Preparing for ICD-10: Why Physicians Must Own This

Preparing for ICD-10: Why Physicians Must Own This

The implementation date for ICD-10 transitions is 10/1/2014.  For those of you who are ignoring the discussions because people have been talking about it for so long–and you think it will all magically come together–think again. The only way your transition is going to go smoothly, is if you are involved. For those of you who are feeling reminiscent of Y2K where the sky was falling but nothing happened, this is fundamentally different.  If there are glitches, you may have no cash flow, and your practice operations will grind to a halt.


As a former girl scout (yes, I know, hard to believe) here’s one time where the “Be Prepared” message is paramount. In order to be successful in moving to ICD-10 you need to:
  • have a basic understanding of the coding/billing process in your office
  • identify the key places where things could go wrong
  • select a physician champion in your office for implementing the pieces that are within the practice control
  • identify an administrative champion in your office to gather detailed knowledge of your claims processes and maintain up-to-date ICD readiness information with your clearinghouse and payers


Why must the physician own this? Because the ICD-10 codes are so specific, billers will not be able to guess/map many of these codes for you. Here’s a great example: otitis media.
In ICD-9 world, codes for acute suppurative otitis media include (note, this is not meant to be a complete list, but done for illustrative purposes)
  • 382.0x series (.00 acute suppurative OM w/o rupture, .01 acute suppurative OM with rupture, .02 acute suppurative OM in disease classified elsewhere
  • 382 .4 unspecified suppurative OM
  • 382.9 unspecified OM
In ICD-10 world H66.00: Acute suppurative otitis media without spontaneous rupture of ear drum is the overall classification for just 382.00 above
  • H66.001….right ear
  • H66.002….left ear
  • H66.003….bilateral
  • H66.004….recurrent, right ear
  • H66.005….recurrent, left ear
  • H66.006….recurrent, bilateral
  • H66.007….recurrent, unspecified ear
  • H66.009….unspecified ear
These are just 8 codes that apply to the single 382.00 ICD-9 above. There are an additional 8 codes that apply to the same group if there is a ruptured eardrum. There are similar sets for chronic OM, and nonspecified OM. If you are curious, here is a good place to view many of the OM codes:


The asthma ICD-10 code set separates out mild intermittent, mild persistent, moderate persistent, and severe persistent asthma, and each of these categories is further classified into uncomplicated, with acute exacerbation, or with status asthmaticus. Billers cannot make a medical diagnosis of whether or not the patient has mild or moderate persistent asthma. The person doing the medical diagnosis must make that call.


So where do I start? First, follow the diagnosis coding trail in your office. Who is the first person who enters the diagnosis code and how do they do it?  If physicians don’t own this currently, implement a strategy to make this change now. If they do, educate them to start thinking about how they will need to change the way they think. Follow the trail of the current ICD-9 codes and modifiers. Who is responsible? How will this be impacted?  


Know how your claims flow works. Identify potential problem areas. Learn as much as possible. Control the parts you can, and be prepared to troubleshoot the parts of claims processing that you can’t control, such as clearinghouses and payers.


Remember if claims get rejected, you don’t get paid. In addition, if you have P4P bonus programs, learn how they are getting mapped to ICD-10 and what is going to happen in the 2014 hybrid year where some of the codes you submit are ICD-9 and the last quarter will be ICD-10.


Finally, prepare for the worst. Make sure you have 3 months cash flow available just in case there are disruptions (some people say 6 months!)  Hopefully none of us will need it, but I am not holding my breath. Ask your bank now to establish a line of credit if you don’t already have one. Have a strategy to pay your staff if the claims processing is delayed. Do the partners temporarily put cash back in the practice? Do you consider not giving quarterly bonus payments until you see what happens?

No matter what you do, have a plan. Don’t get “caught by surprise” when you can be anticipating and planning for problems now.  Do you remember the year H1N1 hit in October?  All we need is an early flu season coupled with ICD-10 implementation and MU2 reporting to create the perfect storm.  Is your ship seaworthy?