ICD-10 Where is it? When is it?

Did you know that we are the only country on the planet that has not converted to the ICD-10 system? ICD-10 has been trying to make its debut in the U.S. for more than ten years now. Currently, the implementation date is set for October 1, 2009.

ICD-10 has over 200,000 diagnosis and procedure codes; ICD-9 has a little over 16,000. ICD-10 codes are all alpha-numeric codes while ICD-9 codes are numerical codes with the exception of V-codes and E-codes. ICD-10 will allow us to code to a much higher specificity and after all, that is the name of the game when it comes to coding our patient's diagnoses for their insurance claims.

Why the big delay in rolling out ICD-10 in the U.S.? This is mainly because providers and payers will need to completely redesign their business processes and systems to be able to handle this massive coding system. Although other countries have switched to ICD-10, no other country uses a version as complex and the U.S. version.

There is a coalition of physicians, labs, and other providers and insurers that are urging Congress to push back the date. This group is urging for an implementation date of 2012 and here is why:

The industry is hoping to begin the implementation date in 2009 after providers and payers have implemented version 5010 and Medicare contracting changes are finished. The providers and payers would then need three years to implement ICD-10 making the full implementation date 2012. It will be interesting to see what happens!

Close "E"ncounters of the Third Kind

Welcome to the land of the unknown…the land where few men have ever traveled…that is, until they came to a PMI coding class. Yes folks, I am talking about the infamous E codes. They can be found in the index in the back of your ICD-9, Vol. II, Section 3, that describes external causes of injury and poisoning. Now let's take a few minutes to get up close and personal with these foreign bodies.

Correct coding requires you to report added information so that you can code an encounter to the highest level of specificity as possible. These codes also support the work-related nature of certain injuries to differentiate worker's compensation care from non-worker's comp care. E codes should be used to describe the accident, circumstance, event, or specific agent which caused the injury or other adverse effect. That is, it will paint the full picture of what made your patient arrive at your doorstep. The Category I Code (CPT code) will describe what you did for your patient.

E codes do not change your payment amount because they are used for stats for informational purposes. These codes will never, ever, as long as you're alive, be a primary diagnosis! It says so in the directions in the index (make sure you turn to this index in your ICD-9 book and read through it before you embark on these codes). Ok, I know that few of you will read the entire thing, but I would like you to take note of the last sentence in the first paragraph: "…it is intended that the E code shall be used in addition to a code from the main body of the classification, Chapters 1 to 17." See I told you so.

Now, I don't know about you but I find E codes fascinating. It's amazing to me how many ways can a person injure themselves. They can have injury caused by: animal (ridden or not), bending (that's it, no aerobics for me – I can hurt myself), bite (human or animal, if you ask me they are sometimes one in the same), earthquake, fire, hurricane, rough landing (like my last job), sound waves (and consumers buy those sound machines to make them sleep - now we know), twisting (the twist is an outdated dance anyway, but now I know why I hurt the next day), in or on and don't forget stated as (that means I've got to rely on you-know-who for this bit of information to be documented in the patient's chart).

When you get your new ICD-9 book, you should always go immediately to the "Summary of Code Changes" to see what's new with all the codes. I have always taken special pleasure in reviewing the E codes. Now I have disappointed in the last two years that there haven't been any new E codes (I know – I need a life) but hey, here's to hoping and praying. Stay tuned for your new ICD-9 books for 2008 as early as August of this year. And don't forget that new codes should be implemented in October.

Making the Most of the Medicare: Incident-to billing rules

Upon an initial reading, the incident-to rules seem very straightforward. Specifically, to be covered on an incident-to basis, the services and supplies must be:

1. An integral, although incidental, part of the physician's professional service;
2. Commonly rendered without charge or included in the physician's bill;
3. Of a type that are commonly furnished in physician offices or clinics; and
4. Furnished by the physician or by auxiliary personnel under the physician's direct supervision.

