Home Forums Discussions Coding and Billing ICD 10

Can anyone tell me what's going on with AC and ICD 10? When will it be loaded and ready to use?

Hi Kathryn,

I don't know the answers, but I am confident it will be ready. Basically, because it will a new list of codes. A different and larger list, but computers laugh at that kind of change.

It would be very nice to have a tool to help you drill down quickly to the most specific ICD 10. I imagine that some ehrs will have nicer tools than others. Probably more important if you deal with left/right issues all the time.

From what I know, your practice management and clearinghouse is going to be a bigger issue. Gateway has a worksheet that could help you. http://www.gatewayedi.com/icd10/meet-icd-10-head-on/

Medicare tips. http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html

If your clearinghouse isn't ready, consider looking for another one. They should have been ready by last month, since the original goal was 2013.

If your clearinghouse is ready, then consider sending in one claim with an ICD 10 code, even if a paper claim, and learning by trial and error. I think that will give you some confidence as well as experience.

Consider tracking your diagnoses such that you have a list of decreasing frequency used over 3-6 months so you can map a conversion for the top 95% of your diagnoses.

I have written 714.0 for rheumatoid arthritis for so many years. I hope I'm young enough to learn how to write M06.9 instead. It will get a lot trickier if the insurer wants a more specific code than nonspecific rheumatoid arthritis, but I think it will be a gradual process of tightening the noose, and they will take a nonspecific diagnosis next October.

My perspective may be different, because I do my own coding and we don't link AC to PM. I'm planning on using the best 3rd party tool if AC or my own programming aren't adequate in the exam room.

John Squire said at the Chicago ACUG that their timetable for ICD10 would be early summer 2014. Apparently they also have to implement SNOMED to make someone happy and that will inadvertently make it easier to find dx based on standard language. They would also map from ICD9 to ICD10.

All sounds good, but the devil is in the details.

Is there going to be any equivalence possible between current diagnoses in ICD-9 and the new codes? I can imagine that we may well have to re-enter everything in the problem list if not. But it seems a 401.9 is going to have a more or less equivalent code someplace in ICD-10, and it will save a huge amount of work if it would link to that.

Hi David,

That would be I10, essential primary hypertension.

And I for one am hoping that is all we need on October 1, 2014. That's why I think we ought to know our most common diagnoses, and do the mapping ourself. Here's a tool that has the disclaimer that it isn't able to officially map from ICD 9 to ICD 10.

http://www.aapc.com/icd-10/codes/index.aspx?w=widget2&txtCode=401.9&txtType=9

Here's a comparison for the old and new hypertension coding.

http://www.hcpro.com/content/233887.pdf

Next October, I assume even Medicare will accept nonspecific diagnoses, since that is what we have been feeding their servers all this time.

Later, it will get a lot trickier. When they see an opthalmologist and get a diagnosis of H35.0, then you won't get paid for your I10. So it will take a while, but we will have to get more and more specific in our coding. That is if we want a clean claim that actually gets paid.

Thanks, that is very helpful. I like the AAFP code translator. I think I will be using it a lot if AC does not have a good lookup tool. In some ways, ICD-10 Makes more sense: i.e. E is for endocrine on your diabetes code E11.9 = 250.00

Wonderful. Thanks,, Dan

Dan,

Thank you for that excellent conversion tool. I have been trying it, using my most used ICD9 codes. Occasionally, it won't find an equivalent, so I found another site where one can search for an ICD10 code by diagnosis name: http://apps.who.int/classifications/icd10/browse/2010/en#/R31

As you said, at the outset I am picking rather general codes.

This is the one that I have been using; may be the same, worse or better, but I put it up for comparison.

That helps see the whole forest. Thanks for that site, Jon

So basically there will just be 10X the number of codes but they will be searchable as before...so no big deal? And then with AC hopefully we can change the name of them to how we refer to them so easy to find since we need to relearn all the codes lol.

Looking at these links, my impression is that ICD-10 is easier than ICD-9, at least for basic codes. I am somewhat anxious, however, and feel like I am waiting for the other shoe to drop. If there are all those plethora of codes, why does this look simple? Could it be that "yes, you can use those codes, but no one will pay you for them unless you say the diabetic neuropathy involves the left leg below the ankle, including the large toe"?

I am not an expert, so I just offer my opinion for stimulating conversation.

Medicare will lead the way in demanding more specific codes, when ICD-10 has more specific codes available. They will be the first to start rejecting payments.

Acute care visits will require drilling into ICD-10 with whatever tool we use. Chronic care will require monitoring to see if a more specific code is applicable. Orthopedics will be a nightmare.

I think they want to get a better synopsis of the patient's progress with the diagnosis codes instead of teaching a computer how to read a progress note. ICD-10 plus CPT codes will give the insurers a better gauge of our quality as providers.

So right now we have ICD-10 being pushed on us, meaningless use of EMR's, Medicare is insolvent and we are threatened every year with a cut, and everyone's insurance plans are being canceled - replaced with "affordable" act compliant, more EXPENSIVE plans. I don't know what next year holds, but it promises to be interesting.

There's this story about frogs (that's us) and a kettle with someone (the government) slowly turning up the heat.

...or was it something about lemmings????

