CMS is making some changes to the ICD-10-CM codes, effective October 1, 2016. In some cases, CMS added new codes and retired others. In other cases, only the description associated with the code changed.
Although these changes are not nearly as sweeping as the transition from ICD-9 to ICD-10 last year, there are some similarities:
October 1 is the so-called “cutover date.” The updated codes apply only to claims with a service date of October 1 or later. Claims with a service date of September 30 or earlier will continue to use the current codes.
Eyefinity has your back. We’re currently updating Eyefinity EHR and ExamWRITER to properly code your exams based on the selections you make during the exam and the date of service. In other words, keep coding the way you always have, and we’ll take care of the rest. We’re also updating the ICD-10 codes in our practice management systems for billing and reporting.
Billers should familiarize themselves with the changes. Billers should be prepared to verify that the correct codes are appearing on claims
Eyefinity has identified over 400 ICD-10 changes that apply to eyecare. Code changes to the following areas take effect on October 1, 2016:
Retinal vein occlusion
Age-related macular degeneration
Primary open-angle glaucoma
Postprocedural hematoma or seroma
We anticipate that CMS will modify ICD-10 codes slightly every year.
We’re adding the ICD-10 changes to OfficeMate/ExamWRITER now, which will be available in a service pack in September. You’ll need to download and install the service pack before October 1 to avoid any disruption in billing.
Eyefinity EHR, Eyefinity Practice Management, and AcuityLogic updates are scheduled in September and will include all of the ICD-10 updates.
The transition to ICD-10 is now just weeks away. Hopefully, you have already upgraded your practice management and electronic health records systems. If you’re an OfficeMate/ExamWRITER user, you need to be running version 12; if you haven’t downloaded it yet, you can do so now on MyInstallCenter. If you’re an Eyefinity Practice Management, Eyefinity EHR, or AcuityLogic user, you’re good to go—there aren’t any upgrades that you need to complete!
Once you’re using updated software, nearly everyone from CMS to the AOA is encouraging you to work with your insurance clearinghouse or insurance carriers and send them test insurance claims with ICD-10 codes. Submitting test insurance claims that contain ICD-10 codes will give you practice in using ICD-10 codes; help you work out any transition quirks with your clearinghouse or carriers before the deadline; and, hopefully, instill confidence in your office’s ability to submit insurance claims and get paid after October 1.
Your insurance clearinghouse or insurance carriers should have provided you with ICD-10 testing information; if they haven’t, contact them.
Remember that if you are using OfficeMate/ExamWRITER 12, you can change the ICD-10 start date for individual insurance carriers, making it easy for you to send test data with ICD-10 codes to carriers. For additional help in preparing for and testing before October 1, review the OfficeMate/ExamWRITER ICD-10 Readiness Checklist and view the step-by-step instructions in the Eyefinity Support Community. If you’re using Eyefinity EHR, Eyefinity Practice Management, or AcuityLogic, review the material in the Eyefinity ICD-10 Resource Center for information on sending test data with ICD-10 codes to carriers.
Test now. The transition to ICD-10 is right around the corner.
Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) teamed up to help doctors ease into the transition for ICD-10 on October 1, 2015.
Here’s a quick overview of the Guidance regarding ICD-10 flexibilities. The Guidance is for all services paid under the Medicare Fee-for-Service Part B physician fee schedule.
Claim Denials. For 12 months, Medicare claims will not be denied solely based on the specificity of diagnosis codes, as long as they are from the appropriate family of ICD-10 codes.
Quality-Reporting Penalties. CMS will not impose penalties for the Physician Quality Reporting System, value-based payment modifier, or meaningful use based on the specificity of diagnosis codes, as long as they use a code from the correct ICD-10 family of codes.
Payment Disruptions. CMS can authorize advance payments, if Medicare contractors are unable to process claims as a result of problems with ICD-10. To apply for advance payment, the doctor is required to submit the request to their appropriate Medicare Administrative Contractor (MAC).
Visit cms.gov/ICD10 to learn more about the CMS/AMA joint announcement and the Guidance, including these FAQs.
By A.J. Johnson, General Manager of Analytics Solutions, TriZetto Provider Solutions
Operational costs for providers continue to rise while reimbursement rates decline. The transition to ICD-10 is expected to compound this problem with denial rates projected to rise anywhere from 100 to 200 percent.1
Providers can offset these financial challenges by identifying, appealing, and tracking claims that were denied incorrectly. This can seem like an overwhelming task, so focus on harvesting your “lowest hanging fruit” to see a better return on your time investment. Here are two ways to identify which denials will yield the highest return when appealed.
Focus on denials with the highest probability of getting paid. These are denials that you can most easily address, such as denials where information was missing from a field or where coding or data was incorrect due to human error. You can quickly fix this information and resubmit the claim for reimbursement.
Other denials may be out of your control, such as denials due to a service that was never documented or benefit eligibility issues. You won’t be able to convince the payer to pay for undocumented services or change their fee schedule contract, so these denials are not worth your time to appeal. However, to help stop this type of denial from occurring in the future, you should go back and review your eligibility verification process to ensure it is working correctly.
