PracticalDermatology

In just over a half-year, ICD-10 will be in full effect across the country. Physicians and practices everywhere will have to adjust to a brand new and much more complex coding and reimbursement system. And yet, across the dermatology spectrum, there appears to be a lack of urgency regarding the changes that ICD-10 will mean for practices. There are a number of ways that dermatologists can prepare for the implementation of ICD-10; some that involve technology, others based in education. The reality, however, is that time is running out, and that all of us need to be ready to ensure a smooth transitionfor the October 1 start date.

ICD-10 MYTHS

With less than nine months to go before implementation, there are several misconceptions about ICD-10 that are worth debunking:

“ICD-10 won't happen because ICD-11 is coming soon.” This is a false claim. It took the Centers for Medicare and Medicaid Services (CMS) roughly 10 years to map ICD-10 all the way to reimbursement, and it will likely take just as long for ICD-11. In fact, the World Health Organization (WHO) just recently announced that it has pushed back its plans to roll out ICD-11 from 2015 to 2017, which means that our transition in the US will probably take even longer. Thus, those who believe that ICD-10 will be shelved until ICD-11 is in effect are likely to be unprepared for October 1.

“There will be a transition period between ICD-9 and ICD-10 that will allow us to use either code.” This is also false. On September 30, 2014, we will all be coding with ICD-9 and October 1, 2014, we will be coding with ICD-10. It's worth noting that the original deadline for implementations of ICD- 10 was October 1, 2013, but CMS extended it one year to give more time to prepare. When the extension was announced, CMS stated that there would be no more extensions for the start of ICD-10. There have been some discussions that CMS may allow to the end of 2014, giving practitioners another three months to prepare, but this is purely speculative. Thus, all physicians should be prepared for the switchover to start as scheduled, on October 1.

“You'll be able to replace your ICD-9 super bill checkoff sheet with an ICD-10 super bill check-off sheet.” Those who use these check-off sheets for easy reference to ICD-9 and expect that ICD-10 will be easily adapted into something similar will be disappointed to learn that ICD-10 is much more complex than ICD-9. Thus, instead of having one checkoff sheet, you may have six.

Accepting that ICD-10 will begin on October 1 is an important first step in preparing for it, but it's also critical that physicians become educated about just how much ICD-10 will differ. Undoubtedly, some of us translate “complex” into “slowing me down,” and to some degree, it is true. ICD-10 will be a difficult adjustment, not just because it is new, but because there will be more codes to bill for. Importantly, there is no relationship between ICD-9 and ICD-10. The two coding systems are completely different, and the reason why ICD-10 is more complicated than ICD-9 is because increased coding precision in coding will help the government process data on disease. For instance, the current system does not differentiate between basal cell carcinomas and squamous cell carcinomas, but the new system will have different codes not only for these different conditions, but also different codes depending on where they appear on the body, and what side of the body they are on (e.g. “SCC of the Right upper eyelid”).

SOLUTIONS IN TECHNOLOGY

Though the transition to ICD-10 is bound to cause physicians some frustration, there are a number of ways to soften the impact. In terms of education, the AAD has a laminated crosswalk that costs less than $20 and contains four pages of codes that will be useful to the dermatologist. It won't cover everything on ICD-10, but it gives physicians a solid primer to become familiar with the most used codes.

Educational resources can be helpful, but when it comes to everyday challenges of ICD-10, the best solutions come from Electronic Health Records (EHR). Many EHRs will soon be equipped with coding solutions that will make the transition to ICD-10 much easier. For example, with Modernizing Medicine's EMA system, once you check off the diagnosis and location, it will automatically generate the correct code in ICD-10. Other EHRs are offering similar solutions, arguably giving physicians more reason to move toward EHRs than the Meaningful Use incentive program ever did. In fact, for those who might be more willing to consider purchasing an EHR for ICD-10 solutions rather than Meaningful Use, keep in mind that you don't need to qualify for Meaningful Use incentives if you would rather avoid the headache. In fact, whatever your reason may be for considering an EHR, the goal in selecting the right system is determining which will make your office run more efficiently.

While EHRs currently offer the best solutions for alleviating the forthcoming difficulties that ICD-10 may likely engender, several other possibilities may present themselves in the future. For example, there may eventually be an app that physicians can purchase on their mobile device that generates codes based on diagnosis and location. This might offer an alternative to folks who would prefer not to invest in an EHR for the primary purpose of dealing with ICD-10.

THE FUTURE IS HERE

Whether you plan to harness technology to aid you in adjusting to the new coding system, or if you plan on poring over the ICD-10 manual (along with your staff), the reality is that ICD-10 is coming. As more solutions and resources become available, it is important to make choices and investments that will ensure a smooth transition for your practice.

Mark Kaufmann, MD is co-chair of the Dermatology workgroup for CCHIT. He is on the Medical Advisory Board of Modernizing Medicine.