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ICD-10 is More Than Just Software Upgrade

CureMD will support you every step of the way; from training your staff, updating your workflows to helping you get paid. See how we are helping practices like yours.

ICD-10
Ready
Software

Our ICD-10 philosophy was to keep things simple & instantly familiar; so you can continue doing things the way you are used to, post October 1.

  • Easy Mapping tool
  • Payor Readiness Tracking
  • Dual-Coding Capability
  • ICD-10 Workflow Support

Physician
Training
Program

Self-help training programs require time, which most practices don’t have.

CureMD physician training program is designed for busy professionals.

We will walk you through the fundamentals of ICD-10 documentation and coding, necessary for a successful ICD-10 transition.

Documentation
Readiness Assessment

How well does your existing documentation support ICD-10 medical specificity?

Let our consultants evaluate your current ICD-9 clinical documentation and suggest ways to improve it for ICD-10.

Call our ICD-10 helpdesk at

(718) 684 9298

ICD-10 Pitstop

Everything you need to know in the last leg of your journey to ICD-10.

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External Resources

Frequently Asked Questions

Does ICD-10 affect CPT codes?

The answer is no.The switch will not affect CPT coding for outpatient procedures. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only.

Will providers be able to use ICD-10-CM/PCS codes on claims prior to the October 1, 2015, implementation date?

No. ICD-10-CM/PCS codes may only be used for services provided on or after October 1, 2015. Claims containing ICD-10-CM/PCS codes for services provided prior to October 1, 2015, will be returned as un-processable. You must submit claims for services provided prior to October 1, 2015, with the appropriate ICD-9-CM code.

What type of training will my staff and I need?

Each person in your practice will require some level of ICD-10 training. It is best to begin with designated experts in your practice. Once they are trained, they can teach the rest of your team. Physicians and coders/billers will need the most intensive training, clinical staff will need intermediate training, and front-office staff and schedulers will require only a basic understanding. You will need to select what methods you intend to train your staff with, be it external, on-site, or online training.

Can I just use a mapping system such as GEM for ICD-10? Is there a cheat sheet I can refer to?

Many mapping tools do not drill deep enough for the fourth through seventh digits. Also, because there is not always a one-to-one mapping between ICD-9 and ICD-10, mapping tools cannot always provide the definitive code for a given situation. We would not recommend using an external cheat sheet. A single ICD-9 code may have dozens – sometimes even hundreds- of possible ICD-10 equivalents. Your best bet is to create your own cheat sheet by identifying the ICD-9 codes you use most frequently in your practice and then determine their ICD-10 equivalent. Learn How

Workers comp and auto insurance payors will continue using ICD-9, even after the ICD-10 transition. Is that true?

To cut a long story short, that is correct. Workers comp and auto insurers are not HIPAA-covered entities. Thus, the national ICD-10 mandate does not apply to them. They can therefore choose to legally continue using ICD-9 post October 1st. We don’t recommend relying on it for too long though. It seems that some states may require universal use of ICD-10 which will bind workers comp and auto insurance to make the switch as well. Moreover, leaders in healthcare –including CMS- are strongly advising these two entities to voluntarily begin using ICD-10 codes once the transition occurs. Thus, legally they are not bound but might make the switch anyway.

I run cash based practice. Should I be worried about ICD-10?

ICD-1O is truly a watershed moment for US healthcare. Even though you don’t deal with insurances your preparation for ICD-10 should be similar to practices that do. Chances are that some of your patients work directly with their insurance companies to get reimbursed for services you provide to them so it’s important for the codes on their invoices to be correct and as specific as possible.

What is the biggest change that ICD-10 will cause for providers?

Because ICD-10 codes are more specific than ICD-9 codes, to accurately code a diagnosis more specific documentation will be required. Many unspecified codes have been eliminated. Therefore, documentation processes currently used by providers will have to be revised to collect the appropriate information for ICD-10 diagnosis coding. We recommend you conduct a documentation gap analysis now and identify what is missing. For reference, focus on the following
  • Disease type is not documented
  • Disease acuity is not documented
  • Documentation not found at all
  • Site specificity is not documented
  • Disease stage is not documented
  • Laterality is not documented
  • One or more details for a combination code are not documented

Should I start keeping extra revenue aside in case of reimbursement delays and lost productivity?

Yes, experts recommend that you have at least six months' worth of revenue available to compensate for challenges that may arise during the months following ICD-10 implementation. Develop a line of credit or supplemental income to ensure your clinic's viability during the transition. Don't wait until after October 1, 2015, because you'll have to vie for financing and pay higher interest rates.

Will it be sufficient if I train my coder in ICD-10 codes?

No. ICD-10 will require you to justify the medical necessity of any treatment. Coders can only code what is given to them. ICD-10 is more robust and requires a significant amount of patient-specific information. If the documentation is not complete and does not provide the necessary information, the physician will be required to provide the coder with more details.

Why should I outsource my billing when I have a certified EHR to handle ICD-10?

The EHR will only have the codes in the system for you and may even help you select a code for a given situation, but will not instruct you on what else is needed to implement ICD-10 in your practice or the guidelines surrounding the codes. Moreover, if denials come in you will end up dealing with them on your own. You will also have to keep track of which payor are operating in the ICD-10 environment and which are still on the ICD-9 environment, so that you can send claims accordingly. Outsourcing billing will relieve you of these things and might be a more cost-effective option.

National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) often indicate specific diagnosis codes are required. Does the recent Guidance mean the published NCDs and LCDs will be changed to include families of codes rather than specific codes?

No. As stated in the CMS’ Guidance, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family of codes. The Medicare review contractors include the Medicare Administrative Contractors, the Recovery Auditors, the Zone Program Integrity Contractors, and the Supplemental Medical Review Contractor.

As such, the recent Guidance does not change the coding specificity required by the NCDs and LCDs. Coverage policies that currently require a specific diagnosis under ICD-9 will continue to require a specific diagnosis under ICD-10. It is important to note that these policies will require no greater specificity in ICD-10 than was required in ICD-9, with the exception of laterality, which does not exist in ICD-9. LCDs and NCDs that contain ICD-10 codes for right side, left side, or bilateral do not allow for unspecified side. The NCDs and LCDs are publicly available and can be found here.

The recent CMS Announcement stated that claims will not be denied post October 1, if the correct family of codes under ICD-10 are used. What is meant by a family of codes?

“Family of codes” is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters. One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.