ICD-10: Are You Ready?

By editor
December 8, 2014

As you should already know, the federal government, HHS and CMS, has decided the start date for using ICD-10 codes (Diagnosis codes) on all insurance claims has been moved back to October 1, 2015. In order for you to be fully ready for this change you will need to develop a strategy and you will need to begin fairly soon or have already started your preparation.

Lets discuss some things that you should be doing. What are your top ICD-9 codes now? Don’t overwhelm yourself with the large numbers of new ICD-10 codes, just get familiar with the ones you are using now. Yes, there are 69,000 new codes but there were 13,600 before and you never came close to using them all. Your practice management system should have a report available that will enable you to run a list of all ICD-9 codes you use and the number of times you used them. This is easy to do and should be done right away.

Next you should crosswalk common codes from ICD-9 to ICD-10. This means converting current ICD-9 codes used to ICD-10 codes and make a cheat sheet for physicians and staff. There are programs available (some free, some very reasonable) that will help with this. They are referred to as GEMS, general equivalence mapping systems. This could be more time consuming but assign a reliable person on your staff to complete this and you will be well on your way to being prepared.

Remember, there may not be a one to one match with the ICD-9 to ICD-10 transition. In 20-25% of the cases it will be a one to many and reimbursement must be taken into account when matching. Determine which ICD-9 codes have the highest impact on your revenue.

You will need to evaluate how your clinical staff will provide information to the billing staff. Remember, you will need to provide more details. Determine how you will modify your encounter forms to accommodate ICD-10 codes. Your old encounter forms will be useless and your new encounter forms may even be 2 or more pages to allow for the greater number of codes to be listed.

You should also find a date in advance of October that you will begin dual coding so all staff can become knowledgeable about the new ICD-10 codes. Side by side coding will help with the learning process. It will be important to get the whole staff involved and committed. Yes, the whole staff. From the Physician to the clinical staff to the front desk. Everyone will be involved and affected by this change.

The investment in a GEMS program could actually reduce your costs by reducing claim rejections. It will also increase productivity and coding accuracy and will be helpful during preparation, training and implementation. You may need to also consider outside help. You will need to assess your situation individually. There are also many free resources available for you online and you should take advantage of them.

Are your venders ready? Take account of all your venders especially those that are directly affected by ICD-10 such as EMR's, practice management systems and clearinghouses. Find out if they are ready for the ICD-10 conversion, will they be ready and fully able to transmit claims with ICD-10 codes when the time arrives? Some other questions to ask them are what plans do they have in place for implementation? Will they have tools in place for you to use and if so how much will they cost and how can they create savings? Will they have software available for testing prior to October? How long will they be running parallel programs? Is your practice truly using your EMR to its full capabilities, meaning are you using the coding templates? And perhaps most importantly, will you need any new software or hardware and what will be your out of pocket costs? The experts predict that up to 50% of smaller and free EMR’s will go out of business due to ICD-10, is yours one of them? This is why it is so important to ask them and for them to provide you documentation on what their plans and strategy is.

It is also important that you realize that your other venders may be there with assistance, however you need to be fully aware that this transition to ICD-10 will take time and planning in advance and will need to be taken care of first and foremost at the office level and by practice personnel. Physicians will also need to be trained and should not be let off the hook. Documentation will be very different as they are stressing detailed documentation and increased specificity. Physicians must document additional information such as the underlying condition or whether drugs induced the issue, the exact body part and so on.

In case your billing or revenue cycle gets slowed due to internal or external difficulties you should have a reserve of revenue on hand. Some are suggesting anywhere from 3-6 months but all practices are different and this will be up to you to decide. Some experts are predicting that 10-15% of practices will fail because of ICD-10. Do we have your attention yet? The time to start preparing is now.

Once ICD-10 is fully in place and used properly, there are actually benefits to the change. The first is that you will be reimbursed faster. Also, less medical notes will be needed due to the greater specificity needed. ICD-10 will also greater reflect today's technology and will capture the greater detail of your EMR. So we all have that to look forward to.

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