ICD-10: Ask Questions Now to Put You Light Years Ahead

There are many unknowns right now with the implementation of ICD-10-CM; however, tackling a few obstacles early on, along with a keen sense of ICD-10 awareness, will put you ahead of the game and able to continue on after Oct. 1, 2013. Waiting until the last minute in hopes of delays will surely jeopardize the financial stability of your practice.

First and foremost, don’t plan on delays based on past experiences. Keep in mind that CMS feels that they have already given an extension of two years based on the Notice of Proposed Rule Making. The original proposed date was Oct. 1, 2011, and the date was extended, based on comments, to Oct. 1, 2013. In addition, the transition to ICD-10 will take numerous resources — failure to budget properly and spread out the task will leave you in a financial pinch. It will be impossible to prepare your practice for ICD-10-CM in just a few short months, so asking a few key questions now will put you light years ahead for implementation.

What Do the Health Plans Have in Store for Implementation?

Take a good, hard look at your contracts and how payments are tied to them. Also look at how any quality payments are processed. Anything based on clinical and diagnostic findings will need to be reassessed, and new guidelines put in place to match up with the more-specific ICD-10-CM codes. Schedule meetings with provider reps early on to see what their plans and timeframes are for addressing these issues so that you will be assured of communications and notifications regarding any changes in payments that may be coming. This will help you prepare and budget.

How Are Your Vendors Gearing Up? Will You Need Software or Hardware Upgrades?

Will your system be able to handle dual reporting during transitions? When will they begin testing, and how do you get on their training and testing schedules? You will want to work with your vendor now to make sure that they have already begun preparation for the changes. If your vendor cannot assure you readiness, you will need to start looking for new vendors now. This is a time-consuming process that could take a year or two to research and put into place. Being caught with a vendor who is not ready will bring the practice to a complete halt.

Will Your Clinical Documentation Stand up to the Level of Specificity Required in ICD-10-CM?

One way to assess and prepare for this is to run a practice management report with your most frequently used ICD-9-CM codes now. Use those codes along with the GEMS files to crosswalk your current ICD-9-CM codes to possible ICD-10-CM code selections. Are you tech-savvy enough to manipulate the files yourself? If not, utilize the AAPC’s free ICD-10 Code Translator at www.aapc.com/ICD-10/codes. You simply type in the ICD-9 code and the work of translating to ICD-10 codes is done for you. Keep in mind that ICD-9 codes do not map 1:1 with ICD-10 codes, and you will not find exact matches. What you will find, though, is the possible code choices and descriptors that will allow you to take a look at your clinical documentation and make sure it will match up with what is needed to assign the more specific ICD-10-CM code. ICD-10-CM addresses laterality, stages of healing for fractures and injuries, trimesters for pregnancies and pregnancy-related issues, and so on. Have someone take your ICD-9 report and walk the codes over using the Code Translator tool found on the AAPC website. Then run a separate report for matching up patients to those diagnosis codes found on your report. Pull the charts and look at the documentation found within and where more information will be required. This way you can begin to work on any documentation issues now so that your encounters can continue to be coded after Oct. 1, 2013.

How Much Training Will Be Needed, and Who Will Need to Be Trained in Your Practice?

Training and education is often expensive, and budgets have been cut in medical practices. Almost everyone in your practice will require some type of training on ICD-10 implementation and code sets; the amount of training will depend on their position and current knowledge of anatomy and terminology, and their current ability to use ICD-9-CM. Consider whether or not you have someone in-house to provide your training or if you will need to obtain training outside of your practice. Either method will require time away from duties, and finances to be budgeted, which should happen early on in implementation planning.

Are You Considering Transitioning to an EMR?

If so, you will not want to try and implement both your EMR and ICD-10 transition at the same time. Careful planning and staging will be required. Meaningful use requirements will need to be met to gain access to stimulus money, and to put that additional burden on top of the major change of ICD-10 implementation could bring a practice to its knees. Begin transitioning to your EMR now to capture all of that available revenue and begin ICD-10 awareness in your practice. Then carefully roll out each stage. Detailed attention is required to workflow and processes, and mapping of all areas affected in the practice. You may consider developing teams in your practice for both EMR and ICD-10 implementation. If you do implement teams, make sure that they meet occasionally to ensure that implementation requirements are met.

Wherever you are in the process, you must leap ahead in planning in order to be successful in the transitions coming your way over the next several years. Careful planning and budgeting are essential to financial health. Meeting the changing demands head on is key to success. Let the journey begin …