Everything posted on this forum relative to Medicare, Obamacare, managed care, and all the other extraordinary hoops that they put docs through to get paid for the good that they do for society makes me ever so grateful that I am opted out of Medicare, participate with no insurance companies, and am nearer to the end of my career than not. To be very honest, this is exactly like the cattle being led to the slaughter. It won't take long before most of you realize that all of your cooperation with Medicare and insurance companies, along with your altruism, is going to eventually either put you out of business, or will dramatically reduce your ability to make a decent (and honest) living.
I urge all podiatrists who read this forum to give very strong consideration to looking into other fields of interest so you can slowly transition into something less regulated and much more lucrative. I've never been more serious since it is painfully obvious that the APMA is leading the death march and most of you are too afraid to do take a stand against the tyranny. I guess there is more honor in going down with the sinking ship. I apologize for bailing out 13 years ago.
Thanks to the efforts of APMA, the association’s members were among the best prepared physicians for the transition to ICD-10. APMA has been working actively to prepare its members for years, and we continue to address the very few concerns that have arisen among our membership.
APMA does in fact provide a list of codes for which there is not a crosswalk, along with APMA’s action on each of those codes. Members can find this information, along with many other helpful ICD-10 tools, on our ICD-10 Resource Page, www.apma.org/icd10. APMA’s Coding Resource Center (CRC, www.apmacodingrc.org) does provide a crosswalk from ICD-9 codes to ICD-10. In addition, APMA offers more than 20 free webinars (including the most current from December 10, www.apma.org/icd10webinars); countless ICD-10 InSight seminars; our ICD-10 FAQs; ICD-10 Test Your Knowledge; and other resources.
If members have questions about ICD-10, they may contact APMA’s Health Policy and Practice Department directly at email@example.com.
Paul Kinberg, DPM, Chair, APMA Coding Committee
RE: Lack of ICD-10 Crossovers
From: Jeffrey Kass, DPM
Since the implementation of ICD-10, it has become obvious to us all that there are many ICD-9 codes that have no ICD-10 crossovers. Furthermore, many of the ICD-10 codes are "unspecified", which is counterproductive to the aim of being more specific, which was supposed to be part of the rationale behind ICD-10. I assume that there is some committee somewhere that is collecting these codes to forward to the people who facilitate new codes. Who are both sets of people? Who are the podiatrists tasked with this?
I was hoping to find some sort of chart or table on the APMA website to ensure codes I come across are listed, but did not find one. We are collectively making one, correct?
So, here we are... hours into the ICD-10 transition. The sky has not fallen, but it might still. "The proof will be in the pudding," as they say. Whether we get paid on these new codes will be up to the insurance companies that we bill. We will see what happens over the next few weeks and months.
The warnings that we may not get paid in a timely fashion may still occur; so be prepared for some "expected" financial shortfalls in your revenue stream during this transition. It is a good idea to identify any available...
Edior's Note: Dr. Borreggine's extended-length letter can be read here.
There is a free one-hour overview webinar at practicefusion.com on code conversion as part of their superbill creation. You can also download free icd9-10 conversion software from icd10america.com. My manager and I compiled a list of our most commonly used codes and created our own handbook of codes to be entered into our billing software, as Medisoft's list was not comprehensive.
APMA provides a number of ICD-10 resources to its members at apma.org/icd10 to help prepare them for the transition to ICD-10 scheduled for October 1, 2015. One tool that APMA offers is the APMA Coding Resource Center (CRC), a fully integrated online coding and reimbursement resource for foot, ankle, and leg-relevant CPT, ICD-9-CM and ICD-10-CM (Volume 1, 2), HCPCS Level II codes, and Medicare LCDs CCI edits, and fee schedules. A portion of your subscription helps support the APMA Educational Foundation Student Scholarship Fund.
