The deadline for transitioning to the ICD-10 code sets is October 1, 2014, yet recent surveys have found that many medical groups have not conducted impact assessments, implemented needed technology or started testing.
What do orthopedic medical groups need to do to prepare for this critical change?
1. View this as an opportunity to improve performance, not just a burdensome requirement.
The ICD-10 code sets represent a major step forward in terms of improving data collection and improving healthcare in the U.S., which is the only major country that is still using the 30-year-old ICD-9 codes. ICD-10’s more expansive system will also enable providers and payers to better track data to measure the quality and safety of care, process claims for reimbursement, and improve clinical, financial and administrative performance.
One of the consequences of the Affordable Care Act is that many health plans are looking to trim their provider network. They will be looking for medical practices that are meeting benchmarks for quality reports and timely claim submissions. A medical group that has failed to take advantage of the new coding system will be at a serious disadvantage.
While there will be significant implementation and training costs for the transition, in the long-term the new ICD-10 codes will enable medical groups to improve patient care and increase reimbursements.
The number of diagnosis codes will increase from 14,000 to 68,000 and the number of procedure codes from 4,000 to 87,000. This sounds overwhelming, however, approximately 25 percent of the IDC-10 CM codes are the same except for indicating the right or left side of the patient’s body. Another 25 percent differ only in the way they distinguish among “initial encounter,” “subsequent encounter” and “sequelae.” Note that ICD-10 CM codes are used for all healthcare settings, ICD-10-PCS codes are to be used for inpatient hospital settings only.
2. Understand the unique challenges facing orthopedic practices.
Orthopedics is a complex specialty so it is not surprising that the orthopedic section of ICD-10 codes is expanding more than any other section. An additional factor is that orthopedic treatment for many Medicare patients often includes the use of durable medical equipment, in addition to physician services. DME is billed differently than physician services; therefore, orthopedic offices and staff will need to submit ICD-10 codes for both Medicare Part A and Part B claims.
The AAOS online Practice Management Center (www.aaos.org/pracman) has a page of resources on the transition to ICD-10 (membership required).
