Home Forums Discussions Coding and Billing ICD--10

There may be something in the forums about this -- the Oregon Medical Association keeps reminding me that ICD-10 is only months away, and once again the sky is falling.

So far, I have managed to simply ignore this.

What is anyone else doing?
Is there going to be an ICD-10 search in AC?
How is this new mandate ever going to help us? Or our patients?

Dear Tom,

Amazing Charts will be moving to ICD 10 codes when they are mandated. This will be handled with an update. Watch for an update at the time the mandate goes into effect.

Thanks,

Claire

With the expected integration of ICD 10 and billing/payment do you think AC will be smart enough to know all the parameters i.e. L,R, initial, ongoing, improving, resolved etc., my hope is that it will not be the elephant in the room and for outpatient care we can use a 'core' group of codes however how integrated the payer side is will determine how we do or don't get paid, sorry just rambling some insecurities of mine.

Dear Koby,

Since the version that will include ICD 10 is still a way off it's very hard to know just what the version will include. I am very happy to send any suggestions you have on. Email me at CRich@amazingcharts.com.

Claire

Claire I think the issues of 'ease of use of ICD 10' will be well beyond what any EMR will be able to deliver even our own AC. Will it matter payment wise if we code Left and it was Right?; if we code 'initial' injury and it was subsequent?, or resolved?
How many mouse clicks will it take to get the correct shoulder pain ICD 10 code when now I just code 719.41 hence the real issue is will there be dumned down listing of codes that will get past the payers requirements to authorize payment? No answers just questions and no desire to sign up for ICD 10 college.

Right now the compliance deadline is October 1, 2014. I think leaning more about it will be useful, but with at least 1.5 years before it will be needed, I think AC can focus on more pressing matters (like V7)

Agree Wendell work on more pressing problems first but do think the payers may be working on the denial algorithms utilizing ICD 10 already so that if and when we are finally required to use it and if it is through the Ver 7 AC practice management piece just hope V7 and whatever clearinghouse used are 1 up on the payers.

I know I have been wishing for years that I could codify "bit by a duck" instead of just a generic animal bite (I know). I have worked with AC for years and feel that the PM will be able to deal with it.

I have been putting my head in the sand, but watched this video from AC, which helped a bit. http://amazingcharts.com/support/video-tutorials/?tx_acvideos_videogallery%5Bvideo%5D=112&tx_acvideos_videogallery%5Bcategory%5D=1&tx_acvideos_videogallery%5Bcontroller%5D=VideoGallery&cHash=5e5922dcce8df2466759fa7960f775ca

Also has anyone paid for and taken this course yet?? www.aapc.com/ICD-10

For me, the change to ICD 10 just does not seem to be that big a deal. In part, this is because of a lucky break.

I was one of those folks who was waiting for integrated PM in AC. When it became clear that that was not going to happen, I accepted the fact that I had to buy a new version of my PM program, Lytec. (Jim, I know that your office uses this also.) Lytec 2014 came out at the end of 2013. It has ICD 10 support. It includes a tool that will convert the diagnosis codes that you have been using. 80% of the codes are 1:1 conversions. For the 20% that are not, it gives you suggested choices and you pick one. So, we did this to add the ICD 10 codes, and cleaned up our code list over the last few days. Since I have been using Lytec for 25 years, almost every diagnosis we need is in Lytec; we very rarely have to set up a new diagnosis.

I hope that others are as fortunate with their PM programs.

AC is way behind, not MU certified until mid 2014, and who knows where they are in ICD 10 preparation or what the procedure will be for converting the existing diagnoses in patients' records. They continue to communicate very little. Confidence continues to erode because of failed initiatives, missed deadlines, etc.

I don't know whether I am going to consider MU 2, so it doesn't matter to me whether I update AC at present. The key function is being able to bill, so, for that, I am ready.

Yes, my confidence has declined as well. There are so many very important problems with the program I have presented to them, and no response. I am so tired of some of these work arounds. Once you start with an EMR, you are sort of stuck. The world of EMRs is generally very disappointing.

I would trade any of you Epic for your AC....warts and all. I believe I am only one of two providers in this hospital system that has successfully attested for MU for three years. I believe they still do not have the capacity yet here to even make MU2. AC is so technologically farther advanced than Epic it is unbelievable. Be thankful for what you have.

