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the upper or lower arm, if it was distal or proximal aspect, and whether the in- jury was a first occurrence or a recurrent issue.


“The nice thing about ICD-10 is that we will be able to spell out very clearly the patient’s clinical condition, which is not something we can do with ICD-9,” said Rhonda Buckholtz, AAPC vice presi- dent for ICD-10 training and education. “The hopes are that we can compare bet- ter information. Now, when we do a clin- ical study, there are often times when we aren’t able to compare apples to apples with other countries.” The reams of new data collected will be a gold mine for researchers who want to study disease patterns and trends. “As more data become available, re-


searchers can put together protocols and practice patterns,” Dr. Spain explains. “On a very large scale, we can start to maybe see how some treatments work and maybe which ones don’t. We can conduct research on the best way to pro- vide services and what services are the best to provide.” Dr. Spain admits that it may take up to five to 10 years of data collection be- fore such research will be fruitful, but “conversion to ICD-10 is the first step.” Ms. Buckholtz said physicians are in


a “wait and see” mode regarding how ICD-10 will affect reimbursement from payers. “They need to work with their health plans as they make the changes. One thing common across the board is that this has to be revenue neutral,” she said. “The health plans can’t pay out more in going from ICD-9 to ICD-10. It’s now up to doctors to document well enough to get reimbursed for all they are doing in their offices.” Pay-for-performance initiatives will change as well, but it’s hard to know how that will be accomplished, Ms. Buckholtz said. In fact, it’s probably too early to understand the full extent of how the switch to ICD-10 coding will af- fect the practice of medicine. What is clear, however, is that if phy- sicians haven’t already begun reading up on ICD-10 coding or haven’t taken any steps to prepare their employees or of-


26 TEXAS MEDICINE February 2012


fice operations, then the time to start is now.


Physicians can ease the transitioning


process by taking a good look at the fol- lowing areas.


Rethink the way you document. Because ICD-10 codes provide a pletho- ra of specific codes, it demands that phy- sicians be very specific in documentation. “It might not be easy to remember or


to be in the habit of collecting that in- formation,” Dr. Spain said. “We have to improve our documentation. The doctor has to learn all this and take the time to gather the information and get it into the record.” For example, today, a physician has only one code choice under ICD-9-CM to record the diagnosis of a fractured clavicle. Under ICD-10-CM, there are 24 codes from which to choose. “Coders can assign only a diagnosis code that best matches your assess- ment. The less specific your assessment, the less specific the code assigned,” Dr. Spain said. “Here is where the trouble lies: Most payers will not reimburse for nonspecified or unlisted diagnosis codes. The result will be unpaid claims.” He adds that the large variety of ICD- 10 codes offered will most profoundly affect orthopedic surgery and emergency medicine. “For trauma and injury, there will be


required codes for mechanism of inju- ry and place of injury,” Dr. Spain said. “Those two specialties see so much trau- ma and injury they will have to carefully document how the injury occurred and where it occurred to submit their servic- es accurately for reimbursement.”


Suggested action


Ms. Buckholtz said physicians should start getting in the habit now by audit- ing their charts. She recommends re- viewing the most frequently used codes and taking a look at the documentation behind some of those codes to see if it includes stringent enough data to accu- rately assign an ICD-10 code. TMA Practice Consulting offers cod-


ing and documentation audits for phy- sicians to determine if their documen-


tation sufficiently supports the level of service coded and billed. Certified pro- fessional coders and medical auditors perform the reviews. (See “TMA Can Help Your Practice Switch to ICD-10,” page 32–33.)


Practices can opt for a comprehensive audit, which is approved for 20 AMA PRA Category 1 Credits™. The compre- hensive audit concludes with a formal, written report that offers:


• An executive summary of the physi- cian’s practice.


• An overview of audit findings, includ- ing coding trends. errors, and oppor- tunities for improvement.


• A summary of each medical record, indicating whether it was coded ap- propriately, along with the reason(s) for the determination. (Legibility, timing of chart authentication, diag- nosis identification, practice fees, and billing discrepancies are also covered in this section.)


• An evaluation and management (E&M) code utilization analysis, com- pared to specialty benchmarks, per provider. This includes graph illus- trations and a breakdown of charges, percent code distributions compared to other providers in Texas, the cal- culated variance, redistribution of frequency and charges, and charge differentials.


• Educational tools and resources, in- cluding coding guidelines, articles, and other reference materials.


In lieu of a comprehensive audit, phy- sicians can sign up for a more affordable medical records and coding “checkup,” which is an abbreviated review of claims coding and medical record documenta- tion. A checkup provides a glimpse into a practice’s coding techniques and al- lows physicians to realize through visual illustrations the underlying trends that directly affect practice revenue. “We can design elective coding and


documentation reviews to fit within every practice’s budget; it’s not a one- service-fits-all or a flat fee,” said TMA practice management consultant Heath- er Bettridge. Ms. Bettridge is a TMA


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