6 glaring and disruptive ICD-10 glitches

A physician reports from the front lines about the code set conversion
By Linda Girgis, MD
05:55 PM
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How was the first week of ICD-10 at your organization?

Despite all the years to gird for the code set conversion I have found thus far that many in the healthcare industry were ill-prepared, after all. 

What's worse, widespread fears about glitches are now coming to life. And more are bound to emerge as we watch exactly how ICD-10 will impact the revenue cycle.

[See also: ICD-10 go-live: Nightmare or non-event?]

They may seem minor to onlookers but the glitches during the first week were both glaring and disruptive to those of on the frontlines actually using the new codes.

Here are the ones I encountered:

1. So much for the CMS grace period. CMS promised a year of accepting ICD-10 claims as long as the code is in the "right family" but other insurers have not followed suit. There is no promise there that commercial plans won't require specificity for paying us. For the most part, in order to ensure being paid, we must code to the highest level of specificity right from the beginning. I heard many doctors adding more than 1 hour a day just to enter correct ICD-10 codes.

2. Clearinghouses. My clearinghouse kicked out all unspecified codes and will not submit them to any insurance carrier. The CMS promise is void in this situation because my clearinghouse will not even allow them to go through without all being recoded.

3. Referrals. As a primary care physician, I do many referrals. My largest payer requires on-line referral submissions. Yet, on October 1, their site did not allow ICD-10 codes to be submitted. They no longer allow paper referrals and I was unable to do any for 3 days. Patients sometimes need urgent referrals.

4. Eligibility checks. Some insurance websites were unavailable for the first 2 days. We were not able to check eligibility on some patients. We may or may not be paid for these visits and according to our insurance contracts, we are not allowed to bill the patient. Any patients I saw on the first 2 days of October who we were unable to verify their insurance was treated for free and there's nothing I can do about it. I know some people will say not to see them without this verification but they were sick. What good is a doctor who doesn't treat sick patients?

5. Wait times. One of my billers spent three hours on-hold with an insurance company.

6. Personnel. While IT systems may have been prepared for ICD-10, the industry personnel not so much. One of my billers was calling about a previously denied claim and was told she needed to resubmit it in ICD-10 format. No, this visit was 3 months ago and it does not apply. Many reps could not answer ICD-10 related questions. Most of the time they were told to just submit the claim and sees what happens. Surely, industry workers should have received more training than this. I did and I'm just a doctor.

To be fair, some of these problems have been ironed out already and others will no doubt be fixed in the coming weeks. The matter or revenue cycle, however, remains: Will we be paid correctly and in a timely fashion?

Unfortunately no one will be able to accurately answer that until the first claims start being adjudicated – likely weeks from now.

What has been your experience during the early days of ICD-10?

Related articles: 

Hiring problems persist as ICD-10 coders tough to find

Inside hospitals' ICD-10 war rooms 

PIck your own ICD-10 adventure