ICD-10 is upon us and despite any last-minute come-from-behind play, like a phased or delayed rollout, it looks like the Oct. 1, 2015, deadline for the transition will finally stand. Given that likely fact, and the fact the transition was delayed from Oct. 1, 2014, healthcare organizations are still not prepared for the coming change.
ICD-10 is the 10th revision of the World Health Organization’s International Classification of Diseases (ICD) coding system, codes used to capture diagnoses in all healthcare settings, while ICD-10-PCS (Procedure Coding System) codes are used to capture procedures only in inpatient settings. As you know, the ICD-10 code set is set to replace ICD-9 in the US in October. All medical practices will need to switch to ICD-10 by the deadline or they will no longer be able to obtain reimbursement for the care they provide to patients. Payers, clearinghouses, billing services and all other entities covered by HIPAA will need to comply with ICD-10.
The California Medical Association (CMA) recently conducted a survey of physician practices to evaluate their readiness for the transition. With only a couple months before the deadline, you’d think practices would be well on their way to the preparation and planning process, but the survey indicates otherwise. More than half of respondents (51 percent) said they were only minimally prepared, while 21 percent indicated they were not at all prepared.
CMA notes that the results are concerning “particularly since Congress has reaffirmed that they want to move forward with the implementation of ICD-10 with no more delays.” Additionally, hospitals and insurance companies have told lawmakers that they are ready for the October 2015 deadline and are pushing for Congress to stick with the October 1 implementation date.
However, healthcare providers behind in the ICD-10 conversion preparations may benefit from following the ICD-10 Quick Start Guide provided by the Centers for Medicare & Medicaid Services (CMS). ONC provides five steps that providers will need to take when it comes to their ICD-10 conversion preparations are the following: (1) developing a plan, (2) training the healthcare staff, (3) updating system processes, (4) working with vendors and health insurers, and (5) testing workflow processes and systems.
According to EHR Intelligence, when it comes to training the clinical staff and moving forward with conversion preparations, there should be a focus on new clinical concepts and documentation obtained through ICD-10 codes. “When training coding and administrative staff including coders, billers and practice management employees, the focus should be on ICD-10 fundamentals.”
Since CMS provides resources — including webinars, national provider calls and presentations, the Road to 10 website, and email updates – physicians should take advance of them. Physicians can also rely on payers, third-party consultants and vendors for additional support, should they need it. EHR Intelligence offers a good place to start: Identify the top 25 most common ICD-9 codes used in one’s medical facility. Common diagnosis codes are also available on the Road to 10 website and other resources. “Teach your healthcare and coding staff how to code the most common cases using the ICD-10 coding set. Using reports via one’s practice management software and billing documents, providers can better identify the most commonly used ICD-9 codes,” the site reports.
Once the top 25 codes are gathered and there is still time before the ICD-10 implementation deadline, providers are encouraged to expand ICD-10 coding of typical cases past and additional 50 or more codes. This would ensure the majority of a provider’s cases are managed effectively under ICD-10.
Even though the ICD-10 coding set has expanded to more than 68,000 codes, providers will only need to use a small section of the set. Along with training staff, updating system processes is vital for one’s ICD-10 conversion preparations. All hardcopy and electronic forms need to be updated while information gaps should be resolved before the October 1 deadline.
Clinical documentation will need to include laterality, the number of encounters (initial or subsequent), kinds of fractures, and other information about related complications. It is useful to put together a documentation checklist detailing new concepts that should be captured with ICD-10 codes. Once systems are in place, ICD-10 end-to-end testing is crucial to ensure a healthcare facility is prepared for the October 1 deadline.