However, in application the rules are full of potential pitfalls for the unwary provider. Incident-to services must be integral though incidental to the physician's or practitioner's services. This has been interpreted by the Centers for Medicare and Medicaid Services (CMS) to require that there be a physician's or practitioner's service rendered to which the auxiliary personnel services are incidental. However, according to CMS, this does not mean that the physician's or practitioner's services must precede every single incident-to service. Rather, there must have been a physician's or practitioner's service, which initiates the course of treatment during which incident-to services will be rendered. So, a new patient visit could never be performed on an incident-to basis. However, follow-up visits after the new patient visit has been conducted could be performed on an incident-to basis. This article is provided courtesy of BC Advantage magazine. To read the entire article, click on the following link.

http://www.billing-coding.com/advantage/index_detail_article_email.cfm?articleid=1420

Top 10 Reasons to Attend PMI's National Conference for Medical Office Professionals June 21 and 22 in San Antonio

Visit PMI's conference link for more information, or call 800-259-5562.

Certification testing will be available on Saturday, April 23. Sit for the CMC, CMIS, or CMOM exams, or choose from 15 specialty coding exams offered by the Board of Medical Specialty Coding. For exam information, contact PMI at 800-259-5562.

Coming in November:
Medical Practice Management Summit 2007
Las Vegas, November 12 - 14, 2007

Tips on Selecting a Reputable Billing Company

Recently, I had the privilege of speaking at a conference for medical billers in southern Florida. Over the course of two days, I spoke on topics ranging from compliance and leadership skills, to increasing collections while reducing denials.

I really think that this group was one of the most attentive, interactive and pleasant crowds I have ever lectured to. Their interests were genuine and their desire for doing things, the right way for their clients was very evident. I was, however, surprised to find that roughly 40-45% of the attendees at this conference were either brand new to the industry or have worked in their current capacity for less than 2 years. This caused me some concern because their inexperience can potentially cost physicians money if the billing services do not know how to code or verify what the doctors offices are providing them as information to bill to the insurance companies. Or they might try collecting for services or levels of services they are not entitled to causing doctors to have to make refunds.

Now, please understand I am not saying all billing companies are this way or even that the majority of them are this way because for me to say that, I would be a fool. There are many experienced and reputable companies out there that work hard to provide a valuable service for their clients.

In the interest of helping physicians find the right fit, I have compiled a list of suggestions for anyone considering outsourcing their billing.

1. Check to see if the company has been reported to the better business bureau.
2. Check to see if any of the officers or employees of the company are listed on the excluded or sanctioned provider lists.
3. Request references from other companies they bill for in the same specialty as yours.
4. Ask lots of questions about what software they are using, ask for sample reports they provide and how often they will be onsite at your office providing you with feedback on how your collection efforts are going.
5. Ask them to explain their appeals process to you and how it matches up to what the carriers use as an appeals process.
6. Do they provide as part of their service annual updates to your encounter forms?
7. Can they negotiate your fee schedule with insurance carriers?
8. Do they have certified coders on staff and if so who are they certified by (PMI, AAPC, or AHIMA)?
9. Have they adopted a third-party billing company compliance program and can they develop one for your group if you do not currently have one?
10. What and how are their fees structured and then compare this to other companies. The most expensive companies are not always the best and going with the cheapest may put you in a position that is not very comfortable.
11. Does the company carry Errors and Omissions Insurance? How much?
12. Are they bonded and insured? How much?

The bottom line here is to make sure to do your homework when choosing a billing company to ensure that you are not taken for a ride. There are great companies led by caring individuals who are happy, willing and able to assist you with your practice needs. Kathy Young, a billing company consultant out of Phoenix, Arizona, was a tremendous reference to me for this article. Also, I had the pleasure of spending time with Ken Engle, a billing company consultant and an educator for billing companies all across the country. Folks like these are the reason the industry has a bright future.

Sean M. Weiss is a Senior Partner and Principal with PMI Professional Resources/The CMC Group; a full-scale medical consultancy, education, products, and legal firm with offices in Atlanta, GA and San Antonio, TX. To contact Sean directly you can email him at sean.weiss@thecmcgroup.net.