The calendar says it’s time to think about the holiday shopping season, and planning for ICD-10. Oct. 1, 2014 is the date for submitting ICD-10 diagnosis codes. What’s your plan for the transition from ICD-9 to ICD-10?
The breadth of changes will have an impact your entire office. It’s obvious that your billing staff and coding staff will need training, but have you considered your other staff — those who schedule surgeries or obtain authorizations and referrals or submit lab and imaging requisitions? They all need to know the new ICD-10 codes.
And, of course, so do you, the healthcare provider documenting the care.
CMS touts some of the benefits of ICD-10, stating that the “added detail embedded within ICD-10 codes informs healthcare providers, supports evolving ACO models and health plans of patient incidence and history, which improves the effectiveness of case management and care coordination functions. Accurate coding also reduces the volume of claims rejected due to ambiguity.”
The now nearly 150,000-code opus is also supposed to:
- Improve operational processes across the healthcare industry by classifying detail within codes to accurately process payments and reimbursements
- Update the terminology and disease classifications to be consistent with current clinical practice and medical and technological advances
- Increase flexibility for future updates as necessary
- Enhance coding accuracy and specificity to classify anatomic site, etiology, and severity
- Support refined reimbursement models to provide equitable payment for more complex conditions
But there will also be significant costs attached to getting ready for the new coding system. Costs that each practice will have to absorb. They include:
- Provider and staff education and training, estimated at $265 to $485 per individual
- Business process analysis, projected at $500 to $2,300 per provider
- Changes to superbills, estimated at $950 per provider
- IT costs, estimated at $1,000 to $2,500 per provider
- Increased documentation, estimated at $14,000 to $17,500 per provider
- Cash flow disruption, estimated at $6,500 to $17,800 per provider
If you need to jump start your transition project, consider an external audit to perform a documentation gap analysis. Look for webinars for your entire staff as an introduction to the change. A refresher in anatomy and physiology will be helpful to ancillary staff.
Reach out to your specialty society too. Check with your technology vendors on their ICD-10 plans; check with user groups.
Look at your current technology implementation. Will your vendor load the ICD-10 code sets on your behalf?
Be sure to ask your EHR vendor for upgrades that include prompts in documentation tools for the additional required information, such as, but not limited to laterality, episode of care, risk factors, location of disease or injury information.
Consider eliminating your encounter slip and transitioning to online charge capture and coding so that you can take advantage of the embedded coding support for your documentation.
Designate one person in the office to manage the project and keep it on track. Your plan should include a testing phase for submitting claims to your clearinghouse and for testing claim processing by your biggest payers. Testing will minimize disruption in your cash flow.
Dual coding (code both ICD-9 and ICD-10) may provide some confirmation that your claim will not be denied, but check with payers to determine if they have a feedback loop for dual coding. Remember, the payers’ systems are changing as well.
Practical next steps:
- Coders have no background in anatomy and physiology? Get them into a course now.
- Buy an ICD-10 book/online access and code the 50 most common codes in your practice.
- Send your coders offsite for a two-day intensive training program and have them test for certification.
- Develop a training timeline for clinical staff. Remember, you need to practice what you learn.
- Read the general guidelines for coding ICD-10 (found on the ICD website and in the front of the book).
Remember, the holidays and ICD-10 are coming; the calendar won’t change that fact. And they’ll both be upon us before you know it.
Rosemarie Nelson is principal, MGMA Health Care Consulting Group and blogs at Practice Pointers.