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ICD-10 for physical therapists
George Konold

Are You Ready for ICD-10? We Are!

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 What are you doing for ICD-10?

Is your Physical Therapy practice Ready for ICD-10?

Our bestPT software was ready last year and our Team has made further refinements this year, including testing it thoroughly.  We do not expect the October 1, 2015 deadline to be pushed again like it was last year. We have prepared for it by adding over 65,000 codes to our software and when you choose an ICD-9 code, you’ll be able to choose from the corresponding ICD-10 codes.  We even give you the ability to test everything with a test patient account.  Check with your Practice Profitability Coach for more details.  Not our client yet? Then click in the upper right or the bottom left for a demonstration.

 

 

Kathleen Casbarro, CPC

A Job Well Done | Physical Therapy Billing, Software, Documentation, ICD-10

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A Job Well DoneiStock_000023954901XSmall.jpg

Technology Holds Promise of Easing Office Tensions

Can the right technology solution get Shannon’s team back together?

“Thanks, guys!” The last kitchen workers called a goodbye and headed out the back door, talking and laughing together.

Mike tossed a towel over his shoulder and sat back in a chair in the darkened restaurant. He often took a few minutes to decompress at the end of the dinner service, sitting in the silence and appreciating his restaurant. When it was empty like this, clean and neat and ready for the excitement of the next day, it seemed filled with promise. When it was filled with people, with the scents of cooking and the clatter of pans and shouts across the kitchen, Mike couldn’t really feel it. Things were happening too fast then.

With a satisfied sigh, Mike stood, dropped the towel into the laundry, and headed home.

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Shannon was still up when he came in. “Tough day?” he asked her. He knew things had been tense at work recently.

“In parts,” she said. Mike could see from her smile that she was having the same satisfied feeling he was. The feeling that came after all the hard work, when things had gotten cleared up and settled and the problems had been overcome. “I think we’ve got a solution for the clinicians,” Shannon continued. “The new software we’re looking at has an internal auditing process that’ll show us where our current documentation is working, and where it needs work.”

“That sounds like your style,” Mike said, taking a seat next to Shannon.

“Definitely. It’s not personal, it’s not about me complaining at them or the front office staff not being on their game. It’s just the space between where we are now with our documentation and the level of specificity where we need to be.”

“Nobody can argue with that.”

“I hope nobody will want to. We’re a great team when we’re all rowing the same direction. I think that seeing where we fall short and knowing what we’re aiming at will help us get together again.”

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Mike nodded. “For a while, it kind of seemed like everybody was blaming everybody else.”

“Or at least expecting to be blamed,” Shannon agreed. “I don’t know quite how we got to that point, but I think we’re going to be able to get past it.”

Mike heard a rustle from a bedroom as one of the kids turned over in her sleep. He leaned his head against his wife’s and she leaned back, and they sat together in the quiet, feeling satisfied.

Can the right technology solution get Shannon’s team back together?

Want to know how to prepare your practice for ICD-10 coding?

watch the workflow webinar recodring now

Kathleen Casbarro, CPC

Practice Makes Perfect | ICD-10

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Practice Makes PerfectTime management

Waiting for the Deadline Can Pose Numerous Problems

How can Shannon keep on track when ICD-10 transition seems to be a moving target?

I’ll be putting both the ICD-9 codes and the ICD-10 codes on my forms,” the home health equipment supplier said through the phone at Shannon’s ear, “and I’ll be expecting to know your plans for the transition beginning in August.”

“August?!” Shannon was startled back to attention. She had been getting distracted by raised voices in the hallway. The supplier she referred clients to for mobility equipment had been talking about ICD-10 codes, the new insurance codes required as of October 1st. Where was August coming from?

And what was that noise in the hall?

“I have to get started in August,” the voice in her ear explained patiently, “because my major payer is Medicare and Medicaid. I need time for my transition.”

“Well, I need time too–” Shannon began, but her supplier cut her off.

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“It sometimes seems as though all of you think this is going to happen by osmosis,” he said. “I value your referrals and I certainly want to keep working with you, but I work with too many referrers and payers to take a wait and see approach. I’ll be checking back with you in the first week of August to coordinate plans.”

