ICD-10 Delay Affects Physicians in Healthcare

Without actual coding system being uttered by a single member of the U.S. House or Senate, Congress approved a one-year extension for the move to ICD-10.

The U.S. Senate passed HR 4302 on Monday evening, executing the 17th short-term patch to delay Medicare payment reductions under the Sustainable Growth Rate (SGR) formula and also delaying enforcement of the "two-midnight" rule, where Medicare would not reimburse hospitals for inpatient services that do not span two midnights. Recovery Audit Contracts are now unable to audit claims under the rule for another six months, through March 31, 2015.

Without the one-year delay to the SGR-associated cuts, physicians would have faced a 24 percent drop in Medicare reimbursement April 1.  And while there was legislation before Congress this year to repeal the SGR, paying for it proved harder to garner support in the House and Senate.

But perhaps the part of the legislation no one in healthcare saw coming was a provision preventing CMS from enacting the ICD-10 coding system until October 2015, at the earliest.  The language was put into a bill crafted through a compromise on the SGR by House Speaker John Boehner (R-Ohio) and Senate Majority Leader Harry Reid (D-Nev.), and introduced by Rep. Joe Pitts (R-Pa.).

The House debated HR 4302 on March 27, but absent a quorum, could not take official action.  Nearly two hours later, however, the congressional body took a "voice vote" of those in the chamber, decided the two-thirds majority was present, and passed the bill along to the Senate with its approval. (Video of the vote, which took less time than reading the name of the bill, is here.)

The Senate debated a full reform of the SGR formula for more than two hours on Monday, but the focus largely centered on whether to take up several bipartisan bills to completely repeal the formula or pass another short-term fix.  No members of the Senate that spoke mentioned the ICD-10 transition before passing HR 4302 with a vote of 64 to 35.

The medical coding switch from ICD-9 to ICD-10 was originally proposed in 2005, and it has twice since been delayed. The implementation date of Oct. 1, 2014, was one CMS reassured physicians numerous times would not change, including most recently at the Health Information Management Systems Society annual conference in February.

But now, the healthcare industry will reset their countdown clocks from Oct. 1, 2014, to Oct. 1, 2015, or even later.  We asked the experts what this delay means for physicians, health IT vendors, and medical coding overall.

- See more at: http://www.physicianspractice.com/icd-10/how-icd-10-delay-affects-physicians-healthcare#sthash.oNHv0x3G.dpuf

ICD-9 To ICD-10 Conversion: Less Impact On Urology Practice With Little Changes

This year you must be assuming how many codes change you would face in the coming year and ways to start preparing for them to keep your coding and billing error-free when you convert from ICD-9 to ICD-10.

All Urologists need to be aware of all the E/M changes. According to the AMA there will be approx 329 code changes in 2014. There will be 175 new codes, 107 revised codes, and 47 deleted codes.
Amongst all the 329 changes, digestive system, molecular pathology, cardiovascular system, complex chronic care coordination services, and transitional care management services will see innumerable code changes and feel the impact heavily. But, there are very few changes in CPT codes for Urology and evaluation and management codes, so there will not be immense changes that one needs to learn for in the coming 2013 year.

As of now there has been no update for ICD-9-CM diagnosis code for ICD-9 2014that will come into effect from Oct. 1, 2013. Till the conversion of ICD-9 to ICD-10 there is a freeze.
Usually, Inpatient Prospective Payment System (IPPS) proposed rule from CMS includes all the likely changes but since there are no changes this year, one can be relaxed. At the meantime one only needs to concentrate on the ICD-10 changes, preparation and its impact.
Ensure a smooth conversion of ICD-9 to ICD-10 with these general differences between both the systems:

• While ICD-10 codes are alpha numeric with up to seven characters in length, the ICD-9 codes are only three to five characters.
• There are 21 chapters in ICD-10-CM while ICD-9 has only 17.
• In ICD-10, ICD-9-CMs V and E codes are included for the main classification, for instance, Placeholders are required to hold places which will be followed by additional characters, for obstetrics, injuries, and external causes of injuries seventh characters are required and complications for Post-operative will now be specifically located to the specific body system where the procedure was held.

In ICD-10 injuries will be first classified by the exact site and then the type of injury, unlike ICD-9 where it used to be classified by injury only.

Why it is Important to convert ICD9 to ICD10

• January 1, 2012 - ALL providers must upgrade to Version 5010 in order to accommodate ICD-10 codes
• October 1, 2013 - ICD-10 codes must be used for all procedures and diagnosis on and after this date. Claims with ICD-9 codes for services provided on or after October 1, 2013 cannot be paid

Background
In health care, coding systems are used to differentiate diagnoses and procedures in virtually all treatment settings. Diagnostic and procedural codes are connected to nearly every system and business process in health plans and provider organizations, including reimbursement and claim processes.

The World Health Organization's Ninth Revision, International Classification of Diseases (ICD-9) is the official system of assigning codes to report diagnoses and procedures in the United States. On October 1, 2013, the ICD-9 code sets will be replaced by ICD-10 code sets. The U.S. Department of Health and Human Services issued a final rule on January 16, 2009, adopting ICD-10-CM (clinical modifier) and ICD-10-PCS (procedure coding) system. To accommodate the ICD-10 code structure, the transaction standards used for electronic health care claims, Version 4010/4010A, must be upgraded to Version 5010 by January 1, 2012. ICD-10 diagnoses codes must be used for all health care services provided in the U.S. on or after October 1, 2013. ICD-10 procedure codes must be used for all hospital inpatient procedures performed on or after October 1, 2013. Claims with ICD-9 codes for services provided on or after October 1, 2013, cannot be paid.

ICD-9 follows an outdated 1970's medical coding system which fails to capture detailed health care data and is inconsistent with current medical practice. By transitioning to ICD-10, providers will have:

• Improved operational processes by classifying detail within codes to accurately process payments and reimbursements
• Detailed information on condition, severity, comorbidities, complications and locations
• Detailed health reporting and analytics such as cost, utilization and outcome
• Expanded coding flexibility by increasing code length to seven characters

DCH's Role

ICD-10 will affect diagnosis and procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. Everyone covered by HIPAA who transmits electronic claims must switch to Version 5010 transaction standards. The change to ICD-10 does not affect Current Procedural Terminology (CPT) coding for outpatient procedures.

DCH is currently working to identify where ICD codes are used within DCH's policies, processes and systems. We are identifying the work effort required to transition to ICD-10 as well as the tasks necessary to remediate the Medicaid Management Information System (MMIS). The ICD-10 implementation will improve DCH's ability to accurately compensate Medicaid providers, and reduce the incidence of improper payments.

Providers' Role
As a provider, you should talk with your software vendor to ensure your system will be upgraded to Version 5010 by January 1, 2012.

Source:https://dch.georgia.gov/icd-10-conversion-why-important