The Workgroup for Electronic Data Interchange has extended the availability of its ICD-10 Issue Reporting Database to help providers with the code transition.
Launched in early 2014 to aid in compliance activities, the industry stakeholder group will continue operating the searchable database of industry-submitted questions answered by coding experts beyond the Oct. 1 ICD-10 compliance deadline.
Providers having problems with the code switchover can submit questions to the ICD-10 Issue Reporting Database, which are referred to experts to provide answers that are put online to help other healthcare organizations.
Jim Daley, director of IT for BlueCross BlueShield of South Carolina and co-chair of WEDI’s ICD-10 Committee, says the decision to extend the reporting database was made in partnership with the Centers for Medicare and Medicaid Services as well as other industry associations.
“When we collect different types of issues, we start to see patterns and work with CMS and industry contacts to show these are the kinds of problems people are encountering that may require further clarification or training,” asserts Daley.
According to WEDI, the database is intended for “broad-based, ICD-10 transition-related questions and challenges that are encountered, rather than specific consulting code mapping for individual patient cases.”
Based on initial queries of the database post-Oct. 1, Daley comments that some providers “just got their billing software and are figuring out how to use it, so that’s causing some issues.” He also observes that “there have been a couple of issues with software that does not correctly set the diagnosis qualifier/indicator that says this is an ICD-9 or ICD-10 code.”
Daley says at this point “it is unclear whether this is end-user error that’s making it happen or if it’s something within the vendor software itself.”
Another potential vendor software issue showing up in questions submitted to the WEDI reporting database involves billing systems that “flat out require ICD-10 codes, which is not the case because there are run-off claims,” according to Daley.
A claims run-off period is a designated time period after a claim-related event has occurred during which claims and/or adjustments may be submitted and coverage triggered, he explains. “This requirement makes it necessary for payers, providers and clearinghouses to have the ability to process both ICD-9 codes and ICD-10 codes for some period of time after the compliance date, since runoff claims will continue to be received using ICD-9 codes,” Daley adds.
While issues can be submitted anonymously to the database, WEDI “highly encourages” submitters to provide full contact information so that the submitter can be contacted directly once a solution to the issue is found.
“We need time for the inpatient claims to start showing up to see if there’s issues going on there,” Daley concludes, referencing the fact that Medicare claims take several days to be processed and by law must wait two weeks before issuing payment. In addition, he says Medicaid claims can take up to 30 days to be submitted and processed by states.
American Medical Association President Steven Stack, M.D., comments that the physicians group “has concerns about the code set” but adds that “it’s definitely too early to know what the impact will be on payment and claims.” Stack believes it will be a few weeks before the industry has some data to begin to make an assessment.
“Clinicians are going to continue to face challenges even after we get past any of the glitches in the revenue cycle part,” he adds. “We’re going to have to find a new balance for what is an appropriate level of detail required. Just because the code set allows someone to put in an incredible amount of detail, it does not mean that the clinician providing care for a patient knows all that detail when they’re doing it.”
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