“I think October is the deadline–” Shannon tried again.

“October it is, and it’s not going to change.” The supplier was beginning to sound testy. “I know a lot of people think there’ll be a delay, but the Centers for Medicare and Medicaid Services have said very clearly that they won’t budge. So I have to be ready on October 1, and I can’t wait till October to start getting ready.”

Shannon stammered a response and ended the call. The noise was still coming from the hallway. She took a deep breath and headed out to deal with it.

“I just don’t see why we have to start doing this now,” Tana was saying to the office manager. There were a few other clinicians standing with her and a couple more office staff watching from a few feet away. Occasional curious looks came from patients as they passed.

“What’s the problem?” Shannon asked, trying to sound upbeat.

“I know we have to change our documentation,” said Tana, “but I thought it wasn’t till October.”

“If we wait till October to start,” said Shannon, “we won’t be in the habit by then and we’ll make mistakes. We have to specify which side of the body and give a lot more detail than we’re used to, so that the new billing codes can be chosen correctly. There are so many new codes that it’ll be a lot more complicated than it is now.”

“So, because we have to take extra time and trouble in October, we have to start right away?” Tana scowled. “That doesn’t make sense. We don’t have lots of free time.”

One of the other clinicians nodded. “I can see the benefits of the new system,” he said, “but it’s totally going to slow us down. Why do that before we have to?”

“Yeah,” Tana agreed. “We’re not children. We don’t need to practice.”

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Shannon knew they weren’t children, but she was fairly sure they needed to practice. Especially if she was going to have to be able to work out the details of the transition in August so she could be sure of a steady supply of home health equipment for her patients.

What’s more, she was feeling wary about the Us versus Them attitude that seemed to be developing between the office staff and the clinicians.

“We’re all in this together and we all need to help each other. We all have to make changes and we know how hard that is. Let’s cooperate, okay?”

Tana rolled her eyes and the knot of workers broke up as everyone walked silently away leaving Shannon alone in the hallway.

Great, Shannon thought, now it can be them against me. She headed back to her office. Clearly, the calendar would have to be updated.

How can Shannon keep on track when the ICD-10 transition seems to be a moving target?

Want to know how to prepare your practice for ICD-10 coding?

watch the workflow webinar recodring now

Kathleen Casbarro, CPC

Piecing It Together

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icd-10 preparation bestPTPiecing It Together

ICD-10 changeover doesn’t present a pretty picture

How can Shannon solve the puzzle of improving clinical documentation?

Shannon leaned back in her chair, gazing out the window with a dreamy look in her eyes. Her husband, Mike, watched her with a smile. They’d been married for years and their life often seemed to be centered around work and kids, but he still enjoyed looking at her.

“I like physical problems,” Shannon mused.

That brought Mike back to earth with a thump he figured must be almost audible. “What are you talking about?”

“Problems with people’s bodies aren’t always easy to fix,” Shannon admitted, “but they’re easier to deal with than emotional ones.”

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“I’m guessing we’re talking about Tana.” Mike said.

“Yep,” said Shannon. “Mike, I don’t get it. She seems to think I’m out to get her with the changes in documentation for the ICD-10 code changeover. We’re all having to make the same changes. The codes require us to be a lot more specific. But Tana acts like I’m persecuting her.”

“The other clinicians aren’t responding that way?”

“Not yet, but I’m worried about it. That kind of bad feeling can spread fast.”

“Some people find change stressful,” Mike said. “I see it at the restaurant. Asking for changes can feel like criticism, too. Like, if there was nothing wrong, you wouldn’t ask for the changes.”

“In this case, if we don’t provide the kind of documentation we’re supposed to, we’re likely to end up with errors in the code or with inadequate clinical documentation.”

“I’m going to assume that that is something like being found storing cooked and raw meat together,” Mike joked.

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“Just like that. We could be audited, we could be out of compliance, and it could be even harder to get paid.”

“None of those things sound good.” The sound of a crash came from the other room. Mike sighed. “I guess I’m going to have to find out what broke.”

“No,” said Shannon, “let me go. I think I need all the practice I can get.”

