1. Your practice hasn't spent a dime to get ready.
There are a dozen excuses for this. "If I send her for training, she'll just want more money or go to another practice." Or, "We'll wait and buy the final version of the ICD-10 book when it's released. It's still in draft form, you know." While large systems and groups are well on their way to ICD-10 preparedness, some smaller groups have taken a wait-and-see approach. They hope that CMS will change its mind, and push back the deadline. Or, they tell themselves, "It will get quieter in the spring, we'll do it then." Lame excuses. Buy the draft version of ICD-10 and educate key staff members; plan physician training for closer to implementation, either in person or online.
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2. Your software vendor tells you not to worry.
Well, if your vendor tells you not to worry and has shown you their mapping program and has installed the latest software, then OK. Is your vendor well established and committed to the program you have? There is a shakeout going on in the EHR and practice-management world, partly related to meaningful use. Look in trade journals, talk to your specialty and professional societies, and be sure your vendor will still be in business, supporting your needs, in 2014. I'd still worry. Or better yet, prepare.
3. You're using a paper encounter form and select diagnosis codes from it.
A long, laudable essay could be written about the benefits and ease of using a paper encounter form. It would need to end with "rest in peace," however. Circling the most common codes and writing in a code that isn't on the form - when a more specific code was available - has resulted in many unspecified codes. It wasn't good practice in ICD-9 and will become impossible in ICD-10. ICD-9 had about 14,000 diagnosis codes and ICD-10 has about 70,000. It is the rare specialty practice that uses a handful of the same codes over and over. Groups using paper encounter forms for diagnosis coding will need a new system.
4. The software upgrade to an ICD-10 compatible version is scheduled for September 2014.
Be on the latest version of your software - get an early upgrade so you can try out the ICD-9 to ICD-10 mappings and begin to educate providers using your system. Worry if the vendor has a late implementation date. At the very least, ask for a test version.
5. Currently, you have claims denied as "not medically necessary" and/or pre-authorizations for diagnostic tests denied because there is "no covered indication."
These are diagnosis-code problems in ICD-9 and they are only going to get worse in ICD-10, when the volume of diagnosis codes explodes to 70,000 codes. There will always be some of these denials in a practice: The patient may not have a covered indication or the payer policy changed. If your practice is experiencing these now, however, the problem will only grow. Expect some glitches as payers migrate their coverage policies from ICD-9 codes to ICD-10 codes.
6. No cash on hand or available line of credit.
Let's say your staff is trained, your providers are scheduled for online specialty training, you own ICD-10 books, and your software has a mapping program that you've tested thoroughly. You've tested with CMS and all went well. There's one more thing to do. Save some cash. One single fly in the ointment, one payer, one clearinghouse glitch, one binary 0 that should be set to 1 has the potential to slow your payments. For example, if one small insurance company that represents 7 percent of your revenue stops paying, how long can you make payroll and pay bills?
7. You never saw an unspecified diagnosis code you didn't like.
It is easy to be complacent about diagnosis coding in a medical practice. After all, most ICD-9 codes support the medical necessity for an E&M service, specific or not. Many procedures have an obvious diagnosis: appendicitis for appendectomy. Diagnostic tests and procedures have always required more care in selecting the accurate code. But, if you run a report and find a high frequency of unspecified codes (codes ending in .9), pay attention. Start using specific ICD-9 diagnosis codes now to ease the transition to the more detailed and descriptive ICD-10 system.
8. A bonus worry. If your system allows users to change the definition of an ICD-9 code from the official ICD-9 language to words that are "easier to find" for the clinician, switch back to official ICD-9 language today. Don't even think of converting to ICD-10 if your current diagnosis descriptions don't match official language.
Betsy Nicoletti is the founder of Codapedia.com. She is the author of "A Field Guide to Physician Coding." She believes all physicians can improve their compliance and increase their revenue through better coding. She may be reached at firstname.lastname@example.org or 802 885 5641.