The implementation date for ICD-10 has been pushed back for the last time. On October 1, 2014, the new set of codes will go into effect. While that seems like a long time away, the time to prepare is now. Anything less can have a major impact on your revenue. With so many moving parts in a practice that are affected by this change, waiting until the last minute to prepare is not a viable option. Below are the proper steps to ensure that your practice is ready for the change to ICD-10.
Before you begin preparing the practice, it is important to be educated on exactly what the changes entail. ICD-10 stands for
International Classification of Diseases, 10th Revision
and is based on the World Health Organization’s ICD-10 codes. The current set of codes, ICD-9, has been in use for the last 30 years. Now considered to be outdated, ICD-9 is maxed out, and in many areas no new codes can be added. Because it can no longer grow along with the medical industry, it was determined that it was time to transition the United States to the new guidelines. It was delayed several times, but now that HIPAA’s approved standards for electronic communications (Version 5010) has taken effect, the infrastructure is in place to make the transition. The US is the only industrialized country that has not converted, and doing so will also align us with worldwide coding standards.
The number one difference that overwhelms providers is the sheer number of codes contained in the new set. The number of diagnosis codes will grow from 14,000 to 68,000. The number of procedure codes will go from 4,000 to 87,000. The second key difference is that the codes will go from being 3-5 digits with only a few letters included, to being 3-7 digit alphanumeric codes. While this is a huge difference, it is necessary to allow for the codes to more accurately measure healthcare services. ICD-10 codes will provide room for growth as healthcare continues to evolve, new procedures are developed, and new conditions discovered.
The next step is to determine a timeline for your practice’s transition. Considerable work must be done over the next 20 months to prepare your office. Once the transition date passes, there will be no filing with the old codes. Therefore, thorough and complete preparation is the only option. The following steps are the key points to put on your timeline:
1. Define the areas of the practice that codes are used. It is advised that the best way to do this is to follow a patient through a visit and note every place that a code is used. This will outline which departments will be effected by switching to the new codes.
2. Contact the proper companies and vendors to determine their readiness and timelines. That includes EMR providers, clearinghouses, billing companies, and labs. It must be established that they are taking steps to prepare for the switch, and they should be able to provide you with the following information:
- What is their goal date to be completely ready?
- How and when will their readiness be tested?
- Will there be any cost to the practice to upgrade?
3. Contact all payors. Verify that they will be able to receive claims, and if test claims need to be sent. Also inquire if there will be any payment renegotiations necessary, or if the current contracts will still hold.
4. Determine the way that staff will be trained on the new codes. Number one above should have outlined exactly which employees will need to be trained, and in what depth. What must be decided is how training will be conducted. There are various avenues depending on the size of the practice, budget, and time constraints. Think about hiring a consultant, purchasing training materials, or arrange a key member to be trained then to train everyone else. Allowing enough time for thorough training is very important.
Following this plan in a timely manner should expose any issues that your practice may have in the transition. While it is natural to be resistant to the change, there is no avoiding it. The reality is that once the US switches over to ICD-10, the quality of care will improve, be more efficient, and be more cost effective. Also, diagnosing will become more exact with fewer errors.
Procrastinating will only cause serious stress and possibly result in hurting your bottom line. Properly prepare and educate yourself and your employees so that you can continue to provide the highest level of medical care possible.
FAQs: ICD-10 Transition Basics. (July 2012). Centers for Medicare and Medicaid Services. Retrieved on January 6, 2013.
Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today. (n.d.) American Medical Association.
January 6, 2012.
Version 5010 Industry Resources. (July 9, 2012). Centers for Medicare and Medicaid Services. Retrieved on January 6, 2013.
Why is ICD-10 -CM/PCS Necessary? (n.d.) AHIMA. Retrieved January 7, 2012.