Mike took his wife’s hand. “We can go together. You’ll have to get your clinicians on the same page alone, but I can certainly help you pick up whatever mess is waiting for us in there.”

How can Shannon solve the puzzle of improving clinical documentation?

Want to know how to prepare your practice for ICD-10 coding?

watch the workflow webinar recodring now

Kathleen Casbarro, CPC

Weighty Issues

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physical therapy documentation | ICD-10 preparationWeighty Issues

The changeover to ICD-10 presents a number of burdens

Are the clinicians in Shannon’s practice ready for the new documentation requirements that go with ICD-10?

Mike strolled into the physical therapy practice. It always made him feel energized just to walk in — the bright colors and happy faces gave the room a sense of energy, and even when it was quiet, he felt as though upbeat music might start at any moment.

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Not today. Mike saw his wife talking with Tana, one of the trainers, and stopped in his tracks.

Tana’s arms were crossed. Her head was pointed down and her lips were tight. She was balanced on both feet but leaning back; Tom felt that she looked ready to protect herself.

Shannon seemed calm, but somehow the more Tana leaned back, the more Shannon seemed to move in. Shannon was gesturing, but it didn’t look as though she was angry.

“Hey!” Mike called out cheerfully. Maybe I can break the spell, he thought.

“Hi, honey. Have you met Tana? My husband, Mike.”

Tana shook hands and smiled, but she still seemed troubled to Mike.

“Nice to meet you, Mike. And Shannon — thanks for letting me know.”

“Sure thing,” said Shannon. “Don’t worry, okay? We’ll work it out!”

Mike thought that Shannon’s usual cheerfulness seemed a little strained, too. He walked with her to her office in silence.

“So? Anything you want to talk about?”

Shannon sighed. “Were you coming to take me to lunch, by any chance?”

“I was coming to let you know that I’ve caught an extra shift tonight; Saul’s getting married tomorrow, so for some reason he wants the evening off. I’m going to cover for him at the dinner service and I probably won’t be home till late. If you’ve got the time, I’d be happy to keep you company over lunch.”

“I’m going to make the time,” Shannon said, shrugging into a jacket. She was silent again as they crossed the room, waving and smiling as she went, and her smile disappeared once they left the building.

“So what’s up?” Mike asked, putting an arm around his wife as they strolled down the street, heading for a favorite sandwich shop.

“Do you remember the day I came home and told you how everybody had gotten so upset at the meeting about the new software?”

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“I do. I remember you felt blindsided.”

“I sure did. And my talk with Tana was like that, too.” Shannon turned into the shop and joined the line of hungry customers. “You know we’re working on making some big changes with the insurance reporting codes.”

“ICD-10 versus ICD-9. It’s engraved on my heart,” Mike joked.

“I know what you mean!” Shannon laughed back. “Anyway, we’ve been working on getting our office systems up to speed for the change in October, and I’ve reached the point where I talk with the clinicians about their approaches to documentation.”

“I remember you said the changes in the codes would affect everything, not just the billing systems.” Mike reached the front of the line and ordered. Shannon grabbed a couple of bottles of water and they headed to a table.

“It’s going to be good in some ways,” she said, picking up the thread of their conversation again, “but it’s important for us to get it right. Just one small example — we have to specify which side of the body we’re working with now.”

“That doesn’t sound like something to be upset about.”

“I know! But somehow as we discussed how specific the new documentation needs to be, it seemed as though Tana felt like I was criticizing her. Worse than that, I thought she was going to cry.”

“Her body language looked very defensive,” Mike agreed. “You don’t have any idea where that’s coming from?”

Shannon shook her head.

“Maybe,” Mike said, raising one eyebrow, “there’s a childhood trauma involved.”

Shannon rolled her eyes. “I don’t know, but I know that we all have to get on board with the new requirements for documentation, or we’re going to be doing a lot of work for free.”

Are the clinicians in Shannon’s practice ready for the new documentation requirements that go with ICD-10?

