Start now, star small to transition to ICD-10

Friday, April 25, 2014

The recent delay in implementation to Oct. 1, 2015, notwithstanding, DME providers need to develop a strategy to handle conversion from ICD-9 to ICD-10. At press time, CMS had not announced how it plans to handle the transition of existing rental patients as it relates to ICD-10. With that said, let’s look at the possible options, then discuss planning.

I held a two-day training session in Dallas in November where we discussed ICD-10 and converting diagnosis codes from ICD-9. DME providers were shocked at how few one-to-one, cross-walked codes there are in ICD-10. With ICD-10, we learned we need much more information than DME providers typically receive to convert the code accurately. So it will not be as easy as converting to the 5th digit in ICD-9. The physician’s staff will have to pull the medical records and review the chart notes to look for specific words to determine the new ICD-10 code.

Here are possible options for how this will move forward:

DME providers must obtain all new CMN/detailed written orders as of Oct. 1.

This will be extremely labor intensive and impede cash flow on a grand scale, because we all know the turnaround time at the physician’s office is slow. This obviously would be the least favorable option by all providers involved, not just the DME companies.

CMS allows DME providers to cross-walk where the ICD-9 code has a one to one cross-walk and/or the provider obtained chart notes at the time of the order and the chart notes clearly indicate the specifics needed to provide a matching ICD-10 code. 

This will still be labor intensive. For those that cannot be matched up by the DME provider, the DME provider can send a form (I have created a form to capture that information or you can create your own). The form asks the physician to provide an ICD-10 for those patients you cannot code. Again, this is labor intensive but less work than option 1 for the physicians.

CMS grandfathers all existing rentals that have a CMN on file and have received payments as of Oct. 1.

For these, the DME provider would continue to rent and bill under ICD-9 until the patient falls off service, whether it’s for a purchase, cap-rental, or pick up. This would be the most ideal due to the overwhelming work that will be required to convert all rentals over.

Some software vendors have already been tested and approved; others just started testing in early 2014. Hopefully, these systems will provide you the cross-walk codes. For example, bronchopneumonia 485 cross-walks to J18.0; COPD 496=J44.9; asbestosis 501=J61; OSA 327.23=G47.33; and Parkinson’s 332.0=G20.

This is no small task, even if your software vendor is ready. Create a project plan and strategy to accomplish by Oct. 1. Start small, maybe with your new patients, to prevent widespread damage to cash flow. First, start getting CMNs and detailed written orders with ICD-10 codes and ICD-9 codes on new patients, even if you have to make a form to accompany the orders to capture the ICD-10 for one location. Second, add another branch or product line until you fully transition within your organization. Third, start converting patients who have diagnoses that you can cross-walk, like in the examples above.

Hopefully by end of April, CMS will release further direction on its expectations with existing rentals. Don’t forget to put your existing rentals and recurring sales into your project plan. hme

Angela Miller is president and general manager of Medical Auditing Solutions, a consulting firm specializing in cash flow, compliance, HIPAA, billing, transition project management and ICD-10. She can be reached at or 409-673-7103.