Leslie,
I agree that AC generally meets my needs for charting despite its shortcomings, but not to have released a version with mandated ICD 10 coding less than 6 months away.... well, that is really problematic. Is Epic not ICD 10 ready?

They "are working on it". Of course, they have a whole huge department of coders and billers so if they miss it on the front end they can likely catch it on the back end.

Donna,

Thank you for the information regarding Lytec 14. I had no idea about the capability of 80% 1:1 conversion. So do you print a superbill from AC and then the in house billers convert to the ICD10 code, or do you do that? Would you mind walking through the steps publicly on the user board, if not, may be we can discuss more in SD.

For anyone that is in a situation in which every dX inside the chart must be coded before sign off I think that with the current AC dX search window, finding the right ICD-10 codes will take longer and cause annoyances. A search window makeover might make things better. Or, it might be necessary to learn the coding system (ie memorizing categories of codes and how extra characters specify certain details).

TMA released this on their website.
http://www.texmed.org/template.aspx?id=30111
Projected costs for ICD-10 transition triple.
Don't know what calculation methodology they used but the numbers seem high.

Jim,
Here is what works best for me.
We use a paper superbilll of our own creation. It contains our CPT codes and about 80 of our most common diagnoses with ICD 9 codes.
I am given one of these for each patient appointment. When I finish with the patient, I quickly circle/write in needed information and it goes back to my secretary. She then enters billing info into Lytec, schedules tests, follow up etc.
Very efficient. I do not have to be finished my AC note for my secretary to do the billing. I only enter CPT codes for visits in AC so that AC could track the data for MU. We will manually revise our superbill for ICD 10 codes. Yes, for some things, paper just works better.

Donna,

Thanks again!

Scheduling tests by your secretary will require ICD 10 codes soon?

Hmmmmm........My nurse does scheduling now, and will have to think this through some more.

I am using the free ICD 9 to ICD 10 CM converter and just started writing out the ICD 10's next to the printed ICD 9 codes on the AC super bill. I am doing this to get use to the new codes and to get the billers use to the codes, until we can upgrade to Lytec 14, and hope to start testing with the clearing house come April.

I got bored tonight.....conversion from ICD 9 to ICD 10

Abd Pain 789.00 R10.9 Flu 487.1 J11.1
All Rhinitis 477.9 J30.9 Gastritis acute 535.00 K29.00
Anemia 285.9 D64.9 Gastroenteritis 008.0 A09
Anxiety 300.00 F41.9 Gen Med Exam V70.0 Z00.00
Arrythmia 427.9 I49.9 Glu, Imp fast 790.21 R73.01
Arthrit, Rheu 714.0 M06.9 Gout, acute 274.0 M10.00
Arthrit, Oste 715.90 M19.90 Heart murmur 785.2 R01.1
Asthma 493.90 J45.909 Headache 784.0 R51
Afib 427.31 I48.91 Hematuria, uns 599.70 R31.9
B12 Def 281.3 D53.1 Herpes Zoster 053.9 B02.9
Bronchitis 466.0 J20.9 Hypertension 401.1 I10
Ca,Nos 199.1 C80.1 Hyperthyroid 242.90 E05.90
Ca, Breast 174.9 C50.919 Hypothyroid 244.9 E03.9
Ca, Colon 153.9 C18.9 Irr Bow, w/o di 564.1 K58.9
Ca, Lung 162.9 C34.90 Lipidemia 272.4 E78.5
Ca, Prost 185 C61 Long Term, Anti V58.61 Z79.01
Cellulitis 682.9 L03.90 Long Term, Med V58.69 Z79.899
Cereb, Isch 437.1 I67.81 Low Back Pain 724.5 M54.9
Chest Pain 786.50 R07.9 Nocturia 788.43 R35.1
Ch Kid Dz l 585.1 N18.1 Osteopenia 733.90 M89.9
Ch Kid Dz ll 585.2 N18.2 Osteoporosis 733.00 M81.0
Ch Kid Dz lll 585.3 N18.3 Palpitations 785.1 R00.2
Ch Kid Dz lV 585.4 N18.4 Parkinsonism 332.0 G20
Ch Kid Dz V 585.5 N18.5 Pharyngitis 462 J02.9
Ch Kid, End 585.6 N18.6 Pneumonia 486 J18.9
CHF 428.0 I50.9 Preop Exam V72.84 Z01.818
Colon Screen V76.51 Z12.11 Preop Lab V72.63 Z01.812
Constip 564.00 K59.00 P-BPH w/o ob 600.00 N40.0
CAD, Nos 414.00 I25.10 P- BPH w ob 600.01 N40.1
COPD 496 J44.9 PSA elevation 790.93 R97.2
Dementia 290.0 F03.90 Reflux, esoph 530.11 K21.0
Depression 311 F32.9 Sciatica 724.3 M54.30
Derm, eczma 692.9 L25.9 SOB 786.09 R06.00
DM ll 250.00 E11.9 Sinusitis 461.9 J01.90
DM l 250.01 E10.9 Syncope 780.2 R55
DM ll, unc 250.02 E11.65 TIA 435.9 G45.9
DM l, unc 250.03 E10.65 URI 465.9 J06.9
Diarrhea 558.9 K52.89 Urinary Freq 788.41 R35.0
Dizziness 780.4 R42 Urinary Hesit 788.64 R39.11
DVT 451.19 I80.209 Urinary Urgen 788.63 R39.15
Edema 782.3 R60.9 UTI 599.0 N39.0
Fatigue 780.79 R53.83 Vertigo 386.9 H81.93
Fibromyalgia 729.1 M79.7 Wt Gain 783.1 R63.5
Wt Loss 783.21 R63.4


