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How Chiropractors Prepare for the ICD-10 Transition Deadline

By Vera Gruessner

- The ICD-10 implementation deadline is only three and a half months away and healthcare providers need to be on their last steps of integrating the new coding system within their practice in order to avoid the potential reimbursement delays from the Centers for Medicare & Medicaid Services (CMS). While there are some bills being introduced into the House of Representatives looking to delay the ICD-10 transition, with so little time before the deadline, it is likely that the implementation will not be postponed any further.

ICD-10 Transition Deadline

To learn more about how healthcare providers are preparing for the ICD-10 implementation deadline, EHRIntelligence.com spoke with Dr. Josh Bock, chiropractor at AFC Physical Medicine and Chiropractic Centers, who discussed training his staff for the ICD-10 transition and specific clinical documentation needs of a chiropractic office.

When asked how chiropractic and rehabilitation practices are preparing for the coming ICD-10 transition deadline, Bock replied, “Like many people in the industry, there are many resources available either through associations or software vendors. There are seminars you can take, books you can buy, and a variety of ways.”

“I’ve sent some staff members to do some training and attend some seminars,” he continued. “We’ve bought the book. We’ve taken a list of the top diagnosis codes in the most frequently used order and already done the conversions. It’s a matter of teaching ourselves.”

When asked about specific types of applications and clinical documentation needs required for a chiropractic EHR system, Bock answered, “It depends on the style of a practice. If it’s a type of practice where the person comes in and only gets an adjustment, the requirements are fairly limited and it would be different than if they had a full-service place. If someone comes in and receives rehabilitative services, nutritional consultation, and lab work, [the requirements would be different].”

READ MORE: CMS to Update eCQM Value Sets for 2017 Reporting Period

“There are minimum requirements set by Medicare. For the adjustment procedure, you’re required to have two out of the four PART findings,” Bock explained. “You have to capture two out of the four of those factors when adjusting somebody. This doesn’t account for management procedures, rehabilitative procedures, or X-ray procedures. Every procedure you do has different documentation requirements.”

“Probably the largest factor that we would need is the ability to copy and paste or pull forward data pertaining to the last visit,” he went on. “Our visits are very repetitive or close together. Being that of a primary care, you may only go once a year or twice a year and it may be for completely different conditions. If we have someone come in with low back pain on Monday, it doesn’t magically go away by Wednesday.”

“The only things that really change is maybe their mobility is better. Instead of eight out of ten for severe pain, it is now six out of ten for more moderate pain. There’s some things that change but the diagnosis of low back pain wouldn’t change because you’ll continue to see the patient for a series of sessions rather than periodically once or twice a year for different types of things,” he concluded.

When asked how chiropractic requirements affect billing and coding, Bock explained that, “In terms of the number of patients we would see, if I strip it down to just an adjustment, that procedure by the chiropractor would take only five minutes. Therefore, we could see 12 people per hour compared to four to six people per hour. Our volume would be typically twice as many as primary care. “In terms of how do I get those patients’ diagnoses codes to move from ICD-9 to ICD-10, some of the diagnoses we use have a direct lineage – meaning there’s only one ICD-10 option. It’s not going to expand to three, four, or six different diagnoses codes that are more specific,” he clarified. “I’m having all of the staff at each of our locations, if there’s only one correlation, make those conversions for us in our software.”

“As for what could realistically be done during the encounter? We don’t have enough time to capture adequate electronic information into the record and provide meaningful customer service with the patient all in a five-minute setting,” he went on. “I would imagine administrative staff assist in the documentation in many medical practices, including ours.”

Regarding how he would prefer a patient to pay, Bock said, “If I knew a patient was going to come three times a week, and they had a $20 co-pay, I would give them those estimations upfront. Our preferences is that patients make payments monthly rather than paying each time they come."

Clearly subsequent visits to a chiropractic office also affect EHR needs and Bock explained that it would be helpful if, within the EHR system, providers could view patient scheduling information.

“It would be helpful in the EHR if we knew if a patient was scheduled for their next visit or not so that we could remind them,” he explained. “I only pull up the health record. I don’t see the schedule. I don’t see if the patient owes a balance. It would be great if my staff could see this information on one screen.”

Bock also spoke about his perspective on meaningful use requirements and the patient engagement objectives.

“The subject of meaningful use – I once thought it would be a fad that would come in and then go away. To be honest, we are currently not taking any steps to capture any meaningful use,” he explained. “Although I could be potentially paying some small fees in penalties, it’s not enough of a penalty to make me change the style of our practice or what we’re currently doing to put more work on our administrative team or our clinicians.”

“What’s the value in a patient dialing in and viewing a completed note that I’d done? I think if another clinician would like to dial into my system and understand what it is that I’m doing, great! There’s value in that,” he clarified. “When it comes to patient communication, if they want to email me, text me, or have a portal into our software for notifications, I’m all in favor of that.”

With a handful of new bills being introduced into the House of Representatives looking to delay or even put an end to the coming ICD-10 transition, Bock discussed how postponing the ICD-10 implementation deadline was unnecessary.

“We are one of the last industrialized nations to implement the ICD-10 process. There’s lots of countries across the world that are using ICD-10 and we are not,” he concluded. “I’m ready to go. Our team is ready to go, but if I have to wait to get paid three to four to six months because I send in a claim with a different code and [insurance companies] are not able to process it and kick back nothing but denials for six months, that’ll put healthcare out of business.”

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