ICD-10 codes more familiar, but claim uncertainty reigns

Marsland, MDThomas A Marsland, MD
Oncologist
Orange Park, Florida

ICD-10 as a Physician and Patient

Oct. 8, 2015

Well, closing in on the end of the second week of ICD-10.  No major crisis so far … we continue to get many notices (emails, social media, snail mail, and other posters) on programs for ICD-10 education.

Read the first week's reactions here

As far as my day-to-day clinic, it really has not affected me significantly. Staff continues to update patient charts as they come in to see us. One area that has popped up is when adding antiemetics-they are requesting we add ICD-10 for the chemo-induced nausea and vomiting. Since we are only two weeks into this so far, we have not seen any billing issues but I continue to hold my breath on that one …

I had some testing done on myself this week.  It was interesting when signing in, as it took a little longer since staff needed more time to be sure they had all the correct ICD-10 codes.  I can see where for hospital-based charges that it is critical to get it right, since they are much more dependent on bundling payments than office based practices ( at least so far…). 

NEXT: A Pediatrician's Payer Success

Chandler, MD, MBAMaria Chandler, MD, MBA
Pediatrician
Long Beach, California

A Minor Step Forward

Oct. 8, 2015

All quiet here.  Nothing new from providers.  Our billing manager says that although we started billing this week, we were informed by the payers that we likely won't see denials for some time even if the codes are not accepted.

Oct. 9, 2015

We received our first confirmation that a payer has successfully accepted our ICD-10 billing!

NEXT: Tech Disconnect for an Optometrist

Rafieetary, OD, FAAOMohammad Rafieetary, OD, FAAO
OptometristGermantown, Tennessee

Signals Still Crossed

Oct. 8, 2015

I have been gone for meetings this week-not much patient care but my clinical administrator says there are still issues in posting charges.

The EHR has responded that the issues with the ICD-10 codes were on the practice management side. Apparently all [my vendor's] practice management system users are having this issue.

NEXT: Patient Care vs. Coding Recall

Miller, ODPamela J. Miller, OD
Optometrist
Highland, California

M54.2: Pain in the Neck

Oct. 5, 2015

It's the start of a full week. Everyone is on board and we only have a few co-management patients that are still on ICD-9 codes. Otherwise, it is only ICD-10 from here on out. I was at a CE meeting all day Sunday but no one even mentioned ICD-10 or coding. I have my society meeting this week, so it will be interesting to see how it is going with my local area colleagues.

Oct. 7, 2015

So far, it seems to be pretty good; although it is a pain in the neck trying to look up the ICD-10 codes.

The question is: Just how many diagnostic codes do I need to have? If the patient is in the office for a complete visual exam and refraction, then the code should just be for the refractive error. If I am seeing them as a follow-up for cataracts, then that is the code. I had a stroke patient come in, and I wasn't able to find the code for stroke or cerebrovascular code. I'm not sure what to do on a case like this-resultant visual field defect, but unable to find the code for just one eye quadrantopsia. So I tried to find the closest code, which was bilateral. Since patient had defect in both eyes, and one was straight quadrant, I am hoping that it was correct.

Oct. 8, 2015

I am expecting no problems, other than time management, with a full load of patients. It is a bit hard to remember to code each patient as I go along, but I am getting a bit better at it. I re-did our exam sheet to reflect an area for ICD-10 codes, to make it easier for my staff and for me to remember. What a pain to try and remember everything when my job is actually to take care of our patients, not spend time looking up codes, etc.

Oct. 9, 2015

It's my last day in the office this week-off to a meeting out of area and back in the office on Monday, a holiday for some, but not for us. So far, it hasn't been too bad, but we will see when we get paid and what the EOBs have listed.

NEXT: Yes, There's a Code for That

Boland, MDMichael Boland, MD
Ophthalmologist
Baltimore, Maryland

Future is a Bit Blurry

Oct. 9, 2015

The first week of ICD-10 was really a non-event for us.  As time went on, we found some minor issues including some codes that were incorrectly linked to diagnoses in our EHR (corneal graft rejection is not the same as bone allograft rejection, for example).

We also have some providers who have diagnosis preference lists that need to be updated to include more specific diagnoses.

