Daniel Prince, M.D.04.01.15
Officials with the Healthcare Information and Management Systems Society (HIMSS, a Chicago, Ill.-based not-for-profit organization focused on better health through information technology) have stated on several occasions that orthopedics will be one of the most significantly impacted specialties by the impending shift from ICD-9 to ICD-10 codes, now scheduled to take effect in October of 2015.
The World Health Organization’s (WHO) International Classification of Diseases (ICD) has served the healthcare community for over a century. The United States implemented the current version (ICD-9) in 1979. While most industrialized countries moved to ICD-10 several years ago, the United States is just now transitioning. ICD codes used by physicians, hospitals and health workers to indicate diagnosis for all patient encounters.
The primary goal of ICD-10 is to more granularly code and track diagnoses, treatments and outcomes. By providing more detailed heath codes, the data collected is more
specific and thus easier to mine for valuable insights. Orthopedics inherently requires high levels of code granularity given the quantity of diagnosis, the multitude of joints, bone and muscles that can be involved and the underlying causes. This makes the transition more substantial in orthopedics and thorough preparation absolutely essential.
For example, under the new ICD-10 coding system, physicians not only will need to code each fracture, but also use separate codes to account for other unique identifiers such as site within the bone (metaphyseal, diaphyseal); laterality (left, right, bilateral); pattern of fracture (Neer 3 part); status of fracture (healing, nonunion, malunion, delayed union); place of occurrence (field, sidewalk, street, etc.); and cause of fracture (MVA, sporting activity, fall, etc.). Eventually, even devices and implants will be coded using the Unique Device Identification (commonly called UDI) system. This is to provide additional structured data with the goal of providing greater insight into the efficacy of devices for diagnoses and treatment.
Physicians who choose to ignore ICD-10 are setting themselves and their practice up for major problems. Even though its implementation has been delayed, ICD-10 will be implemented. Physicians who are not prepared will suffer severe workflow disruption and revenue loss. Ill prepared practices will not transition smoothly, and in a world where every minute with a patient counts, there is no time to manually map ICD-9 codes to their new, and more complex, ICD-10 counterparts. Practices will run the risk of being denied reimbursement due to inaccurate coding. There is a flip side to every coin, and while there are potentially some major risks for those who ignore ICD-10, there are potentially great rewards for those who prepare.
A well-planned transition to ICD-10 actually represents a significant opportunity if one approaches it as such, rather than another line item on a perpetual government compliance list. With a bit of due diligence, one can find new technologies that can automate the complexities of managing the ICD-10 transition to improve one’s practice and ultimately provide the consistent and efficient care your patients are used to. Those who are well prepared for the shift to ICD-10 will not only transition smoothly, but actually benefit from the more granular and structured form of coding.
The responsibility for preparation does not fall on the physicians alone. A great deal of obligation actually lies with their technology and device vendors. One of the biggest drivers behind the shift to ICD-10 is technology, and therefore your technology and device vendors should be one of most essential partners in your preparation and transition.
The recent 12-month delay to implement ICD-10 offers some respite for physicians who have ignored ICD-10, allowing practices to speak with their vendors about how they can help prepare for the impending change. Contact your technology and device vendors. If your practice is using an electronic medical records system, practice management system or other billing systems, contact the individual vendors and ask about their plans and preparedness for ICD-10.
Some important questions to ask include:
• Will your documentation workflow be granular enough for ICD-10 in an orthopedic practice?
• Is your technology prepared to support ICD-10 for orthopedics, and, if not, when will it be?
• What does the ICD-10 implementation process involve?
• Will the technology support both ICD-9 and ICD-10 codes?
• How does your solution account for device interaction and coding?
• What type of training and resources will you provide, and what are the associated costs?
• Does the system algorithmically choose an ICD-10 code, rather than providing an interface requiring the user to search and identify the code?
It will also be very important to work closely with your other service providers, such as coders and claims clearinghouses. You should have a good understanding of their plans to transition to ICD-10 and how that may affect your practice. ICD-10 has many moving parts, so you’ll want to ensure that all of your vendors and partners are moving forward with a clear and synchronized plan within the specifics of your practice.
ICD-10 will affect your practice. It is really up to you to determine whether that effect will be negative or positive. Educate yourself and hold your technology vendors accountable to not only help you function during the shift to ICD-10, but thrive as a result of it. Treat your practice as well as you treat your patients.
Daniel Prince, M.D., M.P.H., practices highly specialized orthopedic surgery as a member of the Paley Advanced Limb Lengthening Institute in West Palm Beach, Fla. Prince is also a physician software engineer with leading electronic medical record system provider, Modernizing Medicine. As a fellowship-trained orthopedic oncologist, his practice focuses on limb-saving surgeries for cancers of the extremities. Prince performs these complex surgeries on adults and children using the newest surgical methods and technological advances. Prince, originally from New York, N.Y., graduated from the University of Notre Dame with a bachelor's degree in biology. He obtained a combined medical degree and master's degree in public health from Yale University School of Medicine and Public Health. He completed his internship and orthopedic residency at Columbia University’s New York Presbyterian Hospital. He also completed fellowships with the International Center for Limb Lengthening and the Sloan Kettering Cancer Center.