In the past month, APMA has added to the CRC an interactive ICD-10 sample diagnosis section of a super bill containing 140 typical diagnoses and conditions for a foot and ankle specialist. In addition, we announced the presence of ICD-10 “shortcuts” that have been added to our ICD-10 Quick List of 1,400 commonly used diagnoses, conditions, circumstances, signs, and symptoms. This “ICD-10 Shortcut” feature opens a window for the ICD-10 code you choose, and shows you the “nth” degree (highest level of specificity choices) along with notes, instructions, and guidelines.
Last night, September 29, APMA hosted another in its series of ICD-10 webinars for members. This webinar was an ICD-10 “Town Hall” presented by Harry Goldsmith, DPM, and members of the APMA Coding Committee. Our ICD-10 InSight Webinars (more than 20 in total) are available for APMA members at no charge at apma.org/icd10InSight. In addition, take advantage of the current trove of ICD-10 resources that can be found at apma.org/ICD10, including ICD-10 “Test Your Knowledge” questions, a list of ICD-10 FAQs, and links to other related resources such as those provided by CMS.
Peggy S. Tresky, MA, Director of Communications, American Podiatric Medical Association
There is no correlation between ICD-10 and board certification for anyone, neither those who are already diplomates nor those aspiring to become diplomates.
Jeffrey Lehrman, DPM, APMA Coding Committee
RE: ICD-10 Grace Period (Josh White, DPM, CPed)
From: Jack Ressler, DPM
Josh White DPM wrote a very informative response to my query on the ICD-10 grace period. I'm not sure how other doctors interpret this grace period, but I don't really know what purpose it will serve. If doctors are allowed to submit wrongly coded ICD-10 claims that will not be rejected during a one-year grace period, what steps will CMS take to make this a learning curve? What are doctors going to learn? It seems like it will be another year of delays while the decision-makers try to figure this one out. I still feel the smoke will not settle until after the 2016 election year.
It was good news that CMS recently announced that for the first year that ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.
This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from...
Editor's Note: Dr. White's extended-length letter can be read here.
APMA has reached out to CMS for additional clarification about CMS’ recently announced “flexibility” with regards to ICD-10 coding and claims acceptance following the October 1 transition. Specifically, APMA is seeking a better understanding of what CMS means by “valid code from the right family.” We will post the CMS clarification when it is received.
It should be noted, however, that CMS has emphasized that ICD-9 codes will NOT be accepted for claims with dates of service after September 30, 2015. APMA will provide updates to the podiatric community as more information becomes available.
APMA’s Coding Resource Center (CRC) has not one, but two ICD-10 crosswalk features built into its full-feature ICD-10 tab. In addition, the CRC Library tab includes, for paid subscribers, a completed (to the ‘root’ code level) sample ICD-10 charge ticket section. The CRC is accessible wherever the subscriber has an Internet connection. The CRC includes CPT, ICD-9, ICD-10, HCPCS, CCI edits, and Medicare LCDs. Subscriptions to the APMA Coding Resource Center are available to both APMA and non-APMA members.
Disclosure: I am one of the primary developers and promoters of the APMA CRC; I make no money from sales of CRC subscriptions.
APMA’s Coding Resource Center (CRC) provides a complete list of ICD-10 crosswalks relevant to the lower extremity. It also includes CPT, HCPCS Level II codes, and Medicare LCDs and fee schedules. Users can save favorites and view tutorial videos. The CRC is available wherever you have an Internet connection, allowing you to look up codes, check CCI edits, review your carrier's LCDs, get the latest coding and reimbursement information, and review a library of guidelines and articles.
APMA members receive a steeply discounted rate for subscribing to the CRC, and a portion of every subscription supports podiatric medical students through the APMA Educational Foundation. A seven-day free trial is available.
Paul Kinberg, DPM, Chair, APMA Coding Committee, Dallas, TX
When it comes to ICD-10 conversion systems, there are simple "tools" and then there are true "solutions." The "solutions" not only allow for coding accuracy, but they also allow for optimization of workflow and efficiency, the loss of which is just as expensive as coding inaccuracy leading to rejected claims. The SmartSheet10 Technology (smartsheet10.com) is the only solution that I have seen that integrates into any electronic health record, allows for the creation of provider customized super bills, and through simple clicks, identifies the most specific code by turning it green. It automatically identifies through pop-up alerts when a unique 7th character is needed.
