Embrace the Change! How to Survive the End of ICD-10 Grace Period

October 1 – Normally, people associate the beginning of the month with a change in the seasons, warm drinks, Halloween... you know, the usual fall-related stuff we all look forward to. While this date was likely highlighted among healthcare providers around the country, it wasn’t exactly for apple picking and trick-or-treating. In fact, many medical organizations probably wished they could somehow postpone flipping their calendars over to October, because it marked the end of the ICD-10 grace period. In other words, the flexibility on not having to be code-specific in ICD-10 has come and gone. Not only that, there are 1,974 code additions, 311 deletions, and 425 revisions. With the looming finalization of MIPS (Merit Based Incentive Payment Systems) later this fall, and the move ever closer to value-based payment systems, the question everyone is asking is this: How do we embrace the change and acclimate ourselves to the end of this grace period?

What is the ICD-10 Code For?

First, a quick refresher on what the ICD-10 code is for. ICD-10 is the tenth version of the International Statistical Classification of Diseases and Related Health (ICD) used in classifying diagnoses and procedures used in healthcare. While ICD-9 contained roughly 18,000 procedure and diagnoses codes, ICD-10 contains closer to 140,000.There are a couple things you can do as a medical organization to navigate this rocky road. Let’s talk about 5 tips that will help you through the transition and avoid those pesky denials.

Tip 1: Code with maximum specificity – It’s a given, but I’m going to say it anyway. If there’s one thing we’ve learned over the past year, it’s that detailing your clinical documentation is absolutely essential – both for your organization and the well-being of your patients. That’s something worth remembering, your documentation is worth far more than reimbursement purposes. You’re also taking patient care and risk management into consideration.

Tip 2: Isolate frequency of unspecific code assignment – If you’re not already coding to the highest level of specificity, it’s important to identify – as soon as possible, might I add – your current frequency of unspecific code assignment. For smaller practices, review your code assignments immediately with the provider if possible. Work together to identify kinks that will allow for more accurate coding. For larger organizations, especially those with multiple practices and specialties, make sure you have a plan in place to review each individual practice and their corresponding providers. Making sure that both parties are knowledgeable is key to more accurate and specific code assignment.

Tip 3: Review code selections in your Billing Service or EHR and update if necessary – After you’ve identified frequency of unspecific code assignment, and action has taken place to educate all parties involved in the documentation process, make sure that your EHR or Billing Service has provided you with any and all code updates and revisions that look place on October 1. Doing so will ensure that your codes are up to specificity and will pass through clearinghouse edits, because that’s definitely an extra step that no one wants to deal with!

“At the end of September, ImagineSoftware clients were notified by Client Support of the ICD-10 code release and were distributed, upon request of each individual client (so there were no surprises), their ICD-10 update package which automatically updated the software with the newest code additions and revisions upon deployment,” says Tyler Baker, Client Success Officer at ImagineSoftware. “This way, clients were prepared before the end of the grace period actually took effect.”

Tip 4: Focus on the most relevant codes – What changes are specific to the conditions you treat? Physicians, billers, and the like should all become familiar with the new, existing and updated expanded code sets for their particular specialty.

Tip 5: Teamwork, teamwork, teamwork! – To expand a little on Tip 4, ensuring that the most relevant codes are documented as specifically as possible – particularly for specialties like radiology that involve ordering physicians, radiologists and coders in the coding process – will not be accomplished without all parties agreeing to obtain as much specific clinical documentation as possible. At the end of the day, it’s important to remember that we’re making moves to value-based payment systems, so specificity will affect payment. Again, I’ll use the radiologist example. The more specific a patient’s diagnosis by the ordering physician, the more data a radiologist can document so that coders can choose the appropriate codes. Be sure to educate all parties on how the organization will be impacted by this process. You’re probably thinking, “This is an awful lot of specificity and codes, how will we manage it all?” but when everyone works together diligently, reports are better, claim denials reduce, and both reimbursement and patient care improve.

ICD-10 flexibility is over. In an industry moving ever closer to value-based care, there’s no room for cutting corners. Tell your patient’s story well, your organization will thank you later.

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