10/22/2013    Barbara Aung, DPM

ICD-10 (Arden Smith, DPM)

I am a solo practitioner. Two years ago, I became
a certified coder and a certified medical auditory
through AAPC. I am also a member of the APMA
coding committee.

I do understand your concerns, and definitely, at
first glance ,it does seem that ICD-10 for
practitioners will be extremely challenging.

Podiatrists, as a whole, have been in the
forefront of knowing coding and billing compared
to other specialties. They have generally relied
on employees who did the coding and claims filing.
In the near future we podiatric physicians will
not be able to give you off the top of our heads
the diagnosis codes as we have been able to; as
you clearly understand the codes are numerous and
require more detail.

This, however, does not make it impossible for
smaller practices to be able to continue practice
in the same manner. There will need to be some
work put into the practice to accomplish this goal
and there are options for all practitioners to get
their practice ready for ICD-10-CM.

First let me review some options:
1. You can hire a certified coder – If you file
claims from your office
2. You can hire the services of a billing service
– they have employees already certified
3. You can get training for your current employee
(s) so that they can continue doing the billing
for you (this however will require much more
training as most office staff do not have the
educational background in medical terminology,
anatomy, physiology etc.. let alone ICD-10-CM
requirements)
4. You can work with your Practice management
vendor – which may be providing the clearinghouse
process – to get the ICD-10 codes applicable to
podiatry ready loaded or to be loaded to the
software, so that you can start practicing; this
will also require a connection to your EMR- or
documentation program.
5. I am sure that there are other options that I
have not listed, but others who respond may
provide additional options.

ICD-10 however doesn't start and end with just
knowing the codes – it has everything to do with
your documentation. Whether you know the codes or
have certified coders or staff does the billing
for you – it is your documentation that is going
to support medical necessity and support the
diagnosis codes you use to submit your claims.

I have been working for two years with my EMR
vendor to get my documentation templates organized
in such a way that regardless of the type of visit
or condition I am treating – my documentation will
provide the information required to support the
claims I will be submitting.

I will give you a simple example - let’s say you
see a patient for closed fracture of a metatarsal.
You document the history and exam as you normally
would do and you would most likely have documented
foot and which metatarsal was fractured and the
procedure you performed. Currently, you might use
the diagnosis for pain, closed fracture. For ICD-
10, you will need to document the history and exam
and document which foot and metatarsal again as
you normally would do.

With ICD-10, you will need to be specific when
coding the fracture to pick the code that
describes the type of fracture, which foot and if
there is a separate code to the metatarsal, you
will also need to have documented how the injury
occurred, whether it was at work, at home or other
locations, and or if an object caused the injury,
and if this is the first time you saw the patient
or this is a follow up visit for the fracture, and
the state of the fracture – that is if the
fracture is already delayed healing, non-union
etc.

So you can see that it is not just a matter of
codes and knowing the codes, it is definitely
impossible for us to memorize these codes. You
will need to use the coding book, but you will
need to document more thoroughly than you probably
do and ever had.

I did an audit of my documentation and found that
even though I am “in the know”, there was room for
much improvement. That is why working with your
EMR vendor to get your note templates to give you
reminders and pointers will be absolutely
necessary.

Barbara Aung, DPM, Tucson, AZ, draung@healthy-
feet.com

Other messages in this thread:

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10/23/2013    Marc Jay Pinsky, DPM

ICD-10 (Arden Smith, DPM)

The response on ICD-10 coding sounds nice and
simplistic. However, VERY few solo practitioners
have the extra money lying around to hire a
professional coder to do the job they or their
office staff have previously provided. The reality
is that ALL docs should be taking the time now to
go dx-by-dx and see what the appropriate ICD-10
crosswalk is. You will be pleasantly surprised to
find out how few dx codes you actually use on a
daily basis and that many ICD-9 codes have only a
single ICD-10 equivalent.

When I switched from paper charts to EHR charting
and did the required documentation needed for
meaningful use, my daily patient load was forced
to decrease. Otherwise, I would never see my wife
at dinnertime ever again. I expect an additional
loss in patient volume when I have to switch to
ICD-10. I see no way that anyone other than the
doctor will be able to code/bill for each patient.

No matter how much you trust your office staff to
read over your notes and bill for the service
provided, YOU will pay the price for any
fraudulent coding and NOT your staff. Simple
services, and non-insurance cases can still be
easily billed through your office staff via an
office superbill. However, I doubt that the
patients with multiple complaints will be able to
be billed via a superbill due to the level of
complexity that most ICD-10 codes require.
This changeover IS going to happen, so try and
cope with the change as best as you are able to.
Start soon. Next October will arrive quicker than
you expect.

Marc Jay Pinsky, DPM, Petersburg, VA,
mjpinsky@juno.com