Of all the efforts you put toward ensuring your organization is financially successful, managing denials may be the most critical step – TriZetto Provider Solutions’ commitment to aiding smooth transitions to ICD-10 is reflected in our service contracting. We offer Eyefinity customers access to several tools for analyzing current revenue cycles, collecting outstanding reimbursements, and planning for challenges you may face as a result of ICD-10.
Early adopters are on the “leading edge” of change, but there are also those on the “bleeding edge” of change. We all know colleagues who moved into early electronic medical records years ago and are now on their second or third system. As a large practice, we didn’t want to fall into this scenario because it means having to deal with multiple episodes of pain associated with major system changes. Our goal was to do it once and do it right.
So, we have waited, watching for technology that will meet our practice needs, and looking for a solution that can fully integrate a PMS and an EHR. Until recently, the only reliable choice for PMS/EHR solutions were on-premises server-based systems, built around Windows-based programming. The cost of the hardware, combined with the dependency of the doctor to use a keyboard in the exam room, were major obstacles. Thankfully, with the industry moving into cloud-based and iPad-compatible systems, these barriers have been dramatically reduced.
With just under six months left to make changes before the ICD-10 cutover, we’ve chosen the Eyefinity cloud platform. The iPad application allows us the flexibility that we need to manage our large practice. The auto-coding capabilities of the system will make us ICD-10 compliant. And, we’ll be able to increase our efficiencies and bottom line. We’re confident that Eyefinity’s solutions will provide best-in-class technology and allow us to meet our ICD-10 deadline.
My practice, like many others, has taken a “wait and see” approach to preparing for the ICD-10 transition. Optometrists, in general, are often slow to make major changes in their practices unless significant impacts to our income are recognized. This goes in both directions: dollars out and dollars in.
Most doctors carry a number in their heads that’s in the tens of thousands of dollars to upgrade or convert to a practice management system (PMS) and electronic health record (EHR) that will make their practice ICD-10 compliant. That’s a hard pill to swallow. So, we avoid this major expense for as long as possible. We continue with “business as usual” for as long as we can.
Unfortunately, because the ICD-10 changes will affect every aspect of our office flow, we can’t procrastinate any longer. Come October 1, 2015, if we don’t have a solution in place and we are not billing ICD-10 codes, we will not be able to collect reimbursements from third party payers. Everyone needs a plan and needs to put it into place now! Our practice chose to work with Eyefinity as our ICD-10 compliant solution because their cloud-based system dramatically reduces our costs of implementation. And, the auto-coding capabilities of the system will not only make it easy for us to use ICD-10 codes, but also increase our efficiencies and bottom line.
As a private practicing optometrist, it seems like there are more and more pressures being applied on how we run our practices. One of the biggest looming pressures has been the implementation of ICD-10 codes. We’ve heard about this massive change in how we will have to bill and code our patient visits for several years. We’ve also heard all of the horror stories of how much more complex this system will be, as compared to the ICD-9 coding system that we’ve become accustomed to.
Our practices received a little breathing room last year, when the mandatory implementation of ICD-10 codes was delayed. But, despite the continued turbulence in Washington D.C. around health care administration, the senate passed H.R.2 April 14 without an amendment to postpone the ICD-10 cutover date. So, it looks like October 1, 2015, is a hard deadline for providers to start using ICD-10 codes. That gives us just under six months left to implement a solution for billing ICD-10 codes in our practice. Do you have a plan?
All Eyefinity products either are or will soon be ready for the ICD-10 transition. Go to the Eyefinity ICD-10 Resource Center to determine if you need to upgrade your on-premises software, or, if you’re already using an Eyefinity cloud product, when your software will automatically update with ICD-10 changes. Not on the cloud, but want to be? Eyefinity has a plan for that, too!
The entire medical industry is aflutter with ICD-10 news, tips, dates, codes, documents, and even a funny comment or two about some of the new codes (W56.22xA – Struck by orca, initial encounter?!). But really, the information that you need most is answers to these two questions:
What are the exact things that I need to do to prepare for the October 1, 2015, cutover date?
What are the exact things that I need to do in order to bill using the new ICD-10 codes?
If you are using OfficeMate/ExamWRITER and plan to upgrade to version 12.0 so that you can bill ICD-10 codes, we have created a short checklist that will help guide you through the ICD-10 transition. It boils down to this:
Before you upgrade to version 12.0:
Finalize all of your open exams in ExamWRITER.
After you upgrade to version 12.0:
Ensure that you have set up your personal ExamWRITER preferences.
Update any custom templates and clinical decision support templates that you created in ExamWRITER that contain ICD-9 codes.
Ensure that your office location address is complete (i.e., mailing address and nine-digit ZIP code) in OfficeMate Administration.
Determine when you want to begin submitting ICD-10 codes, if it’s not going to be on October 1, 2015.
Before the October 1, 2015, Cutover Deadline:
Record all of your fee slips that are on hold in OfficeMate.
Process all of your open insurance claims in OfficeMate.
After the October 1, 2015, Cutover Deadline:
Document exams in ExamWRITER as you have always done, selecting eye lateralities and then diagnoses. Yes – it’s that easy!
There is no step 2! ExamWRITER will automatically code your exams, based on your exam selections, and transfer the codes to OfficeMate fee slips.
Transitioning to using ICD-10 codes may sound daunting, but if you’re using OfficeMate/ExamWRITER 12.0, you are ready!
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.
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).