As expected, small, office-based physician practices were having the hardest time, updating antiquated practice management systems incapable of transmitting a claim in ICD-10.
“In one practice, they didn't get their (software) update until a week before the deadline and it crashed their systems,” said Rhonda Buckholtz, vice president of strategic development for the AAPC, formerly the American Academy of Professional Coders.
Buckholtz adds that another practice learned that 2,500 codes had not been cross mapped from ICD-9 to ICD-10.
Buckholtz declined to name the vendors or the states.
“It's not anything we didn't expect,” she said. But it's “disappointing” that the glitches are as widespread as they appear to be, she added.
Jim Daley, director of IT at Blue Cross Blue Shield of South Carolina and co-chairman of the Workgroup for Electronic Data Interchange said since Thursday's launch of ICD-10, reports have been coming in to the workgroup's database.
Daley said some software vendors had set up their systems to block ICD-9 codes on claims entered on Oct. 1 or later. That was a problem for those providers whose billing wasn't up to date at midnight Oct. 1.
Another reported problem involves the seventh-digit “qualifiers” in claims transmissions that indicate whether the rest of the code is in ICD-9 or ICD-10.
In contrast, Dr. Chris Tashjian, one of 16 physicians at Vibrant Health Family Clinic, River Falls, Wis., said a lab technician came in early Thursday to make the switch and that went off without a hitch.
For the past three weeks, Tashjian said, he'd been practicing by coding in both ICD-9 and ICD-10.
So far, coding in ICD-10 has added just “four or five seconds” to the time he needs to document and code a patient encounter, said Tashjian, who, along with his colleagues will be responsible for doing their own coding.
If any physician “gets stuck” with a more complex code, the group has agreed that rather than slow down workflow with patients, they'll hand off that encounter to the group's four coders.
“We feel we're coding to the best extent we can,” Tashjian said.
Still, Tashjian said, the group decided to hold back “at least 50%” of their pay for the third quarter to meet any cash flow restrictions caused by ICD-10. “We really didn't want to take out a loan,” he said.
The move is “kind of like loaning (the money) to ourselves. We don't expect to have a lot of rejections. We expect to get it all back in the fourth quarter,” he added.