ICD-10 for Pediatrics: The Right Partner Makes the Difference

ICD-10 for Pediatrics: The Right Partner Makes the Difference

Now that you have your ICD-10 practice transition plan under way, you should be having fewer nightmares about October 1, 2014. While change is hard–and this will be a big change–partnering with an EHR that understands the unique challenges of pediatrics makes this much easier. Let’s explore some of these ideas a little further.

Physicians think in words. While my biller might be able to tell you that acute pharyngitis corresponds to ICD-9 “462”, I don’t keep numbers in my head. I always get confused why some ICD-9 codes needed digits beyond the decimal to be compliant for billing (strep pharyngitis needs “034.0”), but others are okay without the decimal. Office Practicum has partnered with Health Language to give our users access to their trilingual search engine (ICD-9, ICD-10 and SNOMED). This will allow users to search in words…even if you’re a bad speller like me! OP limits the search results to only those codes which are allowed for billing purposes if you are on a form that will eventually get sent as a claim.

What about those unique ways pediatricians label conditions and diagnoses? To pediatricians, “OM” means “otitis media”, but to orthopods it often means “osteomyelitis”. “ROM” usually means “right otitis media” to us, but can be “rupture of membranes” to an OB/GYN. Office Practicum’s partnership with Health Language will allow us to bridge any gaps where pediatric colloquial abbreviations may be missing in the global data base.

Have you heard about those strange add-on codes and the 7th character which always has to be in the 7th spot and perhaps an “x” placed before it? Our partner Health Language displays the code with the x in the correct spot for you as you choose it. Let’s look at an example: you search (in words) for right wrist injury and get “S69.81xA”. Now this happened on a playground, so if a payer wants additional information, you type in “playground” and Health Language will give you an appropriate list of choices, including “W09.0xxA” which is “fall on or from playground slide, initial encounter.”Luckily many of these extensive codes only apply to 2 chapters in the ICD-10 manual: Chapter 19 (Injury, poisoning and certain other consequences of external causes) and Chapter 15 (Pregnancy, childbirth and the puerperium). While pediatricians certainly deal with injuries and we will have to support these new code additions for a few of our visits, I would not want to be an orthopedic surgeon learning to code in ICD-10.

Well visits and vaccines are an integral part of what we do in pediatrics. OP gets that. If you haven’t already been made aware, the ICD-9 code for a child well visit (V20.2) can be mapped to two possible codes in ICD-10:

  • Z00.129 Encounter for routine well visit without abnormal findings
  • Z00.121 Encounter for routine well visit with abnormal findings
OP users will enjoy the default to “Z00.129” with easy ability to switch to “Z00.121” for visits in which an abnormality is identified. Vaccines and admin codes will be remapped for you.

While CMS says October 1, 2014 is the drop dead date for the ICD-10 changeover, they can say that because they have control over Medicare. Pediatricians deal with state Medicaid systems where budgets run out of money and nothing ever quite gets done when projected or without additional hiccups. Additionally, some of our patients have private insurance as their primary coverage, but Medicaid as a secondary coverage. This has the potential to create a huge mess. No problem, OP has you covered. Users will have the ability to decide at the payer level who is ready to receive claims as ICD-10 and who is hanging on to ICD-9. If that primary payer wants ICD-10 and your secondary Medicaid payer requires that you reprocess your claim as ICD-9, OP will make this possible. OP will store both codes “under the hood” to be used as needed by any given payer.

And let’s not forget about quality and Meaningful Use reports! For the first 9 months of 2014, most data will be collected using ICD-9.The last quarter, our data for visits will use ICD-10. Somewhere over the course of the year, problem list items will be migrated to SNOMED. No need to worry. All of the Quality Metrics in the Office Practicum QIC calculator support all three coding systems!

Finding people who understand you is key to success in many arenas. Having an EHR that understands pediatrics during the ICD-10 conversion…priceless!