ICD-10 is Still Coming: What You Need to Do to Get Ready

While it is expected that CMS will delay the implementation of ICD-10 to October 2014 instead of October 2013, the final rule confirming these changes has yet to be published. Regardless, it is still important that you and your practice keep moving towards ICD-10 adoption. The switch to the new code-set will affect every aspect of how your organization provides care, but, with adequate planning and preparation, you can make sure that the transition is as painless as possible.

ICD-10 increases the number of codes that can be used for a particular condition by adding additional digits and allowing more of the digits to be alpha numeric. It is hoped that ICD-10 will enable more accurate coding (especially for new procedures), thus facilitating more effective public health reporting, medical research, and identifying cases of fraud and abuse.

ICD-10 is actually made up of two different code sets: ICD-10-CM and ICD-10-PCS. ICD-10-CM will be used for coding diagnoses while ICD-10-PCS will be used for inpatient procedural coding. CMS describes the differences as follows:

ICD-10-CM was developed by the Centers for Disease Control and Prevention for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM.

 ICD-10-PCS was developed by the Centers for Medicare & Medicaid Services (CMS) for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.  (http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10BasicsforMedicalPractices.pdf)

It is expected that while all practices will be affected, those that are procedure-based (like dermatology and surgery) will be disproportionally affected by the transition to ICD-10.

Here are some things you should do (if you haven’t already done so):

  • Appoint an ICD-10 coordination manager and delegate a steering committee to manage the transition.
  • Educate staff and leadership about ICD-10 including changes in documentation requirements from health plans and how this will affect workflow.
  • Determine where you are currently using ICD-9 codes in order determine the aspects of workflow, business practices, and technology that will potentially be impacted by ICD-10. It is important to note that in addition to practice management systems, ICD-9 has been heavily used in EHR systems, clinical decision support rules, and even medical devices.
  • Create a list of staff members who require ICD-10 resources and training, such as billing and coding staff, clinicians, management, and IT staff.
  • Contact your EHR, PMS, and healthcare-related software vendors to determine what their plan is for updating their systems. Make sure to ask them about the cost of these upgrades as in many cases these updates may not be covered under existing software maintenance contracts.
  • Contact the clearinghouses, and billing services your practice uses to determine their ICD-10 plans and timelines.
  • Evaluate your health plan trading partner agreements and contracts to determine if they will be affected by the ICD-10 transition and which (if any) components will have to be renegotiated.
  • Plan a realistic and comprehensive budget. Don’t forget the loss of productivity when developing your budget, just as with EHR implementation you should expect a drop in productivity as you and your staff learn this new coding system.

Keep Up to Date on ICD-10 — Visit the CMS ICD-10 website for the latest news and resources to help you prepare.

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