Founder Letter: ICD-What?

By now, it’s obvious that the entire US healthcare system is going to face a huge change come October 1: the transition to ICD-10. This new—well, new to us—way of coding has been on the discussion table for decades, and for the last several years, its implementation has been the topic of much anticipation as well as a fair amount of resistance. So, if you find yourself in the dark—completely unaware that ICD-10 is happening—then frankly, there really are no excuses for your ignorance or your lack of preparedness. As rehab therapists, we are just as capable of educating ourselves on—and preparing our practices for—the transition to ICD-10 as any other healthcare professional. So, why aren’t we prepared? Sure, there aren’t as many educational resources available to us, specifically, as there are for other, larger groups of practitioners. And yes, you’re very busy treating patients—and that’s the way it should be. But none of these reasons give you a one-way ticket to sticking your head in the sand and continuing to ignore the impending ICD-10 adoption.

Now, I don’t say all of this to put our profession down; I say it out of care and honest concern for our industry. Based on the questions and feedback we received from the 8,000-plus registrants of the ICD-10 webinar we held this past Monday, the rehab industry still has a ways to go in terms of ICD-10 preparation. Don’t get me wrong; I don’t believe we’re the only industry with stragglers who aren’t quite ready to tackle this tough change. And I do think we’ve had some huge barriers to streamlining our prep work: for example, Medicare—at its best—has provided vague information around PT-specific ICD-10 issues, and there’s no guarantee that commercial payers will hold up their end of the bargain when the transition trigger is pulled. So, I understand your anxiety. But, it’s time to face the music. You might not have control over the entire switch process, but you do have control over your own preparedness. And you absolutely need to be ready—better late than never.

To do that, you need to devote time to wrapping your head around this new way of coding. With more than 68,000 codes (compared to about 13,000 in ICD-9), it’s inevitable that you’ll have to adjust your habits and workflows. The days of accepting a referring physician's diagnosis as gospel are over. Furthermore, because ICD-10 is so specific, you’ll need to start thinking about how you can code for all the details you, as a musculoskeletal expert, already pinpoint—and, hopefully, document. Chances are good that you already have everything you need to code for ICD-10 right there in your assessments; it’s just a matter of transferring your depth of knowledge and understanding of a patient’s condition into a list of corresponding codes. Here’s how I suggest you use your time:

Read

If you haven’t already, now’s the time to crack a book (or pull up some educational websites) and do some serious reading. You’ll want to absorb as much information as possible prior to the transition. That way, you can take all that great insight into consideration as you develop your ICD-10 coding strategies, procedures, and workflows. One thing to keep in mind is that you should pay close attention to the mindset you need to adopt in order to code accurately and specifically. For more information on that, check out this blog post on coding for medical necessity.

Evaluate

To make the transition easier, you’ll want to evaluate your processes, clean up your claims, get all of your notes finalized, and ensure you get all caught up with sending claims out before October 1. The less back-and-forth you have to do with payers over ICD-9 code denials, the better. In addition to helping you avoid time-consuming claim resolutions come October, evaluating your claims will help you nail down your most frequently billed codes. If you can create a list of these codes, and then find their closest ICD-10 equivalents—bearing in mind that there is almost never a one-to-one ICD-10 match for a particular ICD-9 code—then you’ll have a better idea of the coding-workflow demands that you’re likely to face early on in the transition. Plus, you’ll get a feel for the basic process you’ll use to drill down to the most specific code option for a particular condition. And with ICD-10, the more adept you are with dialing into specificity, the easier it will be to code come October 1. For more information on selecting the right ICD-10 codes, check out this resource.

Save

Save yourself the headache of overcomplicating this transition. There is a lot to consider, but most of it—realistically—shouldn’t be too hard to implement. For example, laterality is already something you document, but now there’s a code that accurately expresses it. In addition to resisting over-complication, you should try to save some cash. I’ve said it before, and I’ll say it again: if there are problems with this transition, and your cash flow suddenly stops dead in its tracks, you won’t want to be without an extra line of credit or some money in the bank to make it through. To minimize the impact of payment complications, experts recommend having enough cash on hand to cover three months of expenses.

Communicate

Finally, if you learn the ins and outs of ICD-10, but you don’t share your knowledge with your staff, then you aren’t doing yourself any favors. It’s not smart to assume others in your clinic are prepared, because you’re only as strong as your weakest link. And if you have a multi-site company, make sure that all of your clinics are on the same page with regard to your practice’s ICD-10 transition plan. Whether or not you’re a leader in your clinic, it’s crucial that you start a conversation about the impending change. You must start practicing now; that way, everyone’s stress levels will be much lower come October 1, because you won’t be hit with as many unexpected scenarios.

I know what you’re thinking: “This is all great, but where in the heck do I even begin?” If it were up to me, and you were my staff, I’d have you start with the WebPT Blog. On this site, you can get a solid foundation in ICD-10 basics with recorded webinars, interactive quizzes, and downloadable guides. Here on the WebPT Blog, we’re constantly posting new ICD-10 resources. Plus, we have an entire archive of ICD-10 learning materials, including the recorded version of our highly-attended ICD-10 bootcamp webinar, which covers coding examples for PTs, OTs, and SLPs.

Looking for some hard-copy learning materials? We recommend purchasing a therapy-specific ICD-10 code book to supplement the tools available within your clinic’s software. Furthermore, compliance expert Rick Gawenda of Gawenda Seminars offers tons of in-depth, specialty-specific ICD-10 resources and consultative services.

Finally: take a deep breath. Now, let it out. Remember, ICD-10 is not the end of the world. We will get through this. Just be sure to take Henry Ford’s advice to heart: “Hope is not a strategy.” Every little bit of education and preparatory effort goes a long way, and I am confident that by October 1, we’ll be equipped to tackle this transition head on.

Want to specifically know how ICD-10 coding works within WebPT? Register for our September ICD-10 webinar, where we’ll not only walk through the most important to-dos leading up to ICD-Day, but also show you all the ways our intuitive ICD-10 tool can help you check those items off your list.