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How much should a hospital based radiology department budget for because of ICD10? I've heard we could lose up to a million dollars in revenue The amount needed for budget purposes for each department is dependent on many variables. An in-depth system analysis, impact analysis, and staff analysis will need to be performed in order to start to get a picture on what might be needed. I would suggest you go to the AAPC website (www.aapc.com) and look through the Implementation Tracker to assist with the steps necessary. It is a free tool available to members. There are also still AAPC ICD-10 implementation boot camps being held through June of 2013 that cover the implementation process from start to finish. Will CPC's be required to re test for ICD-10 in order to retain their certification? The ICD-10-CM proficiency is required for all AAPC credential holders (excluding CPPM, CPCO, and CIRCC ). It will be available beginning October 1, 2013 and open through September 20, 2015. It is 75 questions, 3.5 hours, open-book, online, unproctored assessment. You may use any resource available to take the assessment. It will only contain questions on ICD-10-CM. When will ICD 10 be incorporated into the test for new coders? The CPC exam is updated on a yearly basis. ICD-10-CM should begin showing up on the exam in January of 2015. I verified this information with the director of the exam department at AAPC. ICD-10-CM will show up on the exams in January of 2015.
Why would any unspecified codes be available? The clinically modified version of ICD-10 that we will use in the United States includes all codes. Just as in ICD-9- CM, there are unspecified codes. Some payors are choosing not to accept them for payment. The danger area I think needs the most attention is codes that include laterality choices, but unspecified codes are assigned. Unspecified codes for some conditions are necessary as providers do not always have a definitive diagnosis and must perform diagnostic tests. Remember, these codes are in use around the world and different countries may utilize the codes differently. Why do they give us unspecified codes if they aren't going to be paid? The clinically modified version of ICD-10 that we will use in the United States includes all codes. Just as in ICD-9- CM, there are unspecified codes. Some payors are choosing not to accept them for payment. The danger area I think needs the most attention is codes that include laterality choices, but unspecified codes are assigned. Unspecified codes for some conditions are necessary as providers do not always have a definitive diagnosis and must perform diagnostic tests. Remember, these codes are in use around the world and different countries may utilize the codes differently.
On slide 10, the physician will have to give the specific dx, correct? I cannot code the moderate, persistent specificity from the documentation without the physician giving it as a dx. Is that correct? As a radiology group we have to go by what is written on the script or the findings on the images. Does this mean we will have to go back to the referring physician for more information? Example Amputation lbk: new code S88.122A correct? w/o comp That may be dependent on the facility that you work in. Coders may be called upon to understand disease processes more in depth in order to be able to code correctly without word for word feeding from the providers. It may be dependent on the facility where the coder works and what type of job duties the coder performs. Depending on the outcome of the radiology report, there may be more querying of the ordering providers necessary. It depends. S88.122A would be an initial encounter for a partial traumatic amputation. Code S88.112A would be an initial encounter for a complete amputation. Both codes are for the left extremity as you indicated. Slide 11 is incorrect. 250.50 is type 2 your example is type 1 It has always been my understanding that I cannot "diagnose" as I am not qualified; that is the pervue of the physician. However, if I am understanding correctly, once the physician gives a base diagnosis, I may review the record for specificity? In a hospital based radiology department, we depend on the registration staff gets the necessary information. I don't think they will have the knowledge to know if the information is enough on the script. Good catch. The code in ICD-9-CM for type 1 diabetic cataracts is 250.51 and 366.41. In the description of your job duty, I would say that you would be verifying and looking for specificty and to see if a more comprehensive code could be assigned. That is definitety part of the implementation process that will need to be reviewed. The better educated that staff is, the better information you will get, and may prevent some back end work.
In regards to the previous question regarding the physician documentation, The facility may require an understanding of the disease process but--how is that going to protect us coders from audits, etc, and keep us from getting in trouble? The old addage of "If it's not documentated, it didn't happen" and we are not allowed to say 'I know what he meant but he just didn't document it' comes into play. I'm not willing to risk my job, my certification or possible a jail term...sorry I am not suggesting that anyone perform any task they feel is putting them in jeopardy or is a compliance issue. My point is, the documentation is present in the note to support that code choice. Every facility works differently. I guess what I am saying is (regarding the phys documentation) is I think the best thing is either query the doctor or have them do an adendum maybe? Will we be able to go into the EMR for a more explicit history or diagnosis? Where are we able to get an ICD-10 book to do these audits before live date? I would follow whatever policy is in place where you work in order to make sure you are covered in relation to code assignment. Unfortunately, EMRs vary greatly and it will depend on the system you have and what is "turned on" for use, etc. I would suggest you contact the vendor and see what exactly your system is capable of in regards to your templates or access. ICD-10-CM manuals are available today. AAPC sells them at http://www.aapc.com/medical-coding-books/index.aspx. Other vendors sell them as well.
Will there be a grace period for implementing ICD 10? All HIPAA covered entities must transition on October 1, 2014. There is no grace period indicated in the Federal Register. There may be some commercial payors that will give a grace period to providers, but there is not mandate for any grace period. Everyone needs to be ready to go on October 1, 2014. Are laterality modifiers for CPT codes still going to be required now that they will be incorporated in the icd-10 code? Have payors given an idea about how long it will take them to switch and become ICD-10 compatiable? Like the length of time for claim review if everything is done right on the facility side? CPT codes and modifiers are used to indicate services and procedures that are performed by providers. I do not know of any plans to delete the laterality modifiers. As stated before, the "go-live" date is the same for all covered entities - October 1, 2014. I would call your larger payors and ask how they are doing with conversion, testing, etc., to get an idea of what to expect. Watch for the testing dates from CMS when they are offered to send test claims. Ask your commercial payors if they plan on holding testing dates prior to the transition date. Currently WC uses Medicare guidelines - such as not accepting consult codes. I am surprised them won't be using ICD 10 codes How will the providers know which code set they require for their claims? They are a non-covered entity, so they are not required. Many are going to follow along with the rest of us. You will want to contact your large WC payors and check. If they do not post on their site, you will have to individually contact them.
Oh my we will be required to use both ICD9 & ICD 10 codes? Yes. Even without the non-covered entity issue, there will still be outstanding claims in appeal, charges not put in the system yet, etc. that will still need to be processed under ICD-9-CM. For providers, the proper code set will depend on the date of service. For example, if in November of 2014 a physician presents charges from September of 2014, they would be entered in the system with ICD-9-CM codes because the date of service was prior to the transition. That being said, there are also the non-covered entities that may not choose to transition to ICD-10-CM and it will be necessary to process all of their claims under ICD-9-CM. Thorough checkin prior to the transition date is necessary to ensure that you are fully prepared for either outcome. DO we know which major insurances are converting to ICD-10 So if a provider fails to document specificity to support a more specific ICD 10 dx, can the provider need to make an amendment to medical record to be able to use the more specific ICD 10 dx? All covered entities must transtion on October 1, 2014. If you are referring to worker's compensation, auto, and other non-covered entities, I do not know of any listing anywhere that indicates which ones are and are not transtitioning. Depending on the facility and the policies and procedures they have surrounding addendums (time limits, etc), yes and addendum would definitely be an option.