Orthopaedic surgeons have less than 6 months to ready their practices for the change from using the International Classification of Diseases, 9th edition (ICD-9) to ICD-10. The federal government may have delayed implementation of many parts of the Affordable Care Act, but it is not going to delay implementation of ICD-10.

Beginning Oct. 1, 2014, orthopaedic practices will be required to use ICD-10 diagnosis coding. Practices that are not prepared and ready to code using ICD-10 will see their revenues disappear. Orthopaedic surgeons and coding staff who are not trained to use the ICD-10 coding system will see their claims denial percentage skyrocket, practice revenues drop precipitously, and personal income drop to poverty level.

The following 6-month prescription will help ready a practice for ICD-10 diagnosis coding.

Education and training
Orthopaedic surgeons and their coding staff will need education and training in the code structure, code descriptions, and patient documentation changes that are necessary to meet the standards required by the ICD-10 coding system. It is simply not realistic to think that a simple search will facilitate the transition. For example, a search of ICD-10 code descriptions for “proximal humerus fracture” will generate absolutely no results. But in fact, ICD-10 includes 1,527 possible codes for a fracture of the humerus.

Orthopaedic surgeons will need to review the clinical documentation required for the top 25 or 30 ICD-9 codes used in the practice. The next step will be to review the ICD-10 code descriptions for these diagnoses and identify the changes that need to be made in documentation.

Coders will need to review anatomy and physiology as well as the code structure. ICD-10 requires more precision and specificity. Coders will need to learn about using the “External Causes of Injury” codes for musculoskeletal trauma.

If the practice employs more than one coder, an internal “peer review” process, in which one coder reviews another coder’s documentation, may be helpful. If physician documentation is judged to be insufficient, coders will need to develop a system to review patient files.

Working with vendors
Every practice should have a list of the vendors that support medical record coding. This may include the electronic medical records system, the practice management and billing system, the picture archiving and communication system, the claims clearinghouse, direct billing software, the Medicare fiscal intermediary, and more.

Practices must begin the communication process to identify the software updates necessary for implementation of ICD-10 immediately. Schedule a testing program where you can submit claims for processing to determine if your coding documentation and code choice(s) are accurate and accepted. According to the Centers for Medicare & Medicaid Services (CMS), in the early stages of implementation, denial rates will double or even triple and days in accounts receivables will grow by 20 percent to 40 percent.

Practices should determine their current claims denial percentage to project a worst case scenario. Because most payers require resubmission of denied claims within 30 days, if denials increase to the extent that resubmissions are backlogged, practices may end up foregoing payment.

AAOS helps
During the 2014 Annual Meeting, the AAOS will hold the following instructional course lectures (ICL) and symposia that will present information on coding and ICD-10 implementation:

• ICL 192—The Top 10 Coding Issues Facing Practicing Orthopaedic Surgeons (Tuesday, March 11, 1:30 p.m.–4:30 p.m.)
• ICL 308—Getting Ready for ICD-10 and Meaningful Use Stage 2 (Thursday, March 13, 8:00 a.m.–10:00 a.m.)
• ICL 408—Coding and Reimbursement Update 2014 (Friday, March 14, 8:00 a.m.–10:00 a.m.)
• Practice Management Symposium for Orthopaedic Surgeons (Tuesday, March 11, 8:00 a.m.–5:00 p.m.)
• Symposium W—Health Care Reform: How Can We Adapt? (Friday, March 14, 8:00 a.m.–10:00 a.m.)

The AAOS also has a 3-part webinar series on ICD-10 coding, which was presented during 2013. Recordings of these programs are still available (www.aaos.org/courses). In addition, AAOS Now has published a number of articles on various aspects of implementing ICD-10, which are available at www.aaosnow.org

Finally, AAOS and KarenZupko and Associates (KZA) are working on a new educational program designed to help orthopaedic surgeons and their staff code the highest frequency diagnoses in each orthopaedic specialty domain. This new series will be available later this summer.

The AAOS–KZA practice management courses for 2014 also include a new program, “Focused ICD-10 Training.” The course will be presented in multiple locations; details can be found online at www.aaos.org/courses

The bottom line? Orthopaedic practices that are not prepared to use the ICD-10 coding system on Oct. 1, 2014, should be establishing a line of credit so that they will be able to stay afloat until they can begin submitting accurately documented and coded patient claims and cash flows return to normal.

Howard Mevis is director of the AAOS department of electronic media, electronic programs, CME-course operations, and practice management group. He can be reached at mevis@aaos.org