ICD-10 Training: What's the cost and who should receive it?

Maxine LewisQ:  I’m developing a budget for my practice for ICD-10-CM. Who should I train on ICD-10-CM? How much will it cost? Ours is a small practice with two full-time providers and four ancillary staff in addition to the biller and coder.

A:  Let’s start with the appointment scheduler. This individual should first determine if this is a new or established patient. While the scheduler does not have to know the exact code number, it is helpful to know what the descriptor requires to properly schedule the appointment. Eligibility must also be addressed at this time.

Physicians and midlevels should be aware of ICD-10-CM coding requirements. If x-rays or surgical procedures are performed in the office, the relevant staff should learn the appropriate ICD- 0-CM codes.

This new coding system allows for considerable specificity. Was the problem on the right or
left side? Is this an initial visit or a follow-up? Was there sequelae? The documentation in the medical chart must indicate this kind of specificity to properly code a service. The information translated from the chart to the superbill is vital for correct coding and reimbursement, and of course must be substantiated by the documentation. There are still choices of codes with descriptors of “unspecified” but these are to be avoided.

Obviously, coders and billers must be trained to use the new coding system. These personnel will require the most extensive training.

The Medicare National and Local Coverage Determinations and the Medically Unlikely Edits must be reviewed. Many of the measures for Physician Quality Reporting System are based on diagnoses, and coders and billers will need to review these. They will also need to understand the payment guidelines used by commercial third-party payers.

Coders and billers must have an understanding of medical necessity, which is a major determinant of payment for services. These personnel may also be responsible for handling appeals. It’s going to be interesting to see how many claims are submitted accurately in the first 6 months after implementation.

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Training time

The Medical Group Management Association recommends that medical practices plan for 16 to 24 hours of training for the clinical staff and 40 to 60 hours for coding staff.

Contracts with payers frequently contain “carve outs” and other specified procedures either for additional payment or procedures not covered. Renegotiating contracts will be important for proper reimbursement.

Plan on spending about $2,400 on staff education and training costs. Most importantly, there will be a significant cash-flow reduction with the increased cost going to information technology, changes to business processes and superbills, and increased documentation.

The Centers for Medicare and Medicaid Services has done a fine job in assisting practices-even providing a timeline for compliance. Even though ICD-10-CM will not go into effect until October 1, 2014, the time to prepare is now.

The answer to our reader’s question was provided by Maxine Lewis, CMM, CPP, CPC-I, CCS-P, president of Medical Coding & Reimbursement in Cincinnati, Ohio. Send your coding questions to medec@advanstar.com.

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