A friend had the luck of having to be hospitalized in rural Phillipines, in a dirty hospital and flies everywhere. But they are already using ICD-10 and getting ready for 11. "Why are the American doctors so backwards?"

at some point docs will jump on my side and push for a cash pay system for office visits.. the pricing will be reasonable..pts will trust you, pay up front, there will be no need for freaking PM's and billing services...you jsut record what you collect at the door when the walk in plus anything additional you did as they are walking out...simple as that...and if one of my pts wants to go next door because the guy charges 25 less a vist, that is fine...you get what you pay for in the end.

it is crazy how much "benefits+ premiums paid by employee" insurance costs a year versus how much you actually use in a given year....

we should just have insurance for major things and hospital stays and all that...and elective surgeries shouldn't have crazy prices in the hospitals either...

one day the gov't will focus on one of the root issues in our health care system and that is malpractice bullshit...yes there is malpractice, but there needs to be a way to send the garbage down a disposal and no one can sue with crap...yes someone operated on the wrong body part or side or left [censored] in you or was negligent and screwed up, sure sue them...but honestly 99.9% of docs are doing this profession to help you...do mistakes get made? yes...

Ketan,

I agree, and my "nuclear option" is just as you describe, and from a business perspective makes the most sense in my mind. If you look at one's yearly dental charges versus primary care out patient charges, I suspect the former is significantly higher.

One could trim overhead significantly by cutting back on staff, which in turn lowers insurance and retirement benefit costs, which could be translated to less costly office charges.

I think this will not only be the trend but the standard in several years for primary care outpatient non-proceduralist offices because it makes sense.

I bring up the dental aspect because most patients pay their dental bill this way without a thought, why not their primary care doc too?

I think you are ahead of the curve.

I totally respect that viewpoint, but it doesn't work for society. I am not wanting to have a political discussion.

If you become a concierge doctor, you will see a lot less patients, take much more time with them, get rid of a lot of staff, enjoy yourself much more, have a lot less stress, and probably make the same amount of money. It's a good choice if you can get it.

But you're only taking care of the middle class and above with the disposable income to afford 1950s treatment. From society's viewpoint, half the population would have a much harder time getting healthcare.

I live in an area where a third are on Medicaid, and a fifth are below that, because they aren't citizens. We lose doctors all the time that leave to go where almost everyone has commercial insurance. Our problem is also that the best doctors won't take Medicare much less Medicaid, and half the population is going to county and church clinics.

I am totally conservative, and have always been to the right of Republicans. But, something is going to have to give. I am constantly dealing with poor patients who have end stage arthritis. It's like living in this mixture of first and third world. I could work 22 hours a day if I opened my practice to all the poor people who want help. I feel like I am being paid very well to help me ignore the suffering of the least amongst us. I don't have a political problem, but a moral problem.

Wouldn't it be the most amazing thing if every patient was equal in every way? I see the mediocrity of the service in England and Canada, so I don't want that either.

I understand your intent and I support your ideas, but it will cause anguish if we all go there. I hope we don't have to go there. We have to make it better from the inside.

Dan,
I agree with your position here. I don't think anyone would argue that serious reform wasn't in order and that reform must include better access to care for all. Forget about doctors pay. This government takeover of health care will be simply disastrous for the physician/patient relationship. The goal of the current reform is not to make every patient equal but to make every physician and treatment exactly the same. The goal of EHR's, ICD-10, meaningful use, blah blah blah is to force every physician to send the same data to the government & insurance companies. There will be intense pressure for physicians to treat patients with specific algorithms for every condition with less and less physician autonomy. This way all the metrics will be standardized for easy measurement to determine "quality of care" which will replace fee for service as the method of payment by the government and possibly insurance. Physicians will all essentially be technicians in the future simply signing off on treatments that have been predetermined. This will erode our status as medical experts in society and devalue the very special relationship we have with our patients. There will be evidence based medicine and nothing else. I cherish the special dual role I have with my patients as both a physician and psychiatrist. I feel like a dinosaur in all these changes, though I am only 44 years old. I just see the future of healthcare interfering with our ability to continue to fulfill the Hippocratic Oath that most of us took in medical school. Anyways, time to have some fun...it's Saturday Night.

There is another analogy to the airline industry..

Airlines are incredibly highly regulated. In the old days, pilots were supposed to make decisions. But, that was hard to regulate, and so everything has become " Standardized." Every pilot is now trained to do everything the same, every time, in pretty much every circumstance, and flying is automated to the point that it is rare now for an airline pilot to actually fly the airplane. Arguably it has made aviation very very safe. But it has also made it rather joyless. People now go into flying for the airlines the way others go into the plumbing trade; it is a good job, but not what you would call exciting.

Hi, I ?m Cathy Lehmann a Clinical Analyst at Amazing Charts. I agree with the advice re: mapping your most frequently used diagnoses from ICD 9 to ICD 10 CM. If you start to practice with the coding, break it down,and remember the 80/20 rule it's more manageable. There are a lot of resources/tools out there for ICD 10 CM. There are tools for both ICD 10 and for ICD 10 CM which is the Clinical Modifications version that CMS will transition to in October 2014. Check the tool you use to see if it is based on ICD 10 CM or the International version of ICD 10.
There is a distinction between the two. Many refer to ? ICD10? when they mean ICD 10 CM. CMS itself sometimes refers to ICD 10 CM by just ?ICD10?, but the International version of ICD 10 is not the same as the National Clinical Modifications of ICD 10 CM (which has much more detail and many many more codes).

Thank you so much Cathy!

I had no clue about that.

Jon's link above is for ICD 10 CM and it has a converter for 9 to 10

http://www.icd10data.com/Convert

I second the thanks to Cathy; I also did not realize that there were 2 versions of ICD 10. I mapped most of my codes using Dan's link above which is ICD 10 CM. The link I posted above appears to be the international version, so do not use it. I'll go back and double check my codes since I used it for a few conversions.