With the ICD-10 overhaul looming, there are several things ophthalmologists need to learn to optimize the implantation.
Listen to Michael X. Repka, MD, MBA, discuss factors that ophthalmologists needs to know about ICD-10 implementation during the annual Current Concepts in Ophthalmology meeting at the Wilmer Eye Institute/Johns Hopkins University.
With the ICD-10 overhaul looming, there are several things ophthalmologists need to learn to optimize the implementation.
By Liz Meszaros; Reviewed by Michael X. Repka, MD, MBA
Baltimore, MD-A few shifts in classification and a few more extra digits will be needed for successful coding under International Classification of Disease (ICD)-10, and ophthalmologists need to familiarize themselves with these before its implementation becomes mandatory, said Michael X. Repka, MD, MBA.
The ICD-10 related implementation date is Oct. 1, 2015. Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims.
“For the implementation, it is quite clear to those of us using electronic health records (HER) that for those 50% of ophthalmic practices that are implemented, it’s going to be fairly pain-free and probably fairly invisible,” said Dr. Repka, medical director for governmental affairs for the American Academy of Ophthalmology. “Practices do not need, however, to have EHR to report ICD-10. Coders can be used to code just the way they did in ICD-9.”
Many similarities exist between ICD-10 and ICD-9 coding, Dr. Repka continued:
· Both require coding to the highest degree of accuracy and completeness.
· If there is another digit available, use it. In ICD-9, coding was to the 5th digit. In ICD-10, explained Dr. Repka, this will become coding out to the 6th or 7th digit in ICD-10 in many cases.
· The best code to report is still the actual disease. Without a confirmed diagnosis, the next best reporting code is a sign or symptom.
· The least appropriate code is ‘other.’ “The reason we avoid ‘other’ is because it does not always lead to prompt payment. It sometimes is even excluded by a payor from coverage,” Dr. Repka explained.
· Sometimes the least appropriate code is ‘unspecified.’ A few payors ignore unspecified codes, he warned, adding “Only use ‘unspecified’ when there is not a more definitive code.”
· Do not code ‘probable,’ ‘suspected,’ ‘questionable,’ or rule out conditions until they are confirmed.
· Do not code conditions that no longer exist.
· Code a follow-up visit for a resolved condition. In ICD-10, there is a new character that never existed in ICD-9 that allows for coding such a condition: subsequent visit.
Dr. Repka offered ophthalmologists six guidelines for the use of ICD-10:
1. Look up the main term in the Alphabetical Index. He warned, however, it may be frustrating determining the main term because all synonyms are included. To help with this, he suggested reviewing the sub-term entries and following any cross-references.
2. Do not code from the Alphabetical Index but locate that listing in the Tabular List. For example, ‘Abscess’:
• Eyelid H00.03-
• Remember: The “–” indicates there are additional reporting options that need to be completed.
3. Observe all cross-reference notations.
4. Add the appropriate final character, when indicated, for example:
• A – initial encounter
• D – subsequent encounter
• S – sequela (Condition resulting from a disease, injury, or other trauma)
5. Add the appropriate final seventh character, when indicated, for glaucoma staging:
• 0 – stage unspecified
• 1 – mild stage
• 2 – moderate stage
• 3 – severe stage
• 4 – indeterminate stage
“In conclusion, you should buy a manual,” Dr. Repka said. “It’s a good thing to do, particularly if the doctor is selecting the codes, and certainly if the staff are selecting codes.
“Take a class. It is possible to learn. Attend a Webinar. Or hire a coder, which is an expensive option. Use an EHR. In most cases this will make it fairly painless. Follow the media to be up to date on implementation,” he concluded.
Michael X. Repka, MD