As all of healthcare creeps closer to the ICD-10 deadline, there are a few mistakes that chiropractors want to avoid during their training and implementation. In today’s post, we will start with perhaps the most innocent (and dangerous) errors: the code converter “iceberg.” Here’s how to avoid this mistake:
The Code Converter Iceberg
Many chiropractors naively assume that the crosswalk from ICD-9 to ICD-10 will be perfectly paved by a “code converter.” In case you are not at all familiar with how code converters function, they work similarly to a language translator tool whereby you enter a word in English to find it’s equivalent in a foreign language. In this case, you enter the ICD-9 code and the ICD-10 equivalent is given.
There are several code converters widely available online and free to use, such as the one provided by the American Academy of Professional Coders. As you might imagine, many EMR systems are employ similar tools inside their system so that you can move from the ICD-9 codes you know to choosing your favorite ICD-10 code. All of this sounds fantastic until you dive a little deeper into ICD-10 and realize that code converters are just the tip of the coding iceberg, with the real danger lurking beneath the surface.
What the Code Converter May Miss
Once you go beyond surface-level ICD-10 crosswalks, you will quickly realize the shortcomings of the code converter. For example, here is what code converters typically miss:
- Lack of Specificity: Many code converters also point you in the right direction but lack the specificity needed to get you to the correct destination. For example, if a converted code is M59.0 (unspecified, aasdf) it may appear that this is the correct choice as that is the only thing the code converter spit out. The reality is that M59.1 denotes the left side and M59.2 denotes the right. Given the fact that you should know whether your patient’s problem is right or left sided, M59.0 immediately becomes a bad choice although, unfortunately, it was the only choice given.
- One-to-Many Correlations: If an ICD-9 code has a single ICD-10 code equivalent, the code converter can be a fine tool to quickly get you there. In other words, you plug in ICD-9 code 123.45 and out comes ICD-10 code A98.765 (not real codes, either way). Unfortunately, this works for only a fraction of ICD-10 codes. Because, in reality, the majority of ICD-9 to ICD-10 conversions are not one-to-one (a single ICD9 code = a single ICD10 code) but one-to-many (a single ICD9 code = several or many ICD-10 codes). Obviously, then, the code converter leaves you thinking that your job is complete, when in fact, you have only a fraction of the codes needed.
- Code Converter “non-Translations” – one aspect of ICD-10 that you probably have heard repeatedly mentioned is the fact that there are many more codes as compared to ICD-10. While some of these codes are more specific variations of ICD-9 (as above, denoting left or right), some of the ICD-10 codes simply didn’t exist in ICD-9. When this is the case, the code converter will fail you. Obviously, the technology is not intuitive enough to find an ICD-9 code when one did not exist.
- Target Temptations — perhaps the greatest temptations to use the code converter to quickly solve problems will not be faced by the chiropractor, but by their staff! As ICD-10 gets underway, it’s easy to envision a scenario where the unprepared doctor and staff come upon a situation where they need an ICD-10 code for an infrequently used diagnosis. The well-intentioned staff member quickly gets out the code converter, slaps down the new code and is onto her next task…only to discover later that they chose an unbillable code, an inappropriate code or one that gets denied due to lack of specificity.
The Bottom Line
If you take the above points into consideration, here’s the bottom line:
- Do Not Use Code Converters as a Stand Alone Tool – code converters are great because they are much faster solutions that digging out your code book and finding the appropriate code. But given their limitations described above, they should be double-checked or at least taken with a grain of salt. Using a code converter alongside your coding book can be a great way to gain speed without sacrificing accuracy.
- Be aware of your EMR limitations: if your EMR system contains a “translation tool” that functions similarly to a code-converter, it will possess the same limitations. Unfortunately, many chiropractors are approaching ICD-10 with complete faith that their EMR system will get them there and provide all the tools necessary. In a perfect world, this would be the case. And while I do believe that most reputable EMR systems will have all the tools necessary for you to function in ICD-10, learning how to USE the tools is still your responsibility.
- Understand the Crosswalks to ICD-10 – finally, most of the code-converter disasters will be averted by those who can recognize their structure and who have a working knowledge of how codes function in ICD-10. Chiropractors who possess these skills will understand the limitations of code converters and be able to utilize their potential time saving ability as well.
Are You Ready for ICD-10 Yet…
Understanding ICD-10 crosswalks and avoiding these mistakes are much easier than you might imagine, especially when you consider that you can learn it all ONLINE through our ICD-10 Implementation Course for Chiropractors and Their Staff. Get started on the road to ICD-10 today, at your own pace and from the convenience of your own home or office!