October 1—the day that marked the transition to ICD-10—is behind us; we made it. And so far, so good. According to this Modern Healthcare article: “One of the most maligned and feared events in healthcare history began with a whimper.” Although ICD-Day has come and gone, it’s prudent to remember that a “whimper” of an introduction doesn’t necessarily indicate what’s to come. That’s because many of ICD-10’s repercussions have yet to reveal themselves—especially when it comes to lost productivity and payments. So, what should providers expect moving forward? Life post-transition might not closely resemble life in a fictional dystopian society. However, our world is bound to look a little different in the weeks—and years—to come.

The Steps

Those providers who took steps to properly prepare their practices for the switch did themselves a huge favor—which undoubtedly contributed to the quiet transition in a huge way. However, we’ve yet to see if payers have done the same. With 30, 60, or even 90-day billing cycles, claim denials remain a very real threat. This holds true for both commercial and non-commercial payers. According to this CMS article, “Even after submission, Medicare claims take several days to be processed, and Medicare—by law—must wait two weeks before issuing payment.” That means we won’t be able to assess the fallout for at least a few weeks. CMS is taking this into account and has announced that they’re:

  • following the transition in real time;
  • monitoring their own systems; and
  • reacting to any issues that come into the ICD-10 Coordination Center.

But even though we’re still in the early stages, the WebPT Billing Service already has positive news: Anthem Blue Cross has confirmed payment of October 1 claims containing ICD-10 codes. And I believe we’ll continue to see more payments roll in as other payers start processing claims.

The Sights

With the preparation phase in the rearview mirror, where should providers set their sights? To move forward, we can’t disregard the intended purpose of this transition. In this Health IT Analytics article, Thomas Gordon explains that “‘ICD-10 will enhance the value of information for population and public health and research. Ultimately, this will lead to improved patient care and better health outcomes at reduced cost.’” We also can’t forget where we’re headed. Even in the early stages, we’ve noticed many providers are still making some decisions that might end up biting them in the you-know-what. To avoid these potentially costly mistakes, be sure to:

  • Check the date of service on the claim. All dates of service from October 1 and beyond should contain ICD-10 codes. It’s easy to overlook this crucial detail, and doing so will almost certainly delay payment.
  • Avoid using unspecified codes as your primary diagnoses. If a more specific code is available—and applicable—then use it first. Why? Because the whole point of ICD-10 is allowing providers to express patient diagnoses in the clearest, most accurate, most detailed way possible.
  • To determine the best diagnosis coding option, start by asking the patient a few key questions about his or her condition during your subjective exam:
    • Who?
    • What?
    • Where?
    • When?
    • Why?

And remember, the more detailed your supporting documentation, the better. For more information about coding for specificity and how these questions will help you land on the correct code, check out this blog post.

The Score

Healthcare providers: 1. ICD-10: 0? For now, it appears that the transition hasn’t taken providers completely out of the game. That said, it’s imperative that we stay on our toes, continue to diagnose accurately, and focus on coding to the highest level of specificity. Coding and documentation complacency just won’t cut it in an ICD-10 world. Plus, as this Examiner article explains, “…the ICD-9 coding system was never intended to be used for documentation of diagnoses in a patient’s medical record. It was a statistical system for public health that was adopted by insurance companies for payment purposes.” It’s finally time to move forward.

As we reflect on the past week and anticipate the ones to come, we need to be prepared to adjust our processes as needed. Because if there’s one thing that dystopian societies and ICD-10 have in common, it’s this: nothing is perfect.