So far, no claims have been rejected outright, but our billing staff tells me that we won't know for sure how the downstream processes are working for several weeks when we might start seeing rejections.

In the meantime, a fun game is typing random words into your ICD-10 database and seeing what comes up:

NEXT: Pediatrician Praise

Brenneman, MDTerry Brenneman, MD
Pediatrician
Raleigh, North Carolina

Code Consolidation

Oct. 7, 2015

To be fair and balanced, I have something good to report about ICD-10. ICD 10 has just one code for a "vaccine encounter," replacing about 15 codes in ICD-9. With ICD-9, if an 11-year-old child got a flu vaccine, an HPV vaccine, a DTaP, and a meningococcal vaccine, 4 different ICD codes were needed. With ICD 10, there is only one:  Z23.

Oct. 8, 2015

I got a note from a speech therapist wanting the correct ICD-10 code for a 5-year-old child with Trisomy 21.  ICD 10 offers four choices based on the karyotype (translocation vs. non disjunction; mosacisicm or not). So, I went to the old records and couldn't find it (the child transferred to our practice two years ago and no records transferred).

My choices now are:

• Give the code for "unspecified Down syndrome" which may or may not result in non payment due to lack of specificity;

• Call mom to see if she knows what the karyotype was; or

• Try to get the old records.

Easy choice. I went for "door 1."

NEXT: Early Success, Late Frustration

Denton, MDMelanie Denton, MD
Optometrist
Charlotte, North Carolina

Code Search Comes Up Empty

Oct. 5, 2015

The transition continues to be fairly simple. I haven't found any codes that are "missing" from ICD-10. Every code I've needed has been very similar to the ICD-9 predecessor. Still too soon to know about reimbursements!

Oct. 6, 2015

I am in the process of opening my own private practice, and actively sampling different electronic record systems. Today, I was able to join a webinar looking at the Crystal PM system. It was interesting to compare the way that the conversion is approached between the two types of software (Crystal PM and Revolution EHR). The consistency between the two is a simple search tool that automatically converts codes. From what I'm able to tell, the conversion is fairly intuitive no matter which software is used. Crystal and Revolution both employ drop-down menus that respond to incomplete queries.

Oct.7, 2015

Like yesterday, I was able to sample another type of EHR called Uprise. While Uprise is not yet available, it is built around ICD-10 and is therefore generating the relevant codes right from the doctor's exam. The only thing I noticed with the software is that sometimes the "unspecified" code was chosen by default, and I think it would be important to change those "unspecified" codes to right/left/bilateral. From my observations yesterday and today, it seems that the leading EHR companies have done a nice job making their records seamlessly convert to ICD-10.

Oct. 8, 2015

Coding was fairly straightforward, but then again most all of my exams were simple vision codes that were already entered for me.

Oct. 9, 2015

I will admit that I did get just a touch frustrated with ICD-10 today as I tried to search for codes. I don't have the option to convert anymore, which was helping me along for the first week, and there were a couple of codes that I couldn't find quickly. I'm not sure when that capability disappeared, but I didn't notice until today. Also, the time lost while specifying blepharitis on each lid individually was a tad frustrating as well. Still no word on reimbursement.

NEXT: Easier Coded Than Paid

Ellis, Jr., MDGeorge G. Ellis, Jr., MD
Internist
Youngstown, Ohio

Practice Has Made Perfect

Oct. 9, 2015

The conversion to ICD-10 seemed flawless. It was a little more time consuming on the documentation end, making sure to detail out in the notes if the problem is new, a follow-up, or sequela; also laterality is a big issue.

I used an aerosolized treatment for bronchospasm, and the codes did not match, so the charge entry was flagged, and the claim needed to be scrubbed and a new code entered. I'm still working on that one.

The proof is in the pudding when it comes to getting paid, as it is too early to determine if we are getting paid on our claims. By the end of next week, we should start receiving payments on our Oct. 1 claims. I spent several hours taking courses online, submitting dummy claims, and putting apps on my iPads and iPhone, including ICD-10 by Precyse, provided by the hospital.

I'm not sure if I was over prepared, or it's easier than I thought it would be.