The contentious ICD-10 transition, often likened to Y2K in more ways than one, hasn't gone off without a hitch. It hasn't caused terrible disruption either.
Four weeks after providers first transitioned to ICD-10 on Oct. 1, the Centers for Medicare & Medicaid Services (CMS) report claims are processing normally with only minimal holdup. Of the 4.6 million claims submitted daily from Oct. 1-27, 10.1% resulted in denial with only 2% attributed to incomplete or invalid information.
Furthermore, only 0.09% of denied claims resulted from an invalid ICD-10 code, compared to a baseline of 0.17% in end-to-end testing, CMS states. As it takes Medicare claims several days to process and two weeks (by law) before providers receive payment—Medicaid claims can take up to 30 days—the numbers are preliminary and CMS plans to periodically update the data in weeks ahead.
While the vast majority of providers experienced no interruption with claims, the AOA did receive reports from doctors of optometry that Medicare Administrative Contractors (MACs) were inappropriately denying claims for eye exam codes, even when the reported diagnosis appropriately supported Medicare coverage and payment for the exam.
"The main issue appears to be Medicare carriers and private insurers not having all the ICD-10-CM codes properly programmed into their systems," says Rebecca Wartman, O.D., AOA Third Party Center Executive Committee member and AOA Coding Expert. "Several Medicare carriers omitted important diagnoses from their Local Carrier Determinations for ICD-10-CM. I am beginning to hear reports about very slow payments from private insurers, as well."
The AOA confirmed with the CMS ICD-10 Ombudsman that the agency is aware of the problem nationally, and that the affected claims will be reprocessed. Doctors can check their Medicare claim status through the following channels:
- Interactive Voice Response (IVR): IVR gives providers access to Medicare claims information through a toll-free telephone number. Visit your MAC website for information on the Provider Contact Center and IVR user guide.
- Customer Service Representative: Visit your MAC website for information on the Provider Contact Center only if you are unable to access claims information via IVR.
- MAC portal: Visit your MAC website for portal features and access.
- ASC X12: The ASC X12 Health Care Claim Status Request and Response (276/277) is a pair of electronic transactions you can use to request the status of claims (via the 276) and receive a response (via the 277). Visit your MAC website for more information.
Member questions about the ICD-10 transition
Despite the substantial coding shift that is ICD-10, and the delays associated with MAC and private insurers, doctors, for their part, have made the transition into the new code set relatively smoothly, says Dr. Wartman.
"The 'Ask the Coding Experts' site has received many interesting questions from providers, but generally, providers seem to have a grasp of the basics they need for properly coding ICD-10-CM," Dr. Wartman says.
What are some of the questions members are asking about ICD-10? According AOA's Coding Experts, questions include:
- Q. How do I code Rosacea Conjunctivitis?
- A. The best fit would be L71.8—Other rosacea
- Q. Is there a code for low-tension glaucoma suspect?
- A. The H40.01 series (open angle with borderline findings, low risk) and the H40.02 series (open angle with borderline findings, high risk) are the most appropriate.
- Q. In ICD-9 the diagnosis code for post-cataract glasses was V43.1. What is the appropriate ICD-10 code?
- A. The appropriate ICD-10 code is Z96.1.
Ask the coding experts
Evaluation and management (E/M) services are incredibly important in patient care, and it’s critical that optometry practices are aware of changes ahead. Meanwhile, the AOA and other leading physician organizations are pushing legislation that would halt Medicare payment cuts resulting from the changes.
Time to review your practice’s billing and coding: Access national benchmark data for optometry practices and join an upcoming webinar to learn more about E/M code changes in 2021.