imageMastering the ICD-10 coding transition to optimize reimbursement for anesthesia services will take an effort, but it can pay off in terms of higher practice revenue, less paperwork and greater overall clinical efficiency, experts said.
Although full implementation of the new International Classification of Diseases (ICD) system is planned for October 2014, a lot needs to happen before then, according to the Centers for Medicare & Medicaid Services (CMS). The agency’s timeline stipulates that doctors and hospitals focus on the communications and high-level training requirements throughout the remainder of 2013 and start more comprehensive training in 2014.
In the meantime, anesthesiologists should take advantage of all training and educational opportunities regarding specific Procedure Coding System (ICD-10-PCS) documentation requirements in support of the hospital inpatient coding department and Clinical Modification (ICD-10-CM) changes for practice areas, said David A. Lubarsky, MD, chief medical and systems integration officer at the University of Miami.
The roots of the ICD system reach back to the late 19th century. The 10th revision covers more than 14,400 distinct codes, and the ICD-10-PCS, more than 76,000. Some of the new codes are excruciatingly specific, such as injuries sustained by a collision with a turtle or headaches associated with sexual activity.
More Than Just More
David A. Lubarsky, MD
Dr. Lubarsky is navigating the transition with the help of Susan Davis, lead project manager of ICD-10 implementation at the institution. Their tasks are many, but include educating physicians about how ICD-10 codes fundamentally differ from the current system. For example, new codes will be three to seven characters long to allow for more specificity than the ICD-9 codes, which had between three and five characters.
“Because ICD-10-CM codes are different than ICD-9-CM codes, and not just an expansion of that system, it is important for anesthesiologists to develop some familiarity with the new code set,” said Marc L. Leib, MD, chair of the American Society of Anesthesiologists (ASA) Committee on Economics. “It is also important to understand that proper selection of ICD-10 codes will require greater anatomical specificity and the purpose of the visit”—whether it be initial treatment, follow-up care or treatment of complications.
“Expertise will be especially important for anesthesiologists who bill for intensive care and pain along with related procedures. In contrast, Current Procedural Terminology codes for physician services are not expected to change,” said Dr. Lubarsky, who is also professor and chair of the Department of Anesthesiology, Perioperative Medicine and Pain Management.
Even if a hospital boasts a stellar billing department, the onus for ICD-10 coding completeness remains on the physician. “Coders simply won’t be able to ‘build’ ICD-10 codes without all of the building blocks of information being in the chart,” Dr. Lubarsky said. In the past, coders without complete information could default to a “not otherwise specified” (NOS) catchall code. Going forward, most NOS payments will be curtailed or denied outright.
Therefore, ensuring complete clinical and billing information up front will save time, Dr. Lubarsky said, and preempt queries to physicians for additional data. “This slowdown in coding will impact cash flow and potentially decrease physician productivity due to rework.”
Dr. Leib agreed. “Anesthesiologists should be prepared for potential disruptions to their cash flow, which may necessitate establishing a credit line prior to the switch-over date.” Best to prepare in advance, he said. “Waiting until the new code set is implemented to prepare for the transition may result in permanent loss of revenue if claims cannot be filed correctly within the payors’ timely filing limits.”
Double Challenge for Docs
Hospitals should already be preparing with new technology. For physicians in independent practices, however, the challenge is twofold: education and technology, Dr. Lubarsky said. The new coding format likely will necessitate an update to billing systems, for example.
Herein also lies an opportunity. “ICD-10 is an excellent reason to upgrade existing computer systems,” Dr. Lubarsky said. Switching from paper charge vouchers to computerized physician billing and installing computerized-assisted coding software for pain and intensive care practices are examples of beneficial upgrades. Software templates that include coding customized to each physician’s specialty can drive greater clinical efficiency and increase patient throughput.
The new coding also will mean more collaboration between anesthesiologists and other hospital staff. “Selecting the most appropriate ICD-10 code will likely require greater communications with surgeons or other physicians,” Dr. Leib said.
“It is our opinion that it is still a little early for anesthesiologists and their coders to prepare for ICD-10 in depth,” Dr. Leib said. “That said, it is not too early for anesthesiologists to prepare their office systems for the new ICD-10 codes. Because ICD-10 coding requires more information, anesthesiologists would benefit from beginning to document now as if their claims were being submitted with ICD-10 codes. By doing so, that will be second nature when such documentation is required after the transition.”
Several revenue impact studies have made the conversion to ICD-10 sound daunting, but the impact on specific practices will vary, said Tony Mira, CEO of Anesthesia Business Consultants, a practice management firm in Jackson, Mich.
“Adequate preparation and training is crucial to minimizing the financial impact. If you have yet to develop an implementation plan there is still time, but you must act now,” Mr. Mira said.
Every anesthesiologist should have their coding staff take a look at their current top 10 ICD-9-CM codes along with their current documentation, Mr. Mira said. “See if an ICD-10-CM trained coder can readily convert them to the new system based on their current documentation. If not, why? What are the critical pieces of information missing in the current documentation?”
For example, if a practice performs a lot of orthopedic cases, laterality is important; does the documentation clearly identify right or left limb? “If you need to expand or capture more information to identify a billable ICD-10-CM code, you want to start making those documentation changes now to minimize the potential revenue impact following the Oct. 1, 2014 effective date,” Mr. Mira said.
“If your vendor has not yet updated your software to accommodate the ICD-10 coding structure, you need to question them sooner rather than later regarding their plans to do so,” he continued.
Questions to ask about the upgrade include: Will the software be able to accommodate both ICD-9 and ICD-10 in all electronic transactions? If not, which ones won’t support ICD-10? What types of training are included in the maintenance plan, and which will carry an additional cost? And, are there any additional costs associated with obtaining necessary software updates?
CMS provides additional guidance for physicians regarding ICD-10 implementation at​Medicare/​Coding/​ICD10/​ProviderResources.html. Other sites offer free information online (e.g.,​anesthesia-cpt-codes-2013). Dr. Lubarsky also recommended subscription services that provide notification and educational content when codes change. The ASA plans ICD-10 educational presentations at the 2013 annual meeting in San Francisco next month. The ASA also will continue to post relevant updates on its website (