How this linkage is done will vary greatly depending on how the individual practice is set up.
“Our practice is looking at our major diagnoses and grouping them on a new Superbill so it will be easier for the physicians,” says Brazeale. “We don’t want the doctors to have to sort through a thousand different codes to get the ones they need.”
They are also planning to do a lot of training for physicians and billing staff, since the ICD-10 codes will require a much higher level of detail. No longer will you be able to just code 714.0 for rheumatoid arthritis (RA). After the 2013 date, you will have to code for RA, for example, in a specific joint, in a specific foot, on a specific side of the body. In addition, the physician’s documentation will have to reflect that amount of detail.
There is no silver bullet that will get a practice through the implementation of ICD-10.
Computer Systems
Other practices will have to take a close look at their computer systems and how they are structured.
“We will go through our charting templates to make sure that the appropriate check boxes are present and that they link to the right codes for billing,” says Byrnes. “I will need to incorporate all of the nuances of ICD-10 into my templates. Then we have to make sure that what is checked by the providers has the proper codes behind them to successfully populate the bills.”
All of this fine-tuning of computer programs and systems should be done carefully to avoid disruptions. Byrnes noted that, during testing for the Version 5010 changeover, the new program broke her profile and she could not get automatic deposits from Medicare for a period of time. Because of this, she suggests that all testing be done on a virtual server so that any conflicts can be worked out without crashing mission-critical computers.
Uncertainty a Big Concern
Currently, the biggest problems with the coding change are the uncertainties as to how implementation will be handled. One issue is that the codes have not been frozen, so none of the work of getting Superbills redone or EMRs programmed can begin.
Rheumatology practices can stay abreast of the latest updates through the ACR practice management department. According to Chung, there will a partial freeze of the ICD-9-CM and ICD-10-CM codes prior to the implementation of ICD-10. The last regular, annual update to both ICD-9-CM and ICD-10 code sets will be made on October 1, 2011. This is likely when work on Superbills and programming can begin.
