ICD-10 delay: What does this mean for optometry?

Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D. 

The Centers for Medicare and Medicaid Services (CMS) had repeatedly stated that ICD-10 implementation would occur on October 1, 2014—no ifs, ands or buts—then Congress stepped in.

This unexpected delay will give us all more breathing room, but only if we take advantage of the extra time.

Congress was supposed to get a permanent fix in place for the roller coaster ride we take all too often regarding Medicare fees. The last fix in late 2013 was supposed to give them enough time to replace the current sustainable growth rate (SGR) formula used to calculate fees. The SGR is not working at all, and would require ODs to take a 24 percent or more reduction in fees. The U.S. House and Senate could not agree and put the permanent fix on hold yet again.   

Also in the bill—Protecting Access to Medicare Act of 2014—was a little surprise for all providers. Congress included a one-year delay in the implementation of ICD-10. This one-year delay follows the previous one-year delay in implementation by CMS that occurred early in 2013. While many are quite happy with the delay, others in the health care industry are not so happy because, per CMS, the estimated cost of another year delay in implementing ICD-10 is between $1 billion and $6.6 billion.

What should optometrists do during the delay? Many ODs had begun to gear up for the transition to ICD-10 scheduled for October 1, 2014. The AOA Third Party Center (TPC) strongly advises ODs to continue this preparation.

This unexpected delay will give us all more breathing room, but only if we take advantage of the extra time. Follow these tips to help you understand and prepare for the new system:

  • Listen to, and participate in, the TPC webinars on ICD-10 to learn and really understand how to use this new coding system.
  • Read as much as possible and attend in-person lectures, such as those offered at Optometry's Meeting® in June in Philadelphia.
  • Review your office procedures to determine where ICD-9 codes are currently used.Begin to convert your typical ICD-9 codes to ICD-10 codes. Each week, also sample a few encounters that were different or unusual. Convert those codes as well.Practice with the new system will be time very well spent.
  • Use the tools from the TPC: The TPC will continue to host new webinars on ICD-10 coding conversion throughout the year. All webinars are recorded and available for you to review on AOA EyeLearnTM. Register now for the next one, on glaucoma and optic pathways, being held Friday, May 23, at 1:30 p.m. Eastern time. The AOA Coding Today webpage has a link on ICD-10 which will be refined over the next year. This tool is an excellent resource.

Finally, while the World Health Organization has some good introductory information to orient providers to this new approach, remember that the U.S. version of ICD-10 is not the same as the international version. The Centers for Disease Control and Prevention is responsible for the U.S. version of ICD-10 and is your go-to resource. 

May 1, 2014

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