Friday, October 18, 2013

The Next Big Change- ICD-10

Sit up and take notice!
Sit up and take notice! This one’s all you.

The content of this blog space is about a new coding initiative.

So right now we’ll bet your thinking…”Awesome! Enhanced has this thing under control. Good for them.”

Because coding is a billing company thing. Right?

Nope. Stop right there!

While it may seem that this coding stuff is the billing company’s problem.

It’s not.

It’s your issue. “Your” is defined as “you” with ownership. Unless “you”- your organization, your providers, your administrators… whoever makes up your department decides right now to accept this as something you control, then there will be nothing we can do as your billing office.

We WILL NOT be able to do our job beginning October 1, 2014 unless you adopt the mindset right now that YOU control the outcome to make ICD-10 compliance possible.

Below, we explain each role.

However, get this now… your documentation, or the lack of documentation, will determine if your claims are able to be billed or not billed when ICD-10 debuts.

If you take nothing else from reading this blog today, copy that last sentence into MS Word, print it out and tape it to your forehead.

Now read on and we think you’ll see why.

Save the Date!
The big trend in wedding announcements is receiving advance notice when a couple is planning a wedding. It’s called a “Save the Date” notice and usually involves a refrigerator magnet with the couple’s nuptials date printed and the intent is to let the person receiving the notice know that they should keep their calendar open for the big day.

Well, consider today’s blog space as our “Save the Date” notice to you.

It’s coming!

The transition to ICD-10 is coming and it’s less than one year away. Officially the big day is October 1, 2014.

What is ICD-10?
ICD-10 is short for the International Classification of Diseases 10th Edition.

It is the title of the world’s system of codes used to identify medical diseases, illnesses and injuries and is used in the United States as a reporting, and therefore, a billing tool to label an illness and/or injury of a patient.

For the last 30 years, the 9th Edition was used (ICD-9). The Health Insurance Portability and Accountability Act (HIPAA) mandated an upgrade of the code set as part of the sweeping changes that HIPAA ushered in with regards especially to Electronic Health Records.

It has long been time for an overhaul as ICD-9 contains outdated terms that are inconsistent with current medical practices. In addition, as needs arise for new ailments, the ICD-9 code set had reached its limit for the number of additional coding that could be incorporated.

From 13,000 to 68,000+ Codes
ICD-9 includes about 13,000 diagnosis codes in a 3-5 alpha-numeric character format.

ICD-10 will expand the code set to in excess of 68,000 codes and increase the character count for up to 7 alpha-numeric combination possibilities.

In a nutshell, computer systems will need to be expanded and an extensive amount of training at all levels of the healthcare system will need to be conducted in order to comply with the new coding system.

How does this affect us as the biller?
As a biller, the resulting change is huge.

Here at Enhanced we have already begun the process of mapping out training and education for our staff regarding the changes.

Remember, we obtain your Patient Care Report for each ambulance incident. Once we review the PCR documentation, we then must find and apply the appropriate ICD-9 diagnosis code (even though no EMS provider can diagnose in the field) in order to submit the bill to the insurance payer in order to initiate the payment process. Our staff must now learn how to use the new code set to continue to make this happen.

But, the new code set is extremely detailed and this is where you come in as our client, and by extension, each and every EMS provider as part of your organization.

The idea of the expanded code set is for the system to become more focal in nature.

So, for example, whereas we could report a leg (femur) fracture with the code 821.0 the corresponding ICD-10 code will translate to two possibilities… either S720.31A defined as “Displaced midcervical of right remur, initial encounter for closed fracture, delayed healing” or S720.32A “Displaced midcerfical fracture of left femur, initial encounter for closed fracture.”

ICD-9 has one code: right or left, it doesn’t matter.

ICD-10 has at least two codesone for right, the other for leftand note the “delayed healing” factor on the first one… interesting twist. And, to further complicate matters, there is a conversation tool called the General Equivalence Mappings (GEM) which provides even more codes for the femur fracture as it is related to various scenarios such as associated injuries and illnesses.

How does this affect you as the provider?
Remember in order for us to do the job as your billing company, we’ll need specifics in your Patient Care Report, as the provider, like never before.

When ICD-10 takes effect next year, expect to hear a lot from your billing company when PCR’s are submitted for billing sans effective detail.

Take our fractured leg example above.

A pre-hospital provider could produce a PCR concerning a fractured femur scenario which only identifies that there was a leg injury resulting in a fracture to the patient’s femur. For our hypothetical scenario today, let’s say that the provider did not mention right or left or give sufficient detail about the nature of the injury, for example if the fracture was open or closed.

Given the limited amount of information in our hypothetical PCR, as the billing company we would technically be forced to return the PCR in order to ask for additional information regarding the location of the fracture and whether or not the fracture was open or closed. There would be no way for us, as your billing agent, to “read between the lines” or “guess” at the location and severity of the leg fracture in order to properly apply an ICD-10 code.

And… that’s just for 9-1-1 trips.

Think about the level of specificity that will be required to explain ongoing and/or chronic conditions in order to justify billing and payment of claims that result from non-emergency/routine transports.

Same message on steroids!
If you read this blog space regularly and/or have attended one of our documentation training sessions or both, you will quickly realize that our message is no different than it’s been for some time now.

Document! Document! Document!

It’s really the key to effective EMS billing.

Your billing office needs sufficient documentation detail in the PCR’s you present for billing to enable us billers to produce a claim for payment that is compliant by allowing us to apply the best and most appropriate ICD-10 code.

ICD-10 takes the whole EMS billing process into overdrive. Call it our consistent documentation mandate message on steroids!

Moving forward to next year’s transition into ICD-10, we’re going to be absolute fanatics (as if we weren’t already) about preaching the sermon of specific detail in all PCR’s narrative documentation.

There will be little to no “wiggle room.” We need specifics with numerical values that translate into pinpoint word picture documentation in each and every PCR that is submitted for billing. ICD-10 will mandate a new level of excellence and specificity we’ve never before seen in the EMS billing industry.

One of many…
This blog will be one of many that we intersperse throughout the next year as we move closer to the October 1, 2014 implementation date.

Enhanced clients… hunker down and get ready!

We’re going to infuse instruction pertaining to our ICD-10 preparations all throughout our communications over the next year. You, as our client and your providers by extension, will make or break this change. Without your buy-in and help in everyday PCR preparation and documentation, the challenge ahead will be insurmountable.

So we’ll help you, coach you, assist in training for what we’re going to need to see in documentation beginning NOW! Client Services will be discussing this with you. You’ll read it here in our blog and you’ll receive specific e-mail messages and eventual instruction throughout our many training opportunities to educate both client administrators and street-level providers.

Not an Enhanced client yet?

First, do this: ask your billing department (in-house or outsourced) if they are preparing for ICD-10. If they act like a deer in headlights, it’s time to think about another billing option (hint- Enhanced Management Services!)

If no one in your billing office has even begun to speak with you about ICD-10; you’ve got a problem and you need to make a change quickly to a billing source that knows where they are going. Your billing office needs to have a plan to attack the changes by providing you with education and guidance, while at the same time developing processes and procedures (like Enhanced is doing) to make the transition from ICD-9 to ICD-10.

Jump on the Enhanced ICD-10 train today. Don’t wait.

Business Development Manager, Chuck Humphrey, is ready to help. E-mail him today at chumphrey@enhancedms.com or give him a call toll-free at (800) 369-7544.

You, too, can be ready for ICD-10 with help from Enhanced!
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