Oncology Practices Face the Biggest Change in Coding Since the Computer-ICD-10

Nick Sambides, Jr.
Published: Wednesday, Mar 05, 2014
Doug Moeller, MD, a medical director at McKesson Health Solutions

Doug Moeller, MD

If you’re not ready for ICD-10, you’re not alone.

Set for full rollout on October 1, the much delayed 10th revision of the International Statistical Classification of Diseases and Related Health Problems is probably the biggest revision to medical coding and billing since computerized medical coding and billing practices began decades ago.

And like the rest of the medical community, oncologists and their support staffs and services face a lot of learning and uncertainty as they prepare to make the transition. Their biggest and most pressing question: How will I get paid under the new system? 

Doug Moeller, MD, a medical director at McKesson Health Solutions, has been working with most major health plans providing software for claims auditing, medical practices, and episodic care. Preparing for ICD- 10 has been a major part of his job.

Create a Cheat Sheet

“Learn first the codes you are most likely to use,” Dr. Moeller said during a recent interview. “What are the codes that you use most? It is probably, I am going to tell you, about 400 to 600 codes for an average oncology practice, for their daily business.”

For a first step to surviving the transition from ICD-9 to ICD-10, he advises that oncologists and their practice support staff compile a list of the codes they most often use under ICD-9. Then they should find the equivalent codes within ICD-10, he said, and make sure that everyone who is part of a given practices’ billing procedures, from doctors to billing managers, understands those codes and where they fit within the daily grind of the practice.

That list “might not be as precise as I will need but it will get the job done. It will make sure that I get my billing out,” Moeller said.

Like ICD-9, ICD-10 has general diagnosis codes that physicians can apply to the earliest billings under the new system. Later billings, he said, can grow in detail and complexity as the physicians and the insurers who handle the physicians’ claims grow more comfortable with the new system.

Code selection should be basic or conservative initially, he said. Codes that seem out of place or exotic to insurance companies will likely raise red flags that will delay the billing process— sometimes for months.

Oncologists can check with their medical associations or regional colleagues for help finding the ICD-10 equivalents to their present basic and advanced codes. Once the “cheat sheet” is initially compiled with all the codes used most frequently, the list should grow by a few hundred a month until it is all-encompassing, Moeller said.

Who Handles the Transition?

Moeller and Dawn Cook, chief practice officer at Penobscot Community Health Care, a nonprofit health center that has 19 outlets throughout Maine, recommend that practices identify individuals already well versed in coding to specifically handle the ICD-10 transition for their offices.

Dawn Cook

Dawn Cook

Cook advised that practices have one or two staffers trained not just in ICD-10 through the various indoctrination programs offered by medical associations, but also in project management, defined by the Project Management Institute as a temporary group activity designed to produce a unique product, service or result.

Small practices comprising of 1 to 6 doctors might not have the funding to hire more staff to tackle the ICD-10 transition, Moeller and Cook said, but designating one or two people already within a practice and familiar with coding to the transition would be wise. Hiring more staff “isn’t something small practices could bite off,” Cook said, “but they can and should have their managers and lead billers take training and tips about project management.” Project managers “take the essence of the idea and run with it,” tailoring small portions of generalized projects like the ICD-10 transition to available staff and ensuring that the individual efforts all fit together comprehensively, Cook said.

“As a profession, health care professionals have not been savvy as project managers, but we have the capacity to do it and now it is a buzzword with many associations that are offering training in this area,” Cook said.

Helpful Organizations

The American Health Information Management Association and the American Association of Professional Coders are 2 of the many professional organizations offering ICD-10 training, Moeller said.


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