By Dr. Robert (Bob) Day, Jr., Broadway Eye Center, Garland, TX
When I started learning ICD coding, my dad, Dr. Robert Day, Sr., was President of the American Optometric Association (AOA), and they had just published the first Current Optometric Information and Terminology (COIT) book in June 1974. It was optometry’s first attempt to participate in the new medical trend of systematically classifying diseases. Optometry was just beginning to become more than simply prescribing a pair of glasses to help patients realize improved vision.
Learning ICD-9 versus ICD-10 is very much like comparing learning multiplication tables to learning calculus. I can’t remember a time when I didn’t know my multiplication tables, but I remember struggling to learn calculus all too well. I probably learned multiplication in the second or third grade. It was a straightforward process where one problem produces only one answer. For example, 2×2 can only equal 4—easy enough, right? Then you advance to calculus (particularly differential) where one problem can produce multiple possible answers. The learning process is far more complex, and the answers, at least initially, are far less obvious. But it can be done; you just need to spend the time to identify your best resource and to understand your goal.
Even now, I calculate simple multiplication in my head, but for calculus I need the help of technology (a calculator) to do calculus. Likewise, ICD-9 is committed to memory, but for ICD-10, I will depend on technology in the form of my electronic health record system to handle most of the ICD-10 coding.
Speculation abounds, but it’s reasonable to assume that ICD-10 will mark the end of the paper super-bill and coding from memory. Under ICD-10, the AOA’s Express Mapping Card alone is four pages with almost 300 codes. ICD-10 is clearly more complex, and trying to manage it without the help of technology will drastically add time and expense to your coding.
In a surprise announcement this morning, CMS extended the 2014 attestation deadline for the EHR Incentive Program, popularly known as “meaningful use.” The submission deadline is now March 20, 2015, at 11:59pm (ET).
This extension gives providers a chance to breathe and a little more time to gather their meaningful use data from 2014 and attest. This is fantastic news for all participating providers who want to avoid Medicare payment adjustments in 2016. This is particularly good news to those who are attesting to meaningful use for the first time, since this is their last chance to receive any incentive money for meaningful use under Medicare.
CMS was careful to point out that this extension applies only to the Medicare EHR Incentive Program. This extension does not affect those providers who are participating under the Medicaid EHR Incentive Program. CMS also urged providers to attest as soon as possible despite the extension.
There’s a lot of confusion and frustration in the healthcare industry right now about the government quality programs, where they overlap (and where they still don’t), and how to report the correct information.
A (Brief) History
The Physician Quality Reporting System (PQRS) has been around since 2007. Traditionally providers voluntarily reported at least three measures by including level II CPT codes on their Medicare Part B claims, and they received an incentive payment from CMS.
Clinical Quality Measures (CQMs) were introduced in 2011 as part of the EHR Incentive Program, better known as meaningful use. This program required providers to manually enter a calculated percentage for six to nine measures to receive an incentive as part of meaningful use.
A Confluence of Program Changes
Recently, the Centers for Medicare and Medicaid Services (CMS) initiated plans to align the PQRS and the CQM measures to make reporting easier for providers. At the same time, CMS is laying the groundwork to discontinue the claims-based PQRS reporting that providers have become accustomed to. CMS’ goal is for providers to electronically submit a file that contains all of their yearly quality data to satisfy the requirements for both PQRS and CQMs. You may have heard of this file referred to as QRDA. Continue reading “PQRS vs. CQMs—What’s the Difference and How Do I Report Them?”
The implementation of ICD-10 does not affect your meaningful use (MU) calculations. While the compliance date for ICD-10 is October 1—well into your meaningful use reporting year—you will not see any impact on your MU calculations.
It seems strange to think that such a disruptive change as ICD-10 wouldn’t impact your MU attestation. The transition from ICD-9 to ICD-10 applies only to diagnosis codes in offices and outpatient settings. The MU core and menu set measures do not require specific diagnosis codes. Therefore, ICD-10 will not impact your MU calculations.
The clinical quality measures (CQMs), however, are very dependent upon the proper diagnosis codes being in place. Eyefinity has you covered in this regard. Our 2014 Edition CQMs will accept your ICD-9 and your ICD-10 codes. Even when you switch midway through your reporting period, your calculations will reflect both code bases.
Here’s the but…
There’s one small detail that you may need to address one time. You’ll need to add any ICD-10 codes to your clinical decision support rules to ensure that your diagnosis still trigger the correct clinical decision alerts (Stage 1, core measure 10; Stage 2 core measure 6).
In our office, preparing for ICD-10 coding is similar to a life-boat drill….go over the basics and depend on the technology used by the boat captain to keep you from getting in the water over your head.
To get started, I identified the resource that’s familiar and comfortable to me. In my case, it’s the American Optometric Association (AOA).
My staff and I viewed webinar recordings from AOA’s EyeLearn Webinar recordings.They were very interesting to watch, but like most continuing education lectures, I’m not likely to remember much of it.
We also chose the AOA’s 2015 ICD-10 Coding Bundle, for those times when we would need to look up specific codes. With our reference library in place, I consciously rejected all online websites that show conversion tables from ICD-9 to ICD-10. These websites only give unspecified eye codes, even though ICD-10 is based on which eye is being coded.
Finally, and in my opinion most importantly, I will depend on the technology of my Electronic Health Record software to take care of 95% of the coding for me. I know that a few patients will present with strange problems (corneal injury to the right eye from a left elbow of a taller person during basketball practice on a Tuesday!) for which I will rely on my reference book. But for the most part, I will trust my EHR to steer me out of the undertow.