APMA News - February 2012 - (Page 26)

Reimbursement Why, Oh, Why ICD-10? APMA received a question recently that echoes what we’re hearing from many other podiatrists about ICD-10: “Without trying to be too sarcastic, where’s the ‘medical necessity’ for switching to ICD-10? It seems pretty complex to me, as well as a big waste of time and money. Between CMS incentives, CMS disincentives, paying for and incorporating an EMR into my practice, and dealing with ﬂat or dropping fee schedules, we now have to gear our ofﬁces to switch our diagnostic coding to a completely different system. My question is, why? Why ICD-10 when ICD-9 was working so well? How in the world did all the medical associations and societies allow this to happen?” Those are fair questions that we might as well address now, rather than in October 2013, when you will be required to implement ICD-10. learning ICD-10 guidelines, appreciating and learning a different coding set, and familiarizing yourself with ICD-10 by “forward mapping” (crosswalking) some of your most frequently used ICD-9 codes to the highest level ICD-10 equivalent. The APMA Coding Resource Center (CRC, available by subscription at www. apmacodingrc.org) will have a “forward mapping” section of the most frequently used ICD-9 codes and their ICD-10 “equivalents.” ICD-10 is all about coding accurately to the highest level of coding specificity (a higher level than ICD-9) and having the medical record documentation to support the chosen code(s). Do not underestimate the complexity of this transition. Resign yourself to the fact that unless you retire or die (or both) before October 1, 2013, you will need to get ahead of this implementation tsunami. Introduce the concepts of ICD-10 to your staff on a gradual basis, contact your software vendor and clearinghouse to ensure they have met Version 5010 requirements to allow you to electronically transfer ICD-10 data, and read all you can about ICD-10 (APMA publishes articles including timelines of where your practice should be, and presents webinars and seminars on ICD-10). If you put off learning about and transitioning to ICD-10 until, say, the spring or summer of 2013, you will probably wish in October that you had retired already. Your concern about money is justified. An often-quoted Nachimson Advisors Study estimated it will cost small practices approximately $82,290 to transition to ICD-10. But that is only part of the story. Knowledgeable sources recommend that you consider putting aside funding (let’s call it a contingency fund) to allow your practice to run if third-party payments are delayed during the implementation process because payers have not yet worked out all the kinks in their own systems. Where’s the ‘Medical Necessity’ for Switching to ICD-10? To answer that question, we have to provide a little background on the current state of ICD-9. ICD-9: has been in use since 1979; was reported in 1993 to be running out of code numbers (and now lacks codes for certain types of conditions or services); is no longer supported by the World Health Organization (WHO), which supports only ICD-10; does not reflect advances in medical treatment or current knowledge of disease processes; lacks specificity and detail claimed to be needed to report diagnoses, conditions, and the circumstances affecting them; includes outdated terminology; and documents data that are difficult to compare with those provided by the rest of the world, which uses ICD-10. • • • • • • • Why ICD-10, When ICD-9 Was Working So Well? And Where Were the Medical Societies? We hope that you have a better appreciation now that ICD9, while great in its day, is outdated. The fact that the WHO no longer supports it doesn’t leave much choice in the matter. Like it or not, the United States is moving to ICD-10. While medical associations and societies did question and even argue against eliminating ICD-9 in favor of ICD-10, the inevitable need for a more comprehensive system was too overwhelming. While there are doctors who are quite vocal, railing against transitioning to ICD-10, their time and effort would be better spent initiating a practice transition timeline for implementation of ICD-10. We recommend you set aside your ICD-10 R45.4 (irritability and anger) and begin following APMA’s recommendations for ICD-10 implementation. With some careful planning and attention to detail, you can make your practice’s transition to ICD-10 go as smoothly as possible. n Given the above, the simple answer is that the United States is switching to ICD-10 on October 1, 2013, because it will be the only supported diagnostic coding reporting option, period. There will be no last-minute reprieve, no grace period. On dates of service October 1, 2013, and beyond, only ICD-10 will be accepted for reporting diagnoses, conditions, and circumstances. So, if you want to be paid for your services by third-party payers, you will have to use ICD-10—and use it correctly. It Seems Pretty Complex to Me, As Well As a Big Waste of Time and Money The complexity of ICD-10 will probably be measured in your level of acceptance and the degree to which you and your staff are willing to manage the implementation of ICD-10 over the time you have remaining before it goes live. The process will involve 26 APMA News February 2012 http://www.apmacodingrc.org http://www.apmacodingrc.org

Table of Contents for the Digital Edition of APMA News - February 2012

APMA News - February 2012
President’s Message
Contents
APMA Social Media: 2011 Success and 2012 Stategy
The National in 2012: Celebrating 100 Years Advancing Podiatric Medicine
APMA By the Decade: 1922–1931
Profiles in Progress: Student Recruitment
2011 Podiatric Practice Survey: Sources for Patient Referrals
Confronting the Residency Shortage
Reimbursement
Federal Advocacy Forum
APMAPAC Chair Report
IT Consultant
Website Wisdom
Technofile
Young Voices
Small Business 101
APMA All Stars
Awards Nominations
In Short
Worthy of Note
Resolutions Submissions
Affiliates Corner
List of Affiliated Organizations
Insurance Advisor
New Members
Death Notices
Annual Scientifi c Meeting Registration Form
Annual Scientific Meeting Sponsors
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index
10 Questions

APMA News - February 2012