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ICD-10: More Questions than Answers

February 9, 2014

Article

As a physician, I will be the champion for the ICD-10 transition and keep staff calm. But even I have some serious reservations about what lies ahead.

Only 273 days away from New Year’s Day, medicine as we know it will change drastically. As much as we would hope for another delay, there are promises that ICD-10 will not be delayed any longer. It is really hard to know who and what to believe about ICD-10, but one thing is sure: It’s going to happen and everyone is dreading the transition.

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We are all being told to start getting ready. I’m not sure what exactly that means. I have read the articles and listened to talks about getting ready. I just don’t think that it will be real for me until it is really here. I tend to be a hands-on learner. Until a system has actually gone live, it is hard to me to absorb what I must do since it doesn’t actually count (I don’t do well in the theoretic realm).

For pediatrics, I was perversely hoping that we would get some more specific codes because there are many times where I am forced to pick a code, all the time telling the parents that their child doesn’t exactly have that diagnosis but it is the closest I can get. Evidently, the total number of pediatric codes is decreasing. Fabulous! We get to continue putting square pegs into round holes. On the other hand, I really feel sorry for the orthopedic surgeons. Some of their codes are going from a single code, to more than 500 choices. That is really going to slow down their delivery of care. I guess it is feast or famine.

I know that as a provider, I will need to do my part in making sure the codes are accurate to the best of my ability. Then it is up to my coders to confirm that I got it right before sending it out to the insurance companies. We currently have two full-time biller/coders for just over 13 full-time providers. When I lay awake at night thinking about the transition, I fear that we may not have enough coders. A good coder is really hard to find … imagine the difficulty trying to find one for pediatrics!

Most of us have an EHR at this point. Is your EHR provider giving you information and updates about how they are going to comply with the change? Have they let you know how they are going to support you during this transition? Have they shown you their solution for the conversion from ICD-9 to ICD-10 yet? I certainly hope that your EHR company is prepared and ready to help you.

So let’s presume that all the providers, outpatient offices, and electronic records are ready to go with ICD-10 on Oct. 1, 2014. What about the insurance companies? Are they going to be ready to process these claims? Judging by some experiences with HIPAA 5010 implementation, I have my worries that they will be truly ready. And what about all these new plans starting this year as part of healthcare reform? Will they be ready for the transition?

If the payers are not ready, ultimately medical practices will suffer. Cash flow will possibly have a huge slow down. This is occurring during the fourth quarter, at year’s end. This is the worst time. We are planning on budgeting carefully in order to have enough cash on hand for our end-of-year expenses.

And then there are the government based-programs: Medicare and Medicaid. Should we take comfort or fear from the way the introduction to the Affordable Care Act was handled in October of this past year? It took two months to get the website up and running efficiently and that took intense media and political pressure to make it happen. If Medicare and Medicaid are not able to handle the transition, do you think that the public and government will be as worried about our billing challenges as they were with the rollout of healthcare reform?

I think that the most important things is to remain calm (I feel like emblazoning that on T-shirts for all the staff to wear on Oct. 1). Yes, we will all slow down as we wade our way through this new system of passing information from our office to the insurance companies. Yes, the reimbursement will likely be delayed in arriving to our offices. Yes, we will probably all have headaches and heartburn from October through December 31st. But like any transition, we will get through it. And as the head of your practice, keeping a calm demeanor will go a long way to reassuring your staff that "this too will pass."