Viewpoint

Woe unto us — ICD-10 is coming

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

The way I figure it, no one is happy about ICD-10. I’ll start explaining why with people like me. We’ve been preparing — and waiting — for CMS to put this colossal collection of codes into operation. My people know this thing inside and out, sort of, but they’ve been waiting for nearly three years — with two postponed start-up dates — to put what they know into use. Should they forget what they know? Keep reading updates? It’s exasperating.

As for the procrastinators, if CMS is really going to make ICD-10 operational on Oct. 1 (there is but one measly bill in Congress to stop it, and even the AMA thinks it’s going to happen) then these people are probably miserable, because they need to make preparations.

Sanity check

With all due respect, you’re nuts if you don’t prepare this time.

Why? Because if you’ve ignored PQRS, EHR and every other other stick and carrot out there, you’ve received less money, but you still got paid. Ignore ICD-10, and you don’t get paid, period. You are out of business by year’s end.

I keep running into ophthalmologists who ask me, “You think we really need to start preparing for that new ICD coding thing?” Yes, start now! It’s not too late. You crammed for tests in medical school. Cram for this and you can be ready.

ICD-10 isn’t as bad as some people insinuate. Yes, there are four times more codes than ICD-9. But many of them concern specifying the right eye, left eye or both eyes.

On the other hand, ICD-10 will prove worse for those who do not have their coding act together. If your practice has not bothered to document correctly, then ICD-10 will be a rude awakening. Even if you have a professional coder in your office, you still have to understand the basics of this system to document to a level that can be coded.

A CMS slide

Late-breaking break: In early July, CMS announced a series of transition changes. There are several, but the big one is this: For the first year that ICD-10 is operational, Medicare will not deny claims solely based on the specificity of diagnosis codes as long as you use the appropriate family in ICD-10. So if your patient has a cortical cataract in the right eye only, H25.011, and you inadvertently code H25.23, Morgagnian cataract in both eyes, you’ll be okay, because it’s all in the H25 age-related cataract family.

But you need to learn the system and code it accurately the first time. It’ll save you a lot of hassle when the patient returns next year for a follow-up exam.

You don’t need to be happy about ICD-10, love it or even respect it. Just learn it so you can get paid. If you run into trouble, call one of us early learners. We need to show off to somebody. OM