concerns facing pediatric and general otolaryngologists. The webinars in this series are: Recurrent Respiratory Papillomatosis Diagnosis and Management of Vascular Malformations Update on Allergic Rhinitis—A Burdensome Disease Down Syndrome: Otolaryngologic Manifestations Evaluation and Management of Sialorrhea in Children Hearing Tests and Hearing Aids: More Interesting Than You Thought Complications of Acute Rhinosinusitis in Children Otitis Media Update Assessment and Management of Velopharyngeal Dysfunction Evaluation of Pediatric Sensorineural Hearing Loss Unilateral Hearing Loss In Children Caustic Ingestion Management of Pediatric Vocal Fold Immobility Head and Neck Masses in the Pediatric Population Quality and Safety in Surgery: How to Become a Better Surgeon Choking and Aspiration in Children: Evaluation and Management Pediatric Sleep Medicine 2014: A Roundtable Discussion Eustachian Tube and Evolution Social Media—A Blessing or a Curse for the Otolaryngologist Genetics and Pediatric Otolaryngology These archived recordings are be available for AMA PRA Category 1™ credit. ENT for the PA-C eLecture Series The annual ENT for the PA-C Conference is jointly presented by the American Academy of Otolaryngology—Head and Neck Surgery Foundation and the Society of Physician Assistants in Otorhinolaryngology/Head & Neck Surgery. The primary audience for the conference is nonphysician clinicians, especially physician assistants, and nurse practitioners who specialize in otolaryngology-head and neck surgery. This eLecture Series, recorded at the 2015 ENT for the PA-C Annual Conference, includes the following presentations: Healthcare Reform Audiogram Interpretation: 10-minute Dizziness Evaluation Evaluation and Management of Facial Nerve Paralysis Everything You Ever (and Never) Need to Know About Salivary Glands Differential Diagnosis and Management of Conductive Hearing Loss Non-otologic Sources of Otalgia Diagnosis and Treatment of Anaphylaxis Evaluation and Management of Pediatric Neck Masses OSA: Improving Treatment Outcomes Vocal Fold Paralysis Diagnosis and Treatment Assisting in ENT Procedures These archived recordings will be available for AAPA CME credit. Visit for these new activities along with the entire catalog of education opportunities offered by the AAO-HNS Foundation.