ICD-10 and ASC! Know what to Expect Initially


Well the day has dawned and ICD-10 is here! And even though the thought of whether ICD-10 is going to affect me or not is still lingering, think again! ICD-10 will affect every provider who used ICD-9-CM diagnosis codes to bill for services provided and hence will now need to transition to ICD-10-CM. The Ambulatory Surgical Centers who employed ICD-10 CM are also affected.

But, the only saving grace is that the ASCs do not have to worry about the procedure portion of ICD-10 also known as ICD-10-PCS as most of the surgery centers usually use the CPT codes to bill for procedures performed.  ICD-10-PCS is much more difficult than ICD-10-CM to grasp because proficiency in anatomy, physiology and terminology is required. Moreover, coders will also need to understand how operative procedures are performed.

So what changes should we be seeing for ASCs using the ICD-10 system?

  1. Coding Knowledge: well for long dual coding has been in the offing to help make the transition from ICD-9 to ICD-10 smooth. But with ICD-10 finally in, and the various new codes that require added diagnostic information to be put in which will still require anatomy and physiology knowledge. Wrong coding of the laterality could and will cause unnecessary resubmission
  2. Improved Documentation: Focus will now initially be in putting information in as much as possible. This is most required given the increased number of codes and hence an increase in documentation will follow which means more precise information input requiring better trained coders
  3.  Pairing of ICD-10 codes with CPT codes: If the ICD-10 codes do not match with the CPT codes, this will affect claims as ASCs may not be reimbursement totally for the procedures carried out. For example if two diagnosis codes used which correspond to four CPT codes to describe the entire procedure, and these do not match, then the claim can be partially rejected.
  4. ICD-10 diagnosis coding requirement: Although CPT codes for outpatient surgery are the same and haven’t changed, but anyone covered under HIPPA, will still require the new ICD-10 diagnosis code to be entered. Whatever CPT code is submitted for payment,  at least one ICD code to support the reason for the encounter needs to be attached
  5. Online submissions:  CMS now insists that data for web-based measures relating to all ASC patients (Medicare and non-Medicare) are to be submitted using a web-based tool and if not done this will then determine future payment adjustments to those ASCs. So this will lead to a reduction in cash flow now and in the future
  6. ASCQR Program requirements: The Consumer Price Index (CPI-U) for all urban consumers is adjusted each year for each ASC based on its performance in the Ambulatory Surgical Center Quality Reporting (ASCQR) Program. ASCs that do not meet ASCQR Program requirements will receive a two percent reduction in their ASC annual payment update.

So yes, ASCs will see a loss of productivity initially, as some studies have predicted that ICD-10-CM/PCS coding will take 69 percent longer overall, which will result in a slowdown of cash flow. So unless your coders have been trained and drilled with the new ICD-10 coding and diagnosis codes, and are equipped to handle the documentation with improved knowledge of anatomy and physiology and online submission claims, there will be an initial hit to your cash inflows.