ICD-10 lurks in shadows

Friday, March 21, 2014

WASHINGTON – It may not be the documentation change grabbing headlines, but the transition to ICD-10, scheduled for Oct. 1, will still muck up the process for HME, industry consultants say.

The biggest misconception that providers have about ICD-10, they say: that there will always be an easy, one-to-one transition from ICD-9 to ICD-10.

“If we think we can just pick a code in the crosswalk, we can’t,” said Sarah Hanna, president of ECS Billing & Consulting North. “It will be important to get the appropriate code from the physician, because down the road, in an audit, they’re going to request medical records to back up that ICD-10 code.”

There won’t always be a direct crosswalk, stakeholders say, because in ICD-9 there are many unspecified codes, while in ICD-10 the codes are more specific and diagnosis-driven.

The transition could prove particularly tricky for capped-rental and resupply items, stakeholders say.

“You’re definitely going to want to work out the codes for rentals prior to Oct. 1, so those claims can keep going out without a holding pattern,” Hanna said.

Like with many documentation changes, providers will be at the mercy of their physician referral sources in many ways, stakeholders say. Are their systems updated for ICD-10? Do they know the right new code?

“We have to prepare for it, but we’re not in control,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “If they’re not trained on it, it’s another thing on top of the list of things that we have to train them on.”

Unfortunately, the early buzz is that physicians won’t be ready for the transition.

“Remember PECOS?” asked Mary Ellen Conway, president of Capital Healthcare Group. “Physicians didn’t know anything about that, to the point where it kept getting delayed.”

There are things that providers can do to make the transition smoother, stakeholders say. First, they should make sure their software vendors are prepared. Brightree, for example, announced this month that it submitted multiple test claims across all its product lines to CMS and 100% of those claims were acknowledged by the agency.

Second, providers should come up with a plan to determine how the transition will affect their operations, including the referral process, revenue cycle management, and CMNs and claim forms, Conway says.

Third, by summer, providers should ask their referral sources if they can dual code, or include both the ICD-9 and ICD-10 codes on claims. At the very least, providers should ask them verbally what the ICD-10 code will be, Conway says.

“Your claims aren’t going to start going out the door ICD-10 by themselves,” she said. “What’s your process?”

The next step in the transition: In July, CMS plans to offer end-to-end testing to a small group of providers.