September 23, 2015
4 min read

What spine surgeons need to do now that ICD-10-CM is almost here

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Daniel Refai

Daniel Refai

In this Spine Coding Source column, Kim Pollock, RN, MBA, CPC, CMDP, and Teri Romano, RN, MBA, CPC, CMDP, present an excellent review of the salient changes that are coming with ICD-10-CM implementation this fall. I agree with their top ten points for preparation.

Daniel Refai, MD
Associate Editor, Neurosurgery 

All HIPAA-covered entities, such as physicians, facilities and health insurers, are required to use ICD-10-CM codes for services performed on Oct. 1, 2015 or later. You have only weeks to make sure you are ready.

Kim Pollock

Kim Pollock

Teri Roman

Teri Romano

Therefore, here are our top 10 tips for ensuring a smooth transition to using an entirely new and different diagnosis code set starting on Oct. 1:

1. Inventory the practice

Inventory your practice to determine the following:

  • l What documents need updating, such as practice encounter forms/superbills and the surgery scheduler cheat sheets;
  • l Who will need spine-specific ICD-10-CM education and training (e.g., spine surgeons, residents, fellows, non-physician practitioners, billers and coders); and
  • l How you will provide this education and training (e.g., American Association of Neurological Surgeons course, American Academy of Orthopaedic Surgeons course, onsite education provided by KarenZupko & Associates (KZA), KZA webinars, etc.,) and when it will take place.
  • Education after Oct. 1 is still valuable. Medicare has given physicians a 1-year period of claims payment review leniency to get diagnosis coding right. However, it is important to note many private payers have indicated a desire for specific diagnosis codes. Beginning with the implementation, unspecified careless coding in operative reports will result in endless hospital queries, as Medicare did not exempt hospitals. So while the grace period is welcomed, it does not mean you get to wait another year to get this right.

    2. Determine top 20 ICD-9-CM codes

    Determine your top 20 billed ICD-9-CM codes. Do this by running an ICD-9-CM frequency report from your practice management information system. With a practice limited to spine, you will likely identify no more than 20 frequently used codes.

    3. Map most frequently used codes

    Map the most frequently used diagnosis codes from ICD-9-CM to ICD-10-CM. Be sure to map to the ICD-10-CM codes with the highest level of specificity and avoid mapping to “unspecified” codes. The point of using ICD-10-CM is for a higher level of specificity than what is allowed with ICD-9-CM.

    Some codes will have a 1:many mapping ratio, such as acquired spondylolisthesis, as shown in the Table.

    You would use M43.16 if the patient had L4-5 (lumbar region) spondylolisthesis. However, you would use M43.19 (multiple sites in spine) if the patient had L4-5, as well as L5-S1 spondylolisthesis.


    Other codes will have a 1:1 ratio, such as these diagnosis codes — ICD-9-CM: 724.2 Lumbago and ICD-10-CM: M54.5 Lumbago.

    You will want to understand the seventh character extension requirement if you take care of trauma patients or patients with pathological fractures. The spinal injury codes (S10-S39), as well as the pathological fracture codes (eg, M80, M84), are highly documentation-dependent and always require a seventh character to indicate the phase of the healing process. Our webinars provide detailed information about these requirements.

    4. Review provider documentation

    Review current provider documentation to determine if it is “code-able” in ICD-10-CM. If so, kudos to you. If not, ensure future documentation has all necessary information to assign the correct ICD-10-CM code.

    5. Dual code

    You should dual code until Oct. 1, 2015. Every day, code a couple of services (office and procedure) using ICD-10-CM to become familiar with the codes and necessary documentation. Get used to ICD-10-CM coding now so that it is not a foreign language to you on Oct. 1.

    6. Investigate workers comp payers

    Determine whether your workers compensation and motor vehicle payers will be using ICD-10-CM codes on Oct. 1. As non-HIPAA-covered entities, they are not required to use the new codes and might still require ICD-9-CM codes.

    7. Use for precertification

    Use ICD-10-CM for precertification of your cases scheduled for Oct. 1, 2015, and later. Some payers may accept both ICD-9-CM and ICD-10-CM codes right now. But it is important to at least use ICD-10-CM codes for precertification because those are the diagnosis codes you will bill and you want them approved prior to surgery.

    8. Use EHR’s electronic charge capture

    Ditch the paper superbill (aka encounter form, charge ticket) and use your EHR’s electronic charge capture tool for office services. Save trees by not using a paper superbill. When you map to ICD-10-CM all the diagnosis codes on your current paper charge ticket, the new one will be several pages long. Therefore, that is not such a good option.

    9. Improve collections now

    Collect as much as you can right now. All sources are predicting cash flow slowdowns with ICD-10-CM implementation. If you are not collecting at 100% functionality, that is not good enough. Work now to improve collections. If your collections are suffering, call us. We can help.

    10. Be prepared for cash flow issues

    Be financially prepared for cash flow issues on Oct. 1, 2015. Keep money in the bank at the end of the third quarter just in case.

    Follow our advice and you should make a smooth transition to the new diagnosis coding set on Oct. 1, 2015.

    Disclosures: Pollock and Romano report no relevant financial disclosures.