ICD-10 Preparation:
Medical Business Journal
Provided CMS’ previous track record for implementation (remember NPI?), the 2013 compliance date may not spark much urgency for providers across-the-board. However, according to professionals, trust that CMS has their act together on this one. In short, for those who are not ready when the “switch” flips on October 1, 2013, the penalty will simply be: you won’t get paid. As a matter of fact, there is an even earlier deadline you need to consider – January 1, 2012. This is when practices’ must fully adopt HIPAA Transactions and Codes Sets version 5010. This conversion is required before you can switch to the new ICD-10 coding system. CMS has promised to be ready to test 5010 one full year before the compliance date. This is reason enough to believe the October 1, 2013 deadline will stand, and you should not believe rumors of enforcement delays. If you haven’t started already, you will want to aggressively begin making implementation plans today or begin looking for another job.
HCPCS 2011: Sneak Peek The Centers for Medicare and Medicaid Services (CMS) posted 2011 HCPCS II changes, which include 147 new codes and modifiers and more than 286 deleted codes. Changes also include the addition of pass-through codes, a large number of G procedure/professional service codes, and many injectable drugs. Overview Deleted Codes: Of the 286 deleted codes for 2011, the majority are in the G codes section (between G0430 and G8521). This includes procedures/professional services like the following: •Diabetic, heart failure and coronary artery disease services; •Osteoporosis and hearing assessment; •Urinary incontinence; •E-prescribing system codes; •Intraocular pressure; •ESRD
Don’t mistake the 5010 adoption for the full ICD-10 implementation. The move to ICD-10 is not merely a software upgrade. The new list of ICD-10 codes will be exponentially more detailed than the current ICD-9. With as much detail on the horizon, practices will have to think about whether superbills will remain practical for use. On the same note, don’t count on an ICD-9/ICD-10 crosswalk to save you from being unprepared either. The government has adopted a standard crosswalk – yes, but there is no guarantee that private health plans will follow. Furthermore, roughly 20% of the new codes are unable to be crosswalked!
C Codes: C9255 C9256 C9258-C9269 C9271
Here are some suggested starting points:
Additions: •Q codes Q4117-Q4121, to support healing of burns or ulcers •Q flu vaccination codes for patients 3 years and older •Skilled services codes (G0162-G0164) •G tobacco/smoking related codes •Risk-adjusted functional status change residual score G codes •G blood pressure codes
Get in touch with your vendors to determine software, hardware and other upgrades you will need for the conversion. How much will it cost under your contracts? Outline timelines for testing and other implementation steps. Contact your health plans to discuss testing and other steps they are taking on their end. Set a budget and arrange training for the appropriate personnel. Research has varied about how much ICD-10 implementation will cost. An MGMA study determined the average, three-physician practice can expect to spend somewhere around $80K-$85K on education, process analysis and other changes. ICD-10 professionals advise considering teaming up with local practices to coordinate on-site trainings to offset some of this cost. For ICD-10 questions or 5010 vendor recommendations, please contact ICD10@mmiclasses.com
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E Codes: E0220 E0230 E0238
There are many injection code addition and deletions in the code range J0558 – J0580 for penicillin G benzathine injection codes. There are also many skin protection wheelchair seat cushion K codes deleted, as well.
Description Changes: •Skin graft codes Q4101-Q4116 (pain assessment and acceptable EHR system G codes) have received changes to their long descriptions. •Wheelchair code, K0669, has been changed as well. These are only part of the changes in store for 2011. To view all HCPCS Level II code changes for the New Year, the Alphanumeric Index and Table of Drugs, go to: https://www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp
Medical Business Journal - MMIclasses.com - Issue 5, Volume 1 - December 2010