Hello from Philadelphia and the 2013 Technology & Informatics Institute, where I attended one of the more challenging OPEN MINDS pre-institute presentations of the day – OPEN MINDS Senior Associates Lisette Wright, M.A. and Sun Vega, teamed up with Jonathan Evans, Chief Executive Officer at Safe Harbor to present Codeageddon: The Ins & Outs Of Surviving The Switch To The New CPT Codes, ICD-10 & DSM-V.
The lesson (or warning as it turned out) was that 2014 will be a huge year for the health and human service field as changes to three different coding sets overlap and produce a perfect storm of information overload. Here are the codes at the center of the storm, and a brief look at how they relate to each other:
Current Procedural Terminology (CPT) – On January 1 the American Medical Association (AMA) changed almost all the CPT psychiatry service billing codes. The purpose is to provide standardize language about how you interact and provide services, provided for reimbursement reasons. While these codes could in theory change every year, major revisions in the behavioral health industry don’t happen very often. The January 2013 major overhaul was something the industry has proven unready for (see Avoid The CPT Coding Nightmare all members).
International Classification of Disease (ICD) – The next generation of these codes, the ICD-10, is coming October 1, 2014. While the industry was given two months to change approximately 30 CPT Codes this year (bringing chaos to many provider organizations), ICD-10 will involve thousands of changes. The current edition (ICD-9) has roughly 14,000 codes, and ICD-10 will have 68,000 codes offering increased specificity, accuracy, and global standardization. This implementation will carry costs ranging from $83,000 to $2.7 million per practice according to the American Medical Association (AMA) (see ICD-10 Transition To Impact Specialists More Negatively all members).
Diagnostic and Statistical Manual of Mental Disorders (DSM) – The American Psychiatric Association publishes the DSM, and the latest edition as of May 2013 is the DSM-V. This does not align (no matter what the venders may tell you) with ICD-10 (see The DSM-V Controversy all members). But, if you want to be reimbursed for the services you provide, you will have to use DSM-V for clinical purposes, as well as bill to the corresponding ICD codes accordingly on health care claims.
Coding changes have implication for everyone – provider organizations and payers alike. Here is the short list of questions about coding that managers in provide organizations should be asking:
Are any ICD10 codes not covered? – What diagnoses will be reimbursable under the new code sets, and how will your contracts/fee schedules with payers change?
What are your payers doing to prepare for the transition, and where are they in the process?
Do we have a plan for education and communication with all staff? Customer service and claims review staff need to know how to handle the new codes.
Have we updated the clinical documentation processes and compliance standards since our old processses won’t work?
Is our internal/external testing of ICD10 claims already happening?
How do the different code sets “line up”, and more importantly how do they not? Do we have a crosswalk for staff, coders, and clinical professionals?
Do we understand General Equivalent Mapping since crosswalks are not a perfect match between codes? No matter what providers might hear, these coding sets will not line up perfectly.
Have we assesed our new usiness processes?
Have we mapped all of our patient diagnoses “touch points”?
Do we have an ICD10 Implementation Plan?
The advice from the field on dealing with the coding changes?
Jonathan Evans, Chief Executive Officer, Safe Harbor & OPEN MINDS Advisory Board Member – I have been wrestling with the mounting regulatory environment for the last 20 years, and I would suggest that much of it has not improved care to patients. And we are at a point where the coding is so daunting that it has really impacted the efficiency of the care delivery system. But, even if you don’t like the rules you have to comply. Last year was really a challenge for us with CPT – we did an internal audit a month and found we were really missing the mark on where we wanted to be. We have now gotten this to where we need it, but it has really been a challenge. What we learned was; Begin with internal audits; Conduct frequent audits; Develop documentation for all the elements required for the different codes; Engage a psychiatrist who has utilized the codes; And, key administrative staff needs to have a working knowledge of the codes to support the transition.
Lisette Wright, Senior Associate, OPEN MINDS – What this means: You must be ready to use these new codes well before October 1, 2014 to avoid revenue cycle disruption. Audits will not be avoidable and all code set and clinical documentation will fair game. We already have increased scrutiny in the industry, and it’s only going to get worse. Everyone will need an ICD10 Transition plan to ensure your organization is ready for the changes. It involves so much more than your vendors EHR ICD10 plans. If you haven’t started already, the one take away from today is go home and start now.
Sun Vega, Senior Associate, OPEN MINDS – I was just catching on to the CPT code changes in 2012. I work in New Mexico, and the state was struggling getting up to speed, especially with prescribing psychologists. It was a complete upheaval paying for those services. As a key part of getting ready and being prepared to deal with these challenges, I’m a big proponent of the back office team being well-versed in the coding and billing requirements. In my experience, you yourself have to become the expert, and you have to teach your network. I challenged myself and my billing team to become coding experts to help support the doctors, that’s how complicated this can be.
The take away from the day? It’s not a matter of if, it’s a matter of when. For a deeper dive in this complicated issue make sure to check out the upcoming December edition of the OPEN MINDS monthly management newsletter when we will look at a ICD-10 implementation plan. And, tomorrow, check out our on-line coverage of Lisette Wright’s session, Making The Switch: A Guide To Successfully Managing The Transition To The New CPT Codes, ICD-10 & DSM-V at The 2013 OPEN MINDS Technology & Informatics Institute. And be sure to follow the live coverage on Twitter @openmindscircle for the latest live updates from the institute – #tii13.
For another free resource, see: The DSM-V Debate Continues all members