Preparing for ICD-10: Steps for urologists to take now, later

I have been bombarded with advertisements to get trained for ICD-10. What do I need to do to get ready for ICD-10, and when do I need to start?

ICD-10 is scheduled to be implemented Oct. 1, 2014. The American Medical Association has requested a delay, and at least one member of the House of Representatives has responded by introducing legislation to delay the implementation yet again. However, the amount of money that has been spent by payers and vendors with deep lobbying pockets has made the delay of ICD-10 implementation highly unlikely. As such, we are recommending that every practice assume that Oct. 1, 2014 is the implementation date.

PRS looked at the implementation date of Oct. 1, 2014 and worked backwards to come up with the following recommended time frames for a practice’s approach to ICD-10 coding.

July 2013. Name ICD-10 champion(s) in the practice. The role of the champion(s) is multifaceted and will need to include:

• contacting system vendors to obtain proof of ICD-10 readiness or projected deadlines

• starting to learn ICD-10 to determine the effect of the change on the practice

• developing a timeline for training of other practice members

• developing training material or selecting a vendor for training staff

• determining current ICD-9 common codes and beginning to develop a clear method for selection of ICD-10 codes for those diagnoses.

April 2014. Begin training of full practice staff in ICD-10 training based on systems used within the practice. PRS recommends two tracks for training:

• Track 1: Physicians and other clinical staff training should focus on ICD-10 coding from clear descriptions. ICD-9 codes crosswalks and comparisons should not be included in training of this group. (Crosswalks from ICD-9 to ICD-10 have been developed with input from the AUA; they are called General Equivalency Maps [GEMs]. Although these provide guidance, they will not be exact and should be used as part of training and are not a substitute for learning ICD-10.)

• Track 2: Training for administrative and billing staff will need to include both training on ICD-10 direct coding and crosswalk and ICD-9 comparison.

As PRS has begun final preparation for our “train the champion(s)” workshops, which begin in July, it is apparent that the new coding structure will impact both the clinical documentation and the coding process. That being said, the change is not the end of the world that has been predicted by some. It is another change to which urologists will have to adapt in the avalanche of change we’re experiencing in health care.

In your January 2013 column (“How to bill for separate stones in the same kidney,” page 32), you mentioned that you can bill for two separate stones if they are located in separate parts of the same kidney. The operative report should also reflect this point. Does this hold true for percutaneous nephrolithotomy as well? I just completed a prolonged PCNL with a 6-cm renal pelvic stone, a 2.5-cm upper pole stone, and three 1- to 2-cm stones in the lower pole calyx. My average PCNL takes 60-90 minutes, but this case took 4-plus hours.

Medicare does not “discriminate” among types of surgery, and the CPT codes for this area do not include references to multiple stones. Therefore, if the stones were separate and were not contiguous, then they could be charged separately from the viewpoint of the Correct Coding Initiative. As you know, you are not being paid 100% for all procedures and instead, you will be paid the multiple procedural rates for each additional procedure. We recommend that you have radiologic proof that the stones were separate and were not contiguous prior to beginning the surgery. If payers are not recognizing the multiple-procedure billing, you will be forced to report your calculus removal codes with a modifier –22 to attempt to increase the reimbursement for the extra work.UT