The World Health Organization’s (WHO) International Classification of Diseases (ICD) has served the healthcare community for over a century. The United States implemented the current version (ICD-9) in 1979. While most industrialized countries moved to ICD-10 several years ago, the United States is just now transitioning. ICD codes used by physicians, hospitals and health workers to indicate diagnosis for all patient encounters.
The primary goal of ICD-10 is to more granularly code and track diagnoses, treatments and outcomes. By providing more detailed heath codes, the data collected is more
specific and thus easier to mine for valuable insights. Orthopedics inherently requires high levels of code granularity given the quantity of diagnosis, the multitude of joints, bone and muscles that can be involved and the underlying causes. This makes the transition more substantial in orthopedics and thorough preparation absolutely essential.
For example, under the new ICD-10 coding system, physicians not only will need to code each fracture, but also use separate codes to account for other unique identifiers such as site within the bone (metaphyseal, diaphyseal); laterality (left, right, bilateral); pattern of fracture (Neer 3 part); status of fracture (healing, nonunion, malunion, delayed union); place of occurrence (field, sidewalk, street, etc.); and cause of fracture (MVA, sporting activity, fall, etc.). Eventually, even devices and implants will be coded using the Unique Device Identification (commonly called UDI) system. This is to provide additional structured data with the goal of providing greater insight into the efficacy of devices for diagnoses and treatment.
Physicians who choose to ignore ICD-10 are setting themselves and their practice up for major problems. Even though its implementation has been delayed, ICD-10 will be implemented. Physicians who are not prepared will suffer severe workflow disruption and revenue loss. Ill prepared practices will not transition smoothly, and in a world where every minute with a patient counts, there is no time to manually map ICD-9 codes to their new, and more complex, ICD-10 counterparts. Practices will run the risk of being denied reimbursement due to inaccurate coding. There is a flip side to every coin, and while there are potentially some major risks for those who ignore ICD-10, there are potentially great rewards for those who prepare.
A well-planned transition to ICD-10 actually represents a significant opportunity if one approaches it as such, rather than another line item on a perpetual government compliance list. With a bit of due diligence, one can find new technologies that can automate the complexities of managing the ICD-10 transition to improve one’s practice and ultimately provide the consistent and efficient care your patients are used to. Those who are well prepared for the shift to ICD-10 will not only transition smoothly, but actually benefit from the more granular and structured form of coding.
The responsibility for preparation does not fall on the physicians alone. A great deal of obligation actually lies with their technology and device vendors. One of the biggest drivers behind the shift to ICD-10 is technology, and therefore your technology and device vendors should be one of most essential partners in your preparation and transition.
The recent 12-month delay to implement ICD-10 offers some respite for physicians who have ignored ICD-10, allowing practices to speak with their vendors about how they can help prepare for the impending change. Contact your technology and device vendors. If your practice is using an electronic medical records system, practice management system or other billing systems, contact the individual vendors and ask about their plans and preparedness for ICD-10.
Some important questions to ask include:
• Will your documentation workflow be granular enough for ICD-10 in an orthopedic practice?
• Is your technology prepared to support ICD-10 for orthopedics, and, if not, when will it be?
• What does the ICD-10 implementation process involve?
• Will the technology support both ICD-9 and ICD-10 codes?
• How does your solution account for device interaction and coding?
• What type of training and resources will you provide, and what are the associated costs?
• Does the system algorithmically choose an ICD-10 code, rather than providing an interface requiring the user to search and identify the code?
It will also be very important to work closely with your other service providers, such as coders and claims clearinghouses. You should have a good understanding of their plans to transition to ICD-10 and how that may affect your practice. ICD-10 has many moving parts, so you’ll want to ensure that all of your vendors and partners are moving forward with a clear and synchronized plan within the specifics of your practice.
ICD-10 will affect your practice. It is really up to you to determine whether that effect will be negative or positive. Educate yourself and hold your technology vendors accountable to not only help you function during the shift to ICD-10, but thrive as a result of it. Treat your practice as well as you treat your patients.
Daniel Prince, M.D., M.P.H., practices highly specialized orthopedic surgery as a member of the Paley Advanced Limb Lengthening Institute in West Palm Beach, Fla. Prince is also a physician software engineer with leading electronic medical record system provider, Modernizing Medicine. As a fellowship-trained orthopedic oncologist, his practice focuses on limb-saving surgeries for cancers of the extremities. Prince performs these complex surgeries on adults and children using the newest surgical methods and technological advances. Prince, originally from New York, N.Y., graduated from the University of Notre Dame with a bachelor's degree in biology. He obtained a combined medical degree and master's degree in public health from Yale University School of Medicine and Public Health. He completed his internship and orthopedic residency at Columbia University’s New York Presbyterian Hospital. He also completed fellowships with the International Center for Limb Lengthening and the Sloan Kettering Cancer Center.