In 1 month, the US healthcare system will transition to International Classification of Diseases, 10th Revision, whether or not physicians are ready to implement the new coding system.
In 1 month, the US healthcare system will transition to International Classification of Diseases, 10th Revision (ICD-10), whether or not physicians are ready to implement the new coding system.
After October 1, 2015, Medicare claims processing systems will not have the capability to accept ICD-9 codes for any services provided after September 30, 2015. However, CMS announced that it will allow some flexibility. For instance, as long as the ICD-10 code used is from the correct family of codes, claims will not be denied and physicians will not be subject to penalties for the Physician Quality Reporting System, the value-based modifier, or meaningful use.
Although medical organizations, like the American Medical Association, supported delaying implementation of ICD-10 yet again, the government has declined to do so. And despite the deadline barreling down, the latest surveys have found that few physician practices have completed testing for transition to ICD-10. The Workplace for Electronic Data Interchange found that as of June, only 20% of physician practices had started or completed testing, and only half said they were or would be ready for the October 1 deadline.
7. Don’t Panic Unnecessarily
One of the biggest concerns about the transition is that the huge increase in the number of codes from ICD-9 to ICD-10 will increase the difficulty of using the new code set. In reality, with more comprehensive and precise codes, it should be easier for providers to find the right code.
In addition, the American Health Information Management Association (AHIMA) pointed out in 2014 that 46% of the increase in codes for ICD-10 simply reflects the ability to identify the affected side of the body.
Early preparation is definitely the best way to be prepared for the transition, but that doesn’t mean it’s too late.
6. Identify Necessary Documentation Changes
Changing to ICD-10 will require a change or modification in the way clinicians document. An increase in documentation time is expected, but using templates will make it easier to implement necessary changes.
Providers should modify the current electronic health record templates being utilized for common chart entries to include the additional information that will need to be captured for an ICD-10.
For instance, the template should now include information such as laterality, chronic or acute/subacute, and whether the issue is recurrent.
5. Perform Your Own Testing
Even organizations that have not participated in end-to-end testing can still conduct checks on the technical system. These will ensure that they can send ICD-10 claims. Plus, Medicare acknowledgement testing can be done at any point until October 1, 2015, without needing to schedule a testing period.
Coding systems should be able to: generate a claim, schedule an outpatient procedure, perform eligibility and benefits verification, prepare to submit quality data, schedule an office visit, update a patient’s history and problems, and code a patient encounter.
4. Prepare in Advance for Disruption
Given that ICD-10 coding is expected to take a significant amount of extra time, and the transition likely won’t be completely smooth—even for well-prepared organizations—it should be expected that ICD-10 may disrupt business operations.
Part of the conversion process should be creating a contingency plan in the event of a major issue. The plan should include who is to be contacted if there is a complication as well as a financial plan in place in case payments are delayed or paused. And once the transition to ICD-10 is complete, update the plan
What conditions account for most of your organization’s revenue? Try coding them in preparation and see if you run into any trouble.
3. Maintain a Culture of Positivity
Although preparation and transition to ICD-10 is a lot of work, there is a lot of good that will come from implementing the new codes. As the deadline approaches, stress the benefits that will come with ICD-10.
For instance, the documentation of ICD-10 is more specific, which will result in fewer denials. Plus, Jackie Stack, director of ICD-10 training and education with AAPC, explained that noncompliance codes that document when patients do not take their medications will protect physicians legally.
2. Practice ICD-10 With ICD-9
There is still time left to get in extra practice by using ICD-10 codes side-by-side with ICD-9 codes. This step will help clinicians become more familiar with the new codes before the required transition.
The easiest way to do this is take a moment when coding in ICD-9 and figuring out what the code would be next month after the transition to ICD-10.
In the long run, practicing might take some extra time now, but will ultimately prevent more problems down the line, such as reimbursement delays, if people aren’t familiar with the new codes after the deadline.
1. Improve Clinical Documentation
Although the overall transition to ICD-10 can be daunting, many experts agree that clinical documentation improvement (CDI) is incredibly importance for a successful transition. Many hospitals have employed CDI teams that will review records and involve physicians if documentation is not specific enough to code in ICD-10.
Nearly a third of respondents to a recent survey from Navicure said increased CDI and coding requirements were the most challenging aspect of ICD-10 transition.
Ultimately, CDI will be beneficial not just for reimbursement purposes, but for the purpose of healthcare quality, according to AHIMA. According to a 2014 report from AHIMA, benefits of robust CDI programs include enhanced public health surveillance; cost containment; fewer erroneous and rejected claims; and administrative efficiencies.
With 1 month left until the ICD-10 deadline, identifying documentation gaps should become a priority.