medical practice analysis

At Eggleston & Eggleston, we seek to provide our client practices the most pragmatic, current financial and management insights. For this, our updated website’s inaugural blog, we focus on one of the issues which has had a major impact on all medical practices: the transition this year from ICD-9 to ICD-10 coding procedures.

The U.S. medical community reached parity in coding procedures with Europe one year ago in October. To ease the transition from ICD-9 to ICD-10, the Centers for Medicare and Medicaid (CMS) set a grace period of one year for United States practices to learn the new system.
As our grace period for adapting to ICD-10 recently expired, medical practitioners can again be penalized for improper coding. Are you coding correctly? The new ICD-10 system contains 55,000 more codes than its 40-year-old predecessor. We have conveniently summarized the changes into three types of code updates you need to incorporate if you have not already done so.

#1: THE “BIG SIX” CHANGES WROUGHT by ICD-10

  • Size: ICD-10 contains nine times the number of codes in ICD-9: 68,000 diagnosis codes and 87,000 procedure codes.
  • Specificity: According to PhysiciansPractice.com, “…the ICD-10 codes allow you to identify etiology, anatomic site and severity, as well as specify the encounter: initial, subsequent or sequelae of an encounter.”
  • Laterality: With the new codes, you are able to designate which side of the body is affected; right, left, bilateral or unspecified.
  • Expandability: ICD-10 affords room for new procedures and diagnoses.
  • Terminology: Revised definitions now provide current, practical information.
  • Combination Codes: It is now possible to code multiple diagnoses with a single code.

#2: MORE DETAILS ENHANCE CODING SPECIFICITY

As updated coding definitions contain more details, according to PrecisionPractice.com, one can now code for “…episode of care: trimester; clinical details such as acute vs. chronic; and [make use of] the expanded ‘cause codes.’”

#3: MODIFICATIONS REDUCE MARGIN of ERROR in CODING

Although similar in many aspects, in certain areas the contrast between ICD Versions 9 and 10 is significant. Some examples include:

  • In ICD-10, a diagnosis code is always alpha; whereas in ICD-9, it could be alpha or numeric.
  • In ICD-10, the letters “I” and “O” have been omitted to avoid confusion with the numbers “1” and “0.”
  • In ICD-10, a procedure code is always seven characters long and contains no decimals.

Now that the grace period has expired, a practice that fails to assimilate and incorporate ICD-10 changes runs a penalty risk. It behooves all practices’ staff members to brush up on these changes.

But the wisest action for practices’ managers in light of the scope of ICD-10’s changes is to hire a medical practice management firm. It really is best to have an expert helping one “stay on the good side” of CMS.

Eggleston & Eggleston, which employs experienced family practice, ob-gyn, plastic surgery, urology, surgical, orthopedic, anesthesiology and pain management coders, is proud to offer a 30-minute complimentary practice assessment by telephone to all our potential clients.

If you are ready to improve performance and maximize revenue, kindly contact us at (540) 345-3556 in Roanoke or fill out our short online form to request your practice assessment. We serve Virginia practices and hospitals, providing in-depth research and customer service second to none.