SAN DIEGO—Despite efforts to delay its implementation and widespread groans about its massive complexity, the new International Statistical Classification of Diseases and Related Health Problems, better known as ICD-10, will take effect on October 1, 2014, a coding expert told an audience of rheumatologists here at the 2013 ACR/ARHP Annual Meeting, held October 26–30. [Editor’s Note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
Complex System of Codes
The previous set of 14,025 codes to describe patient diagnosis and treatment details, ICD-9, has been in place for about 30 years, but this system from the World Health Organization (WHO) can no longer sustain or support additional codes, said Antanya Chung, CPC, CPC-I, CRHC, CCP, director of practice management for the ACR in Atlanta. So the WHO created the more detailed ICD-10, a set of 68,069 codes of three to seven characters each. “ICD-10 is very specific, and has laterality. This specificity improves coding accuracy and the depth of data for analysis,” said Chung. However, rheumatologists and their staff may find learning the new codes a cumbersome, time-consuming process, she acknowledged.
ICD-10: Get Prepared!
Are you ready for the switch to ICD-10? Next year, The Rheumatologist will feature a series of articles on how to prepare your practice. If you have specific questions you’d like the articles to address, e-mail them to [email protected].
Rheumatologists will mainly use the codes in Chapter 13, “Diseases of the musculoskeletal system and connective tissue,” Chung noted, holding up the thick book that contains a list of the new codes. The first three alphanumeric characters of new codes will point to major categories of rheumatic disease, while the rest of the characters will represent subcategories to specify data like affected joints or the presence of certain inflammatory markers in the blood. Chapter 13 contains codes with the prefixes M00–M99, she said.
“It’s not going to come so easily, to know these codes automatically. It is going to be a learning curve,” Chung advised the audience members, who vocally expressed their concerns about the time it will take to master the more complex coding system. The ACR is providing assistance, including developing an online training tool, and access to two full-time staff members to help rheumatologists adjust, she said. She advised rheumatologists to order the full ICD-10 book to cover all the potential patient cases they may encounter. For example, ICD-10’s Chapter 18 covers symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified.
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.
The ACR offers help in mastering ICD-10. The ACR practice management staff is working with the Committee on Rheumatologic Care to develop a condensed book of codes for rheumatologists, hopefully rolling it out in spring 2014 or earlier, she said. Rheumatologists or staff members can take the ACR’s eight-hour ICD-10 training class, either at the State-of-the-Art Symposium on Apr. 26, 2014, in Chicago or in their own offices. There is also a more intensive, two-day class available. In addition, the ACR has two full-time staff members who can review charts for coding accuracy.
Create a timeline for training staff to learn the new codes, Chung concluded. “Learn what you can now, and plan effectively.”
Susan Bernstein is a writer based in Atlanta.
