Despite years of lead time and numerous delays, it’s almost certain that some providers, vendors, and payers will not be 100% prepared for ICD-10 implementation in two weeks.
Acknowledging that, this week CMS published a list of claims submissions alternatives for providers who have difficulties submitting ICD-10 claims due to being unable to complete systems changes or issues with billing software, vendors, or clearinghouses.
The first option is free billing software for providers who submit claims to MACs. CMS stresses that the software is only meant to provide an ICD-10-compliant claims submission format; it will not provide coding assistance. Also, while the software itself is free, fees may be associated with submitting claims through a Network Service Vendor or dial-up.
Providers may also be able to submit professional claims through MAC provider internet portals, but this option is not available for institutional or supplier claims. [more]
By now, providers are no doubt familiar with the group of entities required to switch to ICD-10—those covered by HIPAA—and those that can remain on ICD-9-CM, such as workers’ compensation and auto insurance companies.
State Medicaid offices are also required to switch to ICD-10, but not all of them are going to be ready and CMS has granted an extension to four states, reports Modern Healthcare. The claims processing systems in California, Louisiana, Maryland, and Montana apparently won’t be ready in time, affecting claims for millions of patients and many providers.
CMS approved the states to use a crosswalk system that will accept ICD-10 codes and translate them into ICD-9-CM codes to calculate payments, according to Modern Healthcare. No timeline for when they’ll be fully compliant has been announced. This should raise plenty of concerns for providers, who have spent a lot of time and resources to prepare for implementation.
With less than one month until implementation, CMS says it’s ready for ICD-10, and so are many providers, according to the results from the agency’s final week of end-to-end testing in July.
The round of testing resulted in a similar acceptance rate to January and April testing weeks—but with the largest group of volunteers yet. Approximately 1,200 volunteers, from a broad range of provider, claim, and submitter types participated, including 493 who participated in previous testing weeks.
Testers submitted a record 29,286 claims and CMS accepted 25,646 of them, resulting in an 87% acceptance rate. This is a similar rate to previous testing weeks, and most rejections were the result of provider submission errors that would not occur with actual claims, according to CMS. Errors include incorrect NPIs or submitter IDs, invalid HCPCS codes, and dates of service outside of the range of testing. [more]
Every once in a while, another facility will send us a case to review and help them code. Here at the Fix ‘Em Up Clinic, we are happy to share our knowledge as we prepare for October 1. In that spirit, we present the following case sent to us from Florida.
Tim and a large group of friends were out biking on a Florida highway when they came across the body of a baby alligator. The alligator suffered multiple crushing injuries as a result of being run over by a really big truck.
The alligator may have been squished, but that didn’t stop it from taking out some cyclists from the hereafter. Several of the cyclists, who were cruising at around 30 miles per hour, hit the baby gator’s body and then the pavement.
Tim suffered the most severe injuries, breaking five ribs, several facial bones, and his clavicle. He also suffered a collapsed lung.
Let’s start at the top of Tim and work our way down.
If you are all set for ICD-10, you’re probably fine tuning your coding and documentation, maybe looking at what improvements you can make to your EMR.
If you’re mostly ready, you’re probably scrambling to figure out what absolutely, positively must be done by October 1.
If you aren’t ready at all, you’re in panic mode.
For those of you in the first group, congratulations! You made the most of the multiple delays and you’re ready for any hiccups you encounter after implementation.
Take Shaun, for example. Shaun is the kicker for Anytown’s high school football team. While making a routine tackle in practice, Shaun’s knee connected with another player’s helmet and he had to be helped off the field.
Shaun comes in to see Dr. Landry at the Fix ‘Em Up Clinic. After an MRI, Dr. Landry diagnoses a grade 3 tear of the left anterior cruciate ligament. Dr. Landry recommends surgery to replace the ligament.
When we look up a torn ligament in the ICD-10-CM Alphabetic Index, we’re directed to “see Sprain.” Once you know ligament tears are classified as sprains, you can head right there in the index.
You can look up “cruciate” under sprain, but you will be directed to the knee so we’ll just head right there.
The absolute best ICD-10 education is completely free, assuming you have an Internet connection. It will tell you everything you need to know about coding in ICD-10.
It’s the Official Guidelines for Coding and Reporting (CM and PCS have their own). Yep, I’m talking about the instruction manual.
And okay, the official guidelines won’t tell you everything. But they are a great place to start.
Several years ago, I attended a conference session on tough ICD-9-CM coding challenges. One of the very first things the speaker said was read, learn, and love the guidelines. True in ICD-9-CM, true in ICD-10-CM, and true in ICD-10-PCS.
I can tell when people have read the directions by the questions they ask. Sometimes, the answers are clearly spelled out in the guidelines. Other times, I need to look in Coding Clinic, or reach out to one of our Boot Camp instructors for help.
Armadillos apparently pose more hazards to your health than just passing on leprosy.
A Texas man recently tried to shoot an armadillo three times and ended up being hit by his own bullet. He claims one of the bullets bounced off the armadillo’s shell and hit him in the face. Local law enforcement believe the bullet really ricocheted off a rock.
Regardless, Sam ended up with a fractured jaw. If Sam came into the Fix ‘Em Up Clinic, we would need some additional information to code his broken jaw. Specifically, which part of his jaw is broken?
ICD-10-CM includes nine possible locations on the jaw:
- S02.600-, fracture of unspecified part of body of mandible
- S02.609-, fracture of mandible, unspecified
- S02.61-, fracture of condylar process of mandible
- S02.62-, fracture of subcondylar process of mandible
- S02.63-, fracture of coronoid process of mandible
- S02.64-, fracture of ramus of mandible
- S02.65-, fracture of angle of mandible
- S02.66-, fracture of symphysis of mandible
- S02.67-, fracture of alveolus of mandible
- S02.69-, fracture of mandible of other specified site
Hospitals did not get any ICD-10 relief as part of CMS’ accord with the AMA regarding a specificity grace period. However, they might not need much help, according to the latest Workgroup for Electronic Data Interchange (WEDI) survey.
Approximately 88% of hospitals that responded to the survey expect to be ready for ICD-10 by implementation, with only one respondent anticipating not being ready and 10% unsure.
Physician practices fared worse on this question. Less than 50% said they would be ready, with nearly 25% said they would not be ready and more than 25% are unsure. WEDI conducted the survey of 453 providers, 96 health plans, and 72 vendors in June.
Physician practices also lagged in testing, with approximately 20% in some stage of external testing with vendors compared to nearly 75% of hospitals. [more]
Some, though, can do nasty things.
Consider Legionella pneumophila bacteria. These nasty guys are responsible for at least seven deaths in New York City Legionnaires’ disease outbreak. At least 64 people have been hospitalized.
Legionnaires’ disease falls under category A48 (other bacterial diseases, not elsewhere classified) in ICD-10-CM. That’s a new home for the disease. In ICD-9-CM, the code for Legionnaires’ disease falls under diseases of the respiratory system (482.84, in case you’re interested).
The disease itself hasn’t changed. It’s just been moved from respiratory to infectious diseases.
We also get a second code for Legionnaires’ disease in ICD-10-CM: A48.2 (nonpneumonic Legionnaires’ disease [Pontiac fever]). We don’t have a code for Pontiac fever in ICD-9-CM.
Legionnaires’ disease is a type of pneumonia. Pontiac fever is a less severe, flu-like condition caused by the same bacteria.