Want to know how to prepare your practice for ICD-10 coding?

watch the workflow webinar recodring now

George Konold

ICD-10 | 100x More Complicated | Q&A

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ICD-10 Q&AAs your practice is preparing for the impending ICD-10 changes, you might have many questions concerning physical therapy billing procedures and software requirements. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar ‘ICD-10 | 100 Times More Complicated,’ along with the presenter’s responses. Feel free to add any new questions in the comment section below.

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Q: I have a question about the top 50 ICD-9 codes we use, and doing the crosswalk to ICD-10. Where is the best resource for being able to do that?

A: CMS GEMS would be one website that you can use; that’s CMS’s GEMS System, which is the General Equivalent System that they use — the General Equivalent Mapping System that they use to translate ICD-9 to ICD-10.

Another good site for you is AAPC.com. Click on their ICD-10 link and they have a feature where you type in our ICD-9 and it returns the equivalent ICD-10 code.

GEMS prompts you to choose the lateralities and origins, whereas AAPC is more one-to-one, but GEMS is really what most systems are basing their crosswalk from, and GEMS is built and maintained by CMS, the CDC, and AMA.

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Q: I’ve done all my conversions from ICD-9 to ICD-10 and I’ve done the left and right conversions. We’ve changed some of our documentation so it’s more specific about mechanism of injury — the when, where, the why and the how. What else is there really to do?

A: You really want to make sure that how the practice is supposed to document the guidelines for PT documentation are clearly outlined in your policies and procedures manual. And that means adding in specificity and laterality. The manual should also have references as to where you seek the information; your reference point would be to CMS.

Q: If I want to take a coding course to get certified, do I need to be certified on ICD-9 and ICD-10?

A: Right now, you have to certify for both, but after October 1, you only have to certify for ICD-10.

Q:  Are you able to come out and help us train our staff?

A: We can give you the tools that you need in order to train your practice. For PT documentation, have them listen to our webinar in March, but they can also take external classes — specifically from the AAPC, because their classes on physician documentation are extraordinary. In terms of crosswalking, we will work with you.

Click here to download an additional ICD-10 resource!

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George Konold

ICD-10: 100x more complicated | Webinar

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ICD1-webinar-banner-bestPT-edited

white-spacerStart the new year by preparing your practice for ICD-10. Learn the necessary changes you’ll have to make in order to avoid a drop in your billing performance. 

 Objectives:
  • Billing and Collections: avoid denied claims and underpayments
  • Compliance: reduce audit risk

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PAHCOM CEU

This continuing education webinar meets the criteria of the Professional Association of Health Care Office Management and is approved for 0.5 CEU(s).

Kathleen Casbarro, CPC

Right on Target

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physical therapy billing | ICD-10 Right on Target

Narrower focus makes it easier to hit the bull’s eye with ICD-10
How will software help Shannon make the reporting code changes right on target?

Mike leaned back in the bleachers, laughing helplessly. His wife, Shannon, tried to glare at him, but she couldn’t keep from joining in. They were watching their youngest child’s soccer game, and it was clear that the players had a lot to learn.

“You shouldn’t laugh at them, Mike!”

“How can I help it? They run off in all directions, like they don’t really know where the ball is or what they’re supposed to do with it. It’s hilarious!”

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“They’re little. By the end of the year they’ll be exactly on target.”

Shannon put her arm through her husband’s. She was feeling more relaxed than she had in a long time.

“What are you thinking about?” Mike asked. “It looks like you’ve gotten past your worries over the insurance code reporting.”

“I’m thinking about targets,” Shannon said, surprising Mike. “I’m still a little worried about the reporting code changes, but I think I’ve found a solution.”

“Don’t tell me — you’ll put the new regulations up on the wall and throw darts at them.”

“Not that kind of target.” Shannon rolled her eyes. “A big part of the problem was how complicated the changes are.”

“I remember — 70,000 new codes, right?”

“Yes, but with bestPT I don’t have to sift through all of them. We can update the software now with the new ICD-10 codes, and they’ll be grouped in clusters that will allow us to start in roughly the right area and then drill down to the right codes.”

“Like a target, with the rings narrowing down to the bull’s eye.”

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“That’s how I’m seeing it. Right there on the billing screen we’ll get a crosswalk — like, I can put in 346 and see all the choices for migraine headaches, and then narrow in to the most appropriate code.”