Donna,

I used yours as a template and modified it a bit. It looks great on my google drive file, but my 13 year old computer guru went to bed before he had a chance to make it look presentable on this page, so sorry about the lack of columns.

Thanks jimmie an early cheat sheet

Jim,
Here is the superbill, now with ICD 10.
I actually have a 28 page document of our converted codes from Lytec if you want it. You don't need to manually look up the codes.
Clearly, you and I need more interesting things to do with our lives.

Donna,

I agree!!!

We are soon starting the process of getting the Lytec upgraded to 2014, but wanted to go through each code, to get more familiar and have a quick reference for all the docs and staff here.

Thanks for the offer of the 28 pager, but I bet I will have one soon after the upgrade. uuughghghghhhghh

Here are some useful sites I have found. One I can't find at this time had multiple specialty top 50's (for free), although the third one on the list has top 20 for most specialties.

http://www.aapc.com/ICD-10/codes/index.aspx
http://static.aapc.com/ppdf/ICD9-ICD10-reference-sheet1.pdf
http://www.pulseinc.com/top-20-icd-9-icd-10-conversion-charts-specialty
http://www.icd10data.com/ICD10CM/Codes

http://www.aapc.com/icd-10/codes/

I like this one...

I found this article quite helpful too.

http://www.clearinghouses.org/

Donna and others doing in house billing,

Are there any webinars or courses you have used for getting your staff up to speed on the ICD 10 conversion?

Jim,

Because of the way we work, my staff does not need to know very much about ICD coding. I will instruct them in the basics, but don't plan any formal course. I have already told them that if we need to enter new codes that we will choose them together. As above, all of our existing codes have been crosswalked.

We use the superbill with the ICD codes, so I pick the codes for visits. In Lytec, each diagnosis code is set up with an alphabetic abbreviation: HY hypertension, DM diabetes, etc. These are generally the NOS or uncomplicated designations. Of course, especially with ICD 10, there will be many more choices. My staff have the common ones memorized. In Lytec, these link to the appropriate ICD 9 (and now ICD 10) codes. The idea was to make it as easy as possible for the staff. So, when we started with Lytec 25 years ago, we elected alphabetic shorthand rather than the ICD codes when setting up our diagnosis list. So, it dosen't matter what ICD version, all they have to remember is the mnemonic. I know that many others use the actual ICD code as the Lytec code.

So, this transition is relatively easy for us because:
We chose to set up Lytec with alphabetic abbreviations long ago
AC failed at integrating PM so that I am continuing with Lytec

CMS has files of icd 10 that can get uploaded in MS access -- GEMM files
They claim it can covert icd 9 to 10 and also backwards
This is the official version of conversion
Instructions to load this into access are not clear for novices.
Can someone with more technical expertise look at these files and advise
Thanks

Sunil,

I did some quick googling, and found:
http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and-GEMs.html

Later this year AC will release a version that has ICD10 in it, so help me understand what you are looking to accomplish.