Because it "dual codes" with both ICD-9 and ICD-10 codes and is integrated into your electronic health record, rules can be written to identify whether a specific carrier should receive the ICD-10 or ICD-9 code based on their readiness. All of this makes the SmartSheet10 technology a truly unique solution! While it comes included in the TRAKnet EHR, a monthly subscription can be purchased and integrated into any system.
Disclosure: I am an ICD-10 and coding consultant for NEMO Capital Partners, who own the software.
What Dr. Lukoff and most providers do not realize is that the sites that are free generally code to unspecified ICD-10 coding when you crosswalk the coding. This also happens in the majority of EHR software programs. So, the false sense of security is that you can stop with the coding that the website offers. Take, for example, a very simple diagnosis of hammertoe, ICD-9 735.4 - what the ICD10date.com site provides, like the majority of other mapping tools, is an unspecified code. Try it for yourself - you will get "2015 ICD-10-CM M20.40 Other hammertoe(s) (acquired), unspecified foot". So, if you drill down into the tabular version they provide, you will get the final coding (for this example) after 3 clicks. Do the same for more difficult codes in injuries like fracture of toe - 826.0. It takes several steps to get there.
ICDtenhelp.com, is a site I created; you pay an annual subscription. For people who are unsure, I offer a 7-day free trial to prove my point. It was designed to convert the ICD-9 to all the ICD-10 code possibilities, not just an unspecified code. You will need to know this when laterality exists and when the 7th character coding is required. Try the example I gave above (735.4 hammertoe in ICD-9). My site provides you all the options. It gives laterality, which will be needed. It does not require the doctor or biller to spend more time drilling down into the coding. The most important thing for me was to develop a site that is user-friendly and is quick. I don't know about you, but I value my time. Each click takes time, and time is money.
Disclosure: Dr. Freedman is the owner of ICDtenhelp.com
Any ICD code number description is only useful when it corresponds to a particular CPT code number description (and vice-versa). Any CPT code number description is only useful when it corresponds to a particular ICD code number description. A claim can be wrong, incorrect, and even falsely submitted if the ICD and CPT codes are not matched properly - the wrong ICD for the CPT, or the right CPT but the wrong ICD.
The way the two pair up is important. A CPT which was once used for billing using a given ICD-9 code may not still be used with that same ICD, because some of the ICD code number descriptions are changing. It's important to also know if the CPT still can be used with that ICD-10 code number description as it was used for a corresponding ICD-9 code number description.
Steve J. Kaniadakis, DPM, St. Petersburg, FL
Query: Free ICD-10 Crossover Site
From: Arthur Lukoff, DPM
For those of you who do not want to purchase an ICD-10 program, I suggest that you look into ICD10date.com. It has everything you need. After you enter the root code (this is an icon to the left), it shows a drop-down menu to finalize the code. You can crosswalk between ICD-9 and ICD-10.
Arthur Lukoff, DPM, Ellenville NY
RE: Preparing for ICD-10
From: Joseph Borreggine, DPM
Today, we started bridging our ICD-9 codes that we commonly use in our practice to the new ICD-10CM coding system. This is so I could get a handle on how to convert the current codes we are using to ICD-10. I am not billing with these codes, but rather just doing the conversion when I am done seeing the patient. Our practice has used the APMA coding resource center developed by Dr. Goldsmith and Dr. Freedman's coding conversion manual to generate our own codes that we would use in our office.
The initial process of conversion was rather time-consuming, but when it was done, it contained...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
RE: Unexpected Consequence of ICD-10 Switch
From: Richard Rettig, DPM
In preparing for ICD-10, I did what I thought would be a perfunctory call to my practice management software company, Visionary Medical Systems (one that has a sizable podiatry user base, as it was once promoted directly to podiatrists). Along the way, it was bought up by a larger company who also bought up other systems (familiar story - same thing happened with Medinotes, et al.).
