In Alabama, if a practice hits an issue, Olson recommends contacting the provider desk at Cahaba Government Benefit Administrators (Cahaba GBA). They administer all Medicare Part A and Part B claims in Alabama, Georgia, and Tennessee. “It’s a resource where you actually talk to a person,” she says. “They even assign someone to you, no matter what stage you’re in.”
Medicare also recently announced a process for providers to continue receiving their reimbursements should they hit ongoing coding problems. “If you’re having a lot of denials with Medicare because of ICD-10, Medicare will work with you,” Olson says. “You are not going to get cut off from income.”
But she cautions that though errors will be tolerated, Medicare will require the codes to at least be in the right group. “If you don’t put that it’s a left leg on there, you’ll only get a caution,” she says. “But good coding is always about what is documented, so code to the highest level of specificity your documentation allows.”
To make matters more confusing during this switch, not all situations fall clearly on the October 1 transition date. For hospitals, the date of discharge determines when to start using ICD-10. Someone admitted in September but discharged in October, will need their entire stay coded in ICD-10.
With workers’ compensation claims, the use of ICD-10 becomes even more nebulous. “Double check with the payer, because workers’ comp does not fall under HIPAA, so they’re not obligated to use ICD-10,” Olson says. “Some are and some aren’t.”
Most healthcare institutions by now have developed some sort of transition tool, either manual or digital, to bypass the onerous task of finding a code in the 21-chapter ICD-10 book. But even superbills — a list of a provider’s most commonly used codes — will likely swell from one page with ICD-9 to four or five pages with ICD-10. “And more like 10 to 12 pages for specialists,” says Carrie Gulledge, RHIA, with MediSYS.
Even an electronic superbill, which would allow keyword searches to help speed up the hunt for a code, is “the bottom of the barrel in the EHR [electronic health record] world,” Gulledge says. A far more efficient tool for those with EHRs is Intelligent Medical Objects (IMO), a software that embeds right into EHRs.
“It’s in essence a wizard that helps a provider select the most applicable code for ICD-10,” she says. The third-party tool also shows details about the code, such as inclusions and exclusions, along with additional codes that commonly bill alongside that ICD-10 code. “It gives the provider a deeper level of incite without having a full blown 10 coder at their disposal,” Gulledge says.
IMO users can search by diagnosis or acronym, such as DM for diabetes mellitus. Even partial keywords, such as “abd pain” for abdominal pain, are enough to start the wizard toward finding the ICD-10 code. “It asks you questions until you’re driven to the correct code,” Gulledge says. “And that’s a huge, huge time saver. If you were trying to do that with a code book or even an electronic superbill, it would take you so much longer.”
Not all EHRs have this third-party functionality added to their system. Or providers have found their EHR vendors want to charge upgrade fees or monthly subscription rates for the IMO option or something similar. “But those people don’t have to be left high and dry,” Gulledge says. Some electronic apps exist that run without EHRs.
Basically these options, like White Plus, are a customized electronic superbill offered online. They save practices from creating their own superbills and could save them unsustainable fees offered by their EHR vendor.
“Providers have been focused on what they have to do for meaningful use with its incentives and penalties programs and have probably assumed their EHR vendor would take care of ICD-10 for them,” Gulledge says. “But that’s not always the case.”
Without some sort of tool to help with selecting codes in the new ICD-10, “you not only introduce another level of frustration to the practice, you effectively slow down the revenue coming back into your office,” Gulledge says.
“Keep calm,” Olson says. “We all know there’s going to be issues.” She says if providers get bogged down or overwhelmed, even with electronic tools, they can find a solution. “You may want to outsource it, even for a while. Or get a professional to come in and help you,” she says. “It’s just a code.”