There is company that has asked us to create a mobile app that provides the cross-walk -> is that what you are looking for?

Thanks Indy,

I was trying to see if there is an easy way to have the above cms GEMs files uploaded to ms access to do the crosswalk conversion.

Donna,

Thanks for running through the steps, as this has been extremely helpful.

I think having a PM separate from the EHR is a definite advantage, especially if the EHR is not going to be ICD 10 ready to start testing before the October mandatory date.

Our clearing house will not start allowing us to start testing the ICD 10 codes until June, because the 3 big boys (Medicare, Cigna, and Blue Cross) are not going to be ready till then.

However, even with a nice clean submission at the clearing house level come June, we will be at the mercy of the payors.

Therefore, having at least several months to test the payors will be extremely helpful to minimize any reduction in cash flow.

I would think that if AC would like to continue to grow, keeping the cash flow steady and healthy to physicians utilizing AC is a must. The quicker AC is ICD 10 ready, the best we can all stay in business.

The big unknown here is simply "what degree of specificity will payors require."

Neither the government nor any private payor has tipped their hand here. It will be impossible to "crosswalk" reliably, because ICD-10 is inherently more specific.

If payors allow non-specific codes -- at least in the beginning-- this might work, but there is enormous latitude for claim denial and misunderstanding (read cash flow disruption) unless this whole thing gets a lot more transparent pretty quick

This may help.

http://www.healthcareitnews.com/blog/are-you-ready-icd-10-testing

The House yesterday passed a bill to enact another 1 year "doc fix" for Medicare payments, and to delay ICD 10 for one more year. Still has to go o the Senate.

So much for all of our efforts to get prepared! Blech!

And we just bought the lytec 14 upgrade earlier this week!!!!!

We will be ready either way, hopefully.

Well, that would be one fewer issue for sure. However, we do just like Donna; use a couple dozen non specific codes, and always get paid. I have always considered the whole coding thing a fairly pointless exercise. When we started with AC and would pick a non-specific code, AC would panic and urge me to pick a different code. But I find we get paid exactly the same if I use 401.1 or 401.9. Consequently, I am going to worry even less about specifying which knee was sprained.

My guess is that hospitals are probably ready for ICD-10, and physicians are not. I think Medicare wants to save money with hospital admissions more than with outpatient care. So, I'm guessing that hospitals will have to get specific with their coding ICD-10 before physicians do. If we keep a pulse on what is happening at our hospitals, we will have time to get serious about our practices. I think nonspecific will work just fine until Medicare has the hospitals under control. Then, the temp in the pot for us frogs is going to go up slowly.

If Congress is afraid to give us a 27% pay cut, I don't think Medicare will want to turn off our payments because our note says left elbow and the code isn't specific for the elbow. And commercials won't do anything until Medicare has been doing it successfully.

As to the delay of ICD-10, I don't think any senators will lose votes for delaying ICD-10, and it helps Democrats to keep more healthcare trauma out of the news at election time. No one else in the world is doing ICD-10 with the kind of complex health system that we have. Everyone else is basically single payer.

Of course, I'm not very good at guessing the stock market, lottery numbers or poker, so I'll stick to being a doctor that has to work harder for less money every year. ICD-10? Bring it on!

I watched the AC Webinar on Friday with our staff. Some of the codes are straight conversions, but in other instances the degree of specificity is insane! For instance, a 7 digit code that specifies a RIGHT DISTAL TORUS FRACTURE, NON-DISPLACED, with a number for every part of this is okay, but they also want 2 or 3 other codes because it was a fall from playground equipment and another code because it was at a park location. (They don't want to pay if at a school - they typically have their own insurance). So 3 or 4 separate ICD-10 codes for the fracture because the insurance companies want us to DO ALL THEIR WORK, and because the government also wants to DATA MINE.

The Senate today passed the 1 year delay, so just needs presidential signature.
So, ICD 10 can drop down on the priority list for now.

I feel a bit like the black Knight with this news!!!!


https://www.youtube.com/watch?v=ikssfUhAlgg