Coding for rheumatoid arthritis will be broken down by sites of the body affected, laterality, complications, and whether or not the patient tests positive for rheumatoid factor, Chung said. Audience members noted that the list of complex codes they will have to master is too long and overly specific. However, Chung advised them not to try to use one umbrella code to cover a variety of different situations. “Coding is completely different from billing. Coding is based on guidelines,” she said.
In ICD-10, codes will clarify the date of service and what condition is being treated on that day. “What is the patient’s chief complaint? Even though he or she may have other things going on, they are going to want that primary code to be what you are treating that day,” said Chung. Potential benefits of the new system will be better tracking of patient treatment and outcomes because in the past, the codes were not specific enough. “We will have a better understanding of health outcomes, better measurement of the quality, safety, and efficacy of care, and we will prevent fraud and abuse,” she said.
Look at your practice now. What will you need? Does your staff know ICD-10 is coming and understand what they may need to do?
ICD-10’s Impact
The impact of ICD-10 on rheumatology practices will be considerable, Chung acknowledged. “Expect increased rejections, denials, and pending claims as plans and providers get used to the new codes,” she said. It may be necessary to explain the lag time to patients, as well. In addition, updating health technology systems and training staff will have a financial impact on practices. The approximate cost is $83,290 for a small, three-physician practice, and $1.64 billion for the entire U.S. health system to make the transition, she said. “The price tag for this is very high. There will be a disruption in your cash flow.”
Rheumatologists should start training staff on the new codes and make sure codes are supported by medical documentation, Chung advised. Audits will happen, because medical necessity is not met by using ICD-9 codes after October 1, 2014.
“Look at your practice now. What will you need? Does your staff know ICD-10 is coming and understand what they may need to do? Who needs to be trained now?” she said. Ensure that third-party billing services are also prepared, and find out if top payers have policies in place for the switch, she advised. Some leading payers already are declaring that practices that use unspecified codes could see a cut in reimbursement of 5% to 10%, she warned. For example, in ICD-10, both a patient’s pregnancy and trimester must be coded, Chung said, eliciting groans from the audience.