Converting to ICD-10 would involve a large commitment of resources on their part, so they are electing to sunset all but one of their programs at this time. Oddly, they have done nothing to notify anyone of this. I feel bad for all those who will learn of this for the first time here. They offer another program, but only the demographics will be able to transfer over. It seems that none of the current programs I have tested compare in price to Visionary for clearinghouse submission and ERA.
I am currently looking for a new PM program (not EMR), and welcome any suggestions. Prime factors will be ease of use and price structure, and interactivity with an existing Medinotes program.
Dr. Kornfeld, I in no way fault your inaccurate assessment of me. I have given you no information about myself except for the income of the county I live in. I had honestly hoped that you would give some other advice besides uprooting my family to move to a different area. The fact that you didn't is not a big deal, I'm glad it has turned out so well for you.
I, however, can offer PM News readers another suggestion that was given to me two years ago. If you're not a part of one already, it is time to...
Editor's note: Dr. Shipley's extended-length letter can be read here.
The issue is not to sit back and come up with reasons why we can't get out of a situation. Generally, one would figure out better ways to deal with it. I think there are those of us who have come to the conclusion that many have reached the limits of acquiescence. We have trimmed our staff, grouped together to lessen overhead, tweaked our work flows, and have tried to follow all the rule changes and new regulations which have just increased our work load, all without increased fees. This is because you have absolutely no control over your fees for services rendered and your overhead with all the new regulations.
So, the issue then becomes how to take back control of your business or change your occupation. I agree that different locations are more business friendly and lend to different work models. Our organizations have done much good over the years, but now only help us become more entrenched into the current system - a slowly sinking ship. If, however, all doctors were properly educated as to the business of medicine in the 21st century, they would stand a better chance. Being contract labor for insurance or the government that wants to make all the money and leave us with a pittance while imposing all these conditions is not what any reasonable business person would sign up for. It was not always this way and doesn't have to be if medicine would only flex its muscle. This conversation should continue.
Dr. Kornfeld, you recently posted a thread in PM News that once again stated the need for all podiatrists to move toward a cash payment situation. Even though I don't disagree with your assessment of our nationwide current standings in the medical community with insurance companies and our scope of practice, I do believe some things need to be put into perspective. Assuming that not all podiatrists will convert to your cash model in one unified motion, what do you think will happen in my situation?
(I took the liberty of researching the demographics of the area in which you practice compared to mine.)
According to a 2009 estimate, the median income for a household in the CDP was...
Editor's note: Dr. Shipley's extended-length letter can be read here.
With all that I have been reading regarding the transition to ICD-10, I was wondering if anyone has thought about the fact that every insurance company will now have to utilize the new coding, and this would be the best time for someone (CMS) to mandate a single universal insurance form?
I do not believe that we will be able to utilize the forms as currently printed due to the expanded coding. I would love to hear my colleagues' thoughts, especially those who have been advising us to better prepare as there will be no delay this time.
With the recent failed Obamacare roll-out for the health insurance exchanges, I would like PM News readers to ponder the following:
With the way the new ICD-10 changes will affect healthcare delivery next year when it goes into effect Oct 1, 2014, I would like some to comment positive or negative on how it will affect the profitability of all medical practices across the country due to the coding complexity and...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
ICD-10 has adverse financial consequences well beyond those concerned with preparation for the transition. A Canadian hospital study of ICD-10 implementation reported physician productivity losses of 50% in the first month. A year later, the loss continues at 19%. It is unlikely that the change-over in the U.S. will fare much better.
Anticipation of claims processing interruptions, coding errors, and other heretofore unknown issues, are estimated to result in at least 5 percent physician income loss, and up to a 30 percent short-term cash flow loss. Of course, income loss is money...
Editor's note: Ms. Thompson's extended-length letter can be read here.
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