ICD-10: Stick your toe in the water

Monday, January 23, 2012

BALTIMORE – Even though CMS won’t implement ICD-10 until next year, home medical equipment providers should be familiarizing themselves with these new codes right now, industry consultants say.

At the very least, providers should be reviewing the “general equivalency mappings” or GEMs that CMS has already posted to its website that roughly translate ICD-9 codes to ICD-10 codes, they say.

“I think we’re all underestimating the vastness of where this will touch our daily processes,” said Andrea Stark, a reimbursement consultant with MiraVista, of the 78,000 or so new codes. “ICD-10 is a complete revamp.”

In a nutshell, the ICD-10 codes have up to seven digits vs. ICD-9’s five digits, making them more specific and more diagnosis-driven. For example, E10.321 is the ICD-10 code for Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema.

Some of the things industry consultants say providers should be making plans for: transitioning their active and incoming sales orders to the new codes; updating all of their pre-populated forms to accommodate the new codes; making sure their billing software incorporates the new codes; and re-familiarizing themselves with local coverage determinations or LCDs that will likely be tweaked to reflect the new codes.

Industry consultants say a good way for providers to kick off their ICD-10 efforts is to attend a webinar or seminar on the topic.

“Providers should enroll their billing and coding staff in some classes to understand how the new codes work,” said Sylvia Toscano, owner of Professional Medical Administrators. “That way they can better work with referral sources to make sure they have the correct coding that best describes the patient’s condition.”

CMS wants all healthcare providers to start using ICD-10 codes Jan. 1, 2013. It will require them to use the codes Oct. 2, 2013.

As with any change this big, providers should expect a few bumps along the way, but this too shall pass, industry consultants say.

“Some are starting to look at it now and I’m hearing some grumbles,” said Bruce Brothis, president of Allegient Billing & Consulting. “They’re going to hate it at first, but they’re going to like it down the road, because it’s so much more specific. They have no choice.”