Mike’s attention was drawn to the field and he and Shannon both cheered as their daughter jumped up and down in triumph.

“I feel a little bit like that right now,” Shannon said when the game resumed. “I guess I was imagining myself leafing through a thousand pages in the new code book every time we needed to file a claim. It doesn’t have to be that way. bestPT calls it their three magnets: assessment, documentation, implementation. And it all happens right there on the billing screen.”

“A target with a magnetic bull’s eye?” Mike teased. “Sounds perfect.”

How will software help Shannon make the reporting code changes right on target?

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

Kathleen Casbarro, CPC

Recipe for Disaster?

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ICD-10 changes are a recipe for disasterRecipe for disaster?

ICD-10 carries the ingredients for a perfect storm

Why won’t the reporting changes be a piece of cake?

Mike looked for Shannon as soon as he stepped in the door. The dinner service at the restaurant he owned had been busy and it was late, but his wife had been upset when he left, and he had a feeling she’d still be up, waiting to talk.

He was right. Shannon was staring blankly at the TV, but she brightened when she saw him.

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“Want to talk?” he asked softly. He thought he saw unshed tears in her eyes. “Come on, honey, you’re not getting weepy over a change in government regulations. There must be more going on.”

Shannon rubbed her eyes. “Mike, do you remember how excited we were when we both finally were our own bosses?”

“Of course! I worked as manager at that steak house while you got your training –”

“– and then I worked at the hospital while you got the restaurant going –”

“– and then I opened the practice and we both were doing what we really cared about, and doing it the way we believed it should be done.”

“That hasn’t changed.”

“Not yet!” Shannon’s smile faded. “But Mike, I just can’t see how I’m going to come up with the time or the money to meet the new insurance reporting requirements. The AMA is estimating that it’ll cost small practices $83,000. I can’t help thinking about how hard I’ve worked to build up my physical therapy practice, and I can’t stand the thought that all that work could be for nothing.”

“You know what this makes me think of?” Mike asked, putting an arm around his wife. “Cake.”

Shannon’s eyes grew large. “Cake?”

“Remember how, when I first opened the restaurant, I wanted to serve amazing, unique desserts, but I couldn’t afford a pastry chef?”

“I remember! You practiced baking cakes for weeks, getting everyone we knew to taste all the trials –”

“– and the errors!”

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“And finally you created the perfect cake.” Shannon frowned. “That’s nothing like my situation, though. I can’t do trial and error. We have to be using the ICD-10 codes correctly as of October 1st, and that’s all there is to it.”

“But you’re only remembering the cake, not my brilliant process,” Mike  said playfully. “I identified the obstacles. In my case, those were things like how to make a really special cake without all the special training a pastry chef usually has.”

Shannon perked up. “You’re right. I remember now… Well, in the case of the changes in reporting codes, the biggest issue is the sheer complexity of the new codes.”

“I know you told me they have more digits than the old ICD-9 codes, and that can be an issue for software and filing.”

“Absolutely. The 7-place codes also allow a whole lot of new ones. ICD-9 has about 15,000 codes and ICD-10 has almost 70,000.”

“Wow!”

Shannon grew thoughtful for a moment. “I think my favorite is the new code for being struck or bit by a turtle.”

“Struck or bit.” Mike made a thoughtful face, too. “Why not one code for being bit and one for being struck?”

“You see what I mean, though.” Shannon began to show excitement. “It’s not just one to one mapping of old codes to new ones. It’s the complexity of the new codes that makes it such a big deal. That and the urgency — on October 1st, the old codes just won’t work any more.”

“So it’s a complicated system, and you have to get it right first crack out of the box on October 1st,” Mike summed up. “Very much like my cake situation.”

Shannon laughed. “You’re goofy! But you’re also right. Identifying the reasons that this is challenging does help. I think I’ll be able to sleep tonight after all.”

Why won’t the reporting changes be a piece of cake?

Ready to face the impending ICD-10 changes head on? Attend our free Continuing Education Session ICD-10– 100 Times More Complicated. Register now!

Kathleen Casbarro, CPC

Preparing for the Worst

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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.

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“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.”

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“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!