Orthopedics and ICD-10: No need to fracture your practice while making the switch

Written by Dr. Jason Weisstein, MD, MPH, FACS, Medical Director of EMA Orthopedics at Modernizing Medicine | August 12, 2015 | Print  |

Orthopedic surgeons, as with most physicians in the modern healthcare industry, must always operate at peak efficiency to adequately treat their growing patient load.


They are also required to stay updated and adhere to all of the mounting government mandates such Meaningful Use, PQRS, HIPAA and of course ICD-10. While ICD-10 has seen numerous delays and physicians have been granted a grace period after the October 1st start date, there are advantages to be gained from adopting the more modern and structured code set. ICD-10 may seem daunting, but the fact is that with some careful planning, concerted effort and the right tools, orthopedic physicians stand to benefit from the new codes with improved care and streamlined operations. ICD-10 will improve the recognition of injury risk and severity, improve communication between providers and insurers and potentially allow for improved payment models.


To get an idea of the potential challenges associated with ICD-10, I looked at 50 of the most common ICD-9 codes for orthopedics. Upon translation to ICD-10, I discovered that the codes break out into over 1,000 new, more granular codes. When I say granular, here are a few real ICD-10 codes that demonstrate just how specific these codes are.


T63622A – Suicide by jellyfish
V9542XA – Injury during forced landing of a spacecraft, initial encounter
V9107XA – Burn from water skis catching on fire
W61.12XA – Struck by Macaw, initial encounter


Doctors are already under tremendous pressure without having to code for spacecraft, jellyfish, or macaws and adding roughly 140,000 new health codes to the mix presents another potential hurdle. With the onset of ICD-10, doctors wishing to migrate to the new codes will now have to also account for context of injury, site specificity, laterality, degree of fracture, fracture healing stage, place of occurrence, procedural complications, etc. For example, what is traditionally known as a closed 2 part surgical neck fracture, will soon become a two-part displaced fracture of surgical neck of right humerus, initial encounter for closed fracture, which is, of course, an S42.221A in ICD-10 jargon. The specificity in many cases will reach to the sixth or even seventh character level.


Physicians who are forced to manually translate from traditional ICD-10 codes will potentially face serious interference with their patient interactions and workflow. Additionally, those who are unable to effectively adopt ICD-10 in a way that automatically generates codes are missing out on a substantial opportunity to collect a huge number of structured data sets, which can ultimately be mined for trends in orthopedic disease modification and subsequently best practices for diagnoses and treatment.


While there will come a time when ICD-10 coding will be mandatory for reimbursement, the potential rewards for those who effectively adopt the new codes at the outset may outweigh the consequences. Preparation is the key, and while it's important and necessary for doctors to embrace and get educated on the options for the transition, preparation is not only the responsibility of the doctor. If the technology exists to more effectively transition to ICD-10, then some responsibility must also lie with the technology vendors.


Here are a few key best practices that can enforce vendor responsibility and help the provider choose the best solution:


Don't delay. It may seem obvious, but procrastination may be one of the biggest threats associated with the move to ICD-10. This is only exacerbated by what seems like perpetual delays and leniency in enforcing the new codes. As a result, nearly all ICD-10 resources emphasize the importance of planning for the code change – from determining the amount of budget you'll need to invest in systems and staff training, arranging for any system implementation and anticipating the potential revenue impact to your practice during the changeover.


Contact your technology vendors and hold them responsible. If your practice is using an electronic medical records (EMR) system, practice management (PM) system, or other billing systems, contact the individual vendors and ask about their plans and preparedness for ICD-10. Ensure that your technology vendors will help you to automate ICD-10 and operate on structured data to help extract value from the increasing amount of health information collected.


Talk it through. Communicate with your technology vendors early and often to ensure that you understand their readiness and that you have all the information you need. You may also want to inquire about how your other service providers, such as coders and claims clearinghouses, plan to transition to ICD-10 and how that may affect your practice's plans. ICD-10 has many moving parts, so you'll want to ensure that all of your technology vendors and partners – and staff – are moving forward with a clear and synchronized plan.


Always consider workflow. If your practice has an EMR system in place, understand
whether that software will automatically assign the exact ICD-10 code to a diagnosis, or if you'll need to select from a range of codes during or after the patient visit. Because of the specificity and long list of choices for the new code set, manually selecting from a range of choices will likely slow down your documentation at the point of care, leave you more vulnerable to choosing the wrong code and ultimately negatively affect workflow. As any physician in private practice knows, margins are thin, and if your EMR system requires manual searches to identify ICD-10 codes, you might lose a minute or two per patient visit.


Think of the big picture. Instead of viewing ICD-10 as a box to check on a seemingly endless government compliance "to do" list, consider ideas to shift the challenge into a strategic opportunity for your practice. With a bit of research, you'll find new technologies that can automate the complexities of managing the ICD-10 transition for you. Select a solution with intuitive data capture and coding system that will automatically assign your documentation to the correct, specific ICD-10 code. Leverage technology to take the manual steps out of the coding process.


ICD-10 will be a major shift for orthopedic practices in 2015 and beyond, and while change of this magnitude can be daunting, a well-planned transition to ICD-10 actually represents a significant opportunity. It will be essential to educate and prepare staff for the deluge of new, highly specific codes and develop appropriate workflow adjustments. As adoption of EMR and PM systems continues to soar, it will also be important to ensure that any existing or prospective technology will support the new codes and also minimize workflow interruption.


Ultimately, ICD-10 will affect your practice in either a negative or positive way, and it is up to you to make a plan and ensure that your technology vendor partners are on board and accountable for the impending shift.

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