Preparing for the Worst

physical therapy billing_ICD10 part2Preparing for the Worst

Without proper implementation, ICD-10 could spell disaster

How will the change to ICD-10 codes affect Shannon’s physical therapy practice?

Shannon was in a bad mood. Mike could see it on her face as she came through the door, even though she tried to greet the kids in the usual way and show excitement over their news. Mike was able to leave his restaurant for a while in the afternoon so he could be home when the kids got back from school, but they always crowded around Shannon when she got home, eager to tell her about their school days and to show her their homework.

watch the ICD-10 webinar recodring now

“Okay, kids, that’s enough,” Mike said, stepping in to hug his wife. “Give me a minute with Mom, and set the table for dinner.”

As the children ran off to the kitchen, Mike smoothed Shannon’s hair. “What’s going on?”

Shannon slumped onto the sofa. “I don’t know if I’ve mentioned the upcoming changes in insurance reporting,” she began.

“Oh, of course,” Mike joked. “I’ve been thinking about insurance reporting a lot lately, and it’s completely stressing me out, too.”

“Mike, this is serious. I’ve just spent almost the whole day researching this.”

“I’m listening.”

“We have to switch to new codes on October 1st,” Shannon explained, “or we don’t get paid at all. The new code book has 1,107 pages — they don’t all apply to my physical therapy practice, but it’s not like the ones that affect me are sorted out for me. We can’t transition or try it out ahead of time, and the new codes may allow the payers to cherry-pick reasons to deny a claim based on the severity of the condition.”

“Slow down! I’m not getting all of this, and I’m sure there’s more coming, but you might be getting worried before you need to,” Mike suggested. “Everybody has to do this, right? There must be some plan for how to make the change smoothly.”

“The AMA estimates that a practice the size of mine will spend $83,000 to make the changes. They’ll affect billing, scheduling, the way we make notes in patient files… everything, really. And they’ll increase our chances of being audited, too, because the changes in workflow and reporting requirements will create disruptions.”

watch the ICD-10 webinar recodring now

“You’re always telling me how great Theresa is,” Mike pointed out. “Maybe she can–”

“Theresa’s a great office manager,” Shannon interrupted, “but these changes aren’t just her problem. Our whole billing system will have to change, and that means extra time and money, and extra chances to make mistakes.”

“I know you always hate software upgrades,” Mike teased, but Shannon wasn’t in the mood.

“Mike, I’m really worried about this. It’s not as though I was looking for a new challenge. I have to keep my equipment and my skills up to date and run my business, on top of taking care of my patients.”

“I’m sorry, sugar,” Mike sighed. “I have to get back to the restaurant to oversee the dinner service. We can talk more when I get home. Dinner’s in the oven.”

“Thanks for listening,” Shannon said, taking off her coat. “I’ll try not to cry in front of the kids, but no promises about you. You might have to listen to more complaining. I don’t know where the extra time and money to take care of this will come from.”

How will the change to ICD-10 codes affect Shannon’s physical therapy practice?

Want more information on ICD-10? Watch our ICD-10 webinar recording!

16 replies
  1. Robin Kortman
    Robin Kortman says:

    Ultimately the unknown is scary, Shannon has great reason to stress, changes as severe as ICD 10 could cost her practice significant revenue. Proactively Shannon could put together the diagnoses codes currently used, then research how ICD 10 will affect them to start.

  2. Marvel
    Marvel says:

    Stories involved with every blog make it more interesting and also make us to be more cautious…Thank you best PT sharing it with us..

  3. Astrid Bidanec
    Astrid Bidanec says:

    That’s a great tip, Robin! I would also recommend focusing on the codes that are actually used by Shannon on a regular basis, rather than trying to memorize bizarre codes like “Struck by Turtle.”

    After all, you can eat an elephant– one bite at a time! 😉

  4. funnyguydavid
    funnyguydavid says:

    The whole thing is playing out as some sort of “Mission:Impossible” scenario, with a coding system that will self-destruct on October 1. And somehow, this is supposed to make things easier.

  5. Jason Barnes
    Jason Barnes says:

    Waiting only makes things worse. Practice owners need to get educated and start now with this change. Joining a community of people that are working together to solve this is recommended. There is strength in numbers!

  6. Michelle Corrigan
    Michelle Corrigan says:

    As the insurance companies continue to make complicated changes to keep practice owners money it is increasingly important to secure a practice management system that is up to date and is continuing to update with the payers. Education on changes is also increasingly important for practice owners, finding seminars now and becoming familiar with the changes prior to October 1 is crucial

  7. Heather Miller
    Heather Miller says:

    This is not going to be the last of the major changes that will happen. Shannon needs to find a system that will be able to grow with the changing times.

  8. Reuven Lirov, M.A.
    Reuven Lirov, M.A. says:

    ICD-10 is going to be a monster and a scary one at that. Spending the necessary time at webinars is going to be a must for all staff members, especially practice owners who don’t want to be solely dependent on staff for this game changing event.

  9. Thomas Jorno
    Thomas Jorno says:

    Transitioning to a new software platforms comes with challenges, even in the best circumstances. It’s important that they moves to an office management solution that will be able to support all of the ICD-10 changes well in advance of the deadline. It will be a painful mistake to wait until fall before starting to implement these changes.

  10. Candace Coleman
    Candace Coleman says:

    The office is not realizing that the pain of transitioning into an ICD-10 compliant software is LESS than the pain of what they are doing now and the frustration they will experience on Oct 1 without the proper software and support.

  11. monica
    monica says:

    Knowledge of ICD-10 changes are vital for smooth maintenance of PT records. Less knowledge is always dangerous so changes should be known well before practicing.

  12. Charles Pritchard
    Charles Pritchard says:

    Spend the necessary time now learning more about ICD-10 and preparing for the complex change coming. Get involved and ask questions.

  13. Lisette Acevedo
    Lisette Acevedo says:

    Shannon and Mike are getting overwhelmed with the upcoming changes. How can they minimize their risks, while also making their transition into ICD-10 smoother?

  14. Aseer Kailas
    Aseer Kailas says:

    Planning to deal with this change is vital. Make a list of ICD codes that you use commonly, along with CPT codes. Make sure your PMS, EHR / EMR vendor is proactively mapping ICD with possible CPT’s. Signup for additional educational seminars especially if your office is a Multi specialty practice.

  15. Sonia Dhawan
    Sonia Dhawan says:

    Transitioning to this new platform would surely be challenging ! The Key would be to gain as much knowledge as possible – attend the related Webinars etc , so that during the transition phase one is well equipped for his or her’s practice to function well and to bear Minimum losses and delays.

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