Prepping Your Practice for ICD-10

You hear that doctors? ICD-10 is coming! No more delays this time, and the day of reckoning is October 1, 2014. Perhaps it seems a long way off, but be warned, it'll creep up faster than expected, especially for those not prepared for it. Prepared physicians are successful physicians, and here's a way to equip yourself, your practice and your employees when the change comes along.

By way of introduction, ICD-10 is a long-awaited change to an old and outdated system. ICD-9-CM was first established in the 1970s and with the proliferation of medical technology, knowledge and general communication, no longer services the 21st Century Physician in a beneficial way. It's running out of codes and it never really had the proper mechanisms to address concepts like reimbursement. It also lacked morbidity coding and leaves many US physicians unable to make accurate predictions and comparisons regarding worldwide disease patterns.

To be specific, physicians and their practices will only use ICD-10-CM. They will not use ICD-10-PCS (Procedure Coding System), as this is for hospitals to use to report resources they use in specific in-patient scenarios. Physician services in any setting, whether they be an office visit or an in-patient procedure, will still be coded using the traditional Current Procedural Terminology (CPT) and the Healthcare Procedural Coding System (HCPS).

Though the systems are somewhat similar, ICD-10 will offer many more variations than its predecessor. One of them is a longer set of alphanumeric codes. All ICD-10-CM codes are alphanumeric, as opposed to just the supplementary classifications (V codes) and causes of injury (E codes) codes specific to ICD-9-CM. Furthermore, ICD-10-CM codes can be up to seven characters in length, rather than the previous character limit of five.

The number of possible codes will increase drastically from roughly 13,000 to 68,000. Though most physicians won't use them all (only a small number related to their specialty) it's important to note that nonspecific codes will still be used, as they were in ICD-9, as a means to assign codes to circumstances where documentation isn't available. The new, more detailed documentation of ICD-10 will still allow physicians to take full advantage of the information in the form of very detailed codes. This emphasis on specificity means that codes will be easier to assign correctly, mostly because there are fewer ambiguities. Many believe this will have a positive effect on physicians as there will be fewer coding errors and fewer unpaid claims and non-coverage issues. More specific codes can also decrease the requests for submission of additional supporting documents on many claims.

Structure

ICD-10-CM is structured quite differently In addition to the longer alphanumeric codes, it describes diseases differently. Specialty societies have been recruited to help provide input into the codes and newer, more relevant terminology has been included. One example is that Hypertension is no longer split between "benign" and "malignant." It has one code (110) which describes essential (primary) hypertension and includes a diagnostic statement of high patient blood pressure.

One code, instead of two, will be used for many complex conditions. Coding professionals and those involved with reimbursement will see a benefit in the increased implementation of combination codes. There has been trouble in the past of ensuring correct data entry when diseases required two codes (as an example "diabetic neuropathy"). This simplifies forms development, and decreases the chances of getting lost in the paperwork. This also cuts down on the risk of physicians billing codes that aren't actually supported by medical record documentation.

How to Prepare

The shift to ICD-10-CM affects both the practice management system and the electronic health record. Practice leaders should determine the impact that the change can have on their practice as soon as possible. Basic impact assessment, including a system inventory, can help soften the blow of the new system. It's important to note that some vendors may already be implementing ICD-10-CM codes now, particularly those who sell products outside of the US. It's important for practices to ensure that their vendors are ready, or are planning on switching over, before the time comes.

The good news is that you won't need to obtain any additional technology to use ICD-10-CM, although you may want to invest in proper encoding software as it will improve the accuracy of code assignment. During the changeover, practices should plan on keeping both ICD-9 and ICD-10 codes in their system for some time. This time will vary from practice to practice, but it'll be especially handy for instances in which claims haven't been paid and have service dates prior to October 1, 2014.

Languages of Learning

Dena K. Malin identifies the new coding procedures as a "language" in her article, Get Ready, Doctors: ICD-10 Compliance Date is Coming October 1, 2014, and encourages practices to be "cognizant" of the fact that "learning occurs at different rates and ways for different resources. Those with different skills often require additional methods." Essentially, not everyone learns the same way or at the same rate. Consideration of another's learning principles must be thoughtfully executed to ensure that the new procedure provides the least amount of disruption.

Some members of your practice will be visual learners and they will need to see examples of the new code in order to become familiar with it. Others learn best by hearing, and others are more kinesthetic and prefer a hands-on approach. These basic principles of education will be handy for selecting training programs to best suit the needs of a practice's staff.

One way your practice can successfully integrate the new system among all employees is to make a basic checklist of all the staff members who will be affected by the ICD-10 transition. You can establish a process and a method for communicating your specific agenda with these staff members and you can measure continuing progress. This requires careful consideration on how best to disseminate the information, be it in-person discussions, emails, PowerPoint presentations or web seminars.

Work Flow

A full assessment and understanding of all the points of a practice's workflow, particularly those that will be impacted by ICD-10, is crucial to a streamlined transition. You can create a list of all elements that relied on ICD-9 and make a specific plan of action to see what is needed to transition each area and process. Defining which staff members will be responsible for each and which will rely on an external source also helps. By treating each system as its own separate entity and by monitoring progress, attention and resources can be shifted to the areas where they're most needed. If there are any changes that need to be made, it's best to figure them out now than later on when the deadline hits.

Defining clear roles and responsibilities and assigning them to team members will ensure a smooth transition. Some physicians may find it useful to assign one staff member as the ICD-10 leader, someone who's ultimately responsible for ensuring that the overall implementation stays on track in time for the deadline.

Training can be split into three distinct groups: clinical staff, billing and coding and executive. Each group would have a different training rubric with a different implementation timeline and requirements. Some might see it most useful for this training to occur during normal working hours and others might see a need to dedicate extracurricular time to it. Regardless, training options are many and so are helpful resources.

Practice Management Systems

Talking with your practice management system vendor about their specific vendor plan ensures that everyone is on the same page. Clarify when they will be ready and in full adherence to both ICD-10 and 5010 standards. You can also find out if your system can handle both ICD-9 and ICD-10 codes for some time.

Money

A specific budget may need to be allocated for this training. The specific training methods you choose will determine how much money, but cost should be addressed for tangible items like forms, templates, software updates and coding books. Securing a line of credit to reduce the impact of cash flows issues can also be beneficial. Advance preparation can sidestep potential negative impact.

An Ounce of Prevention = A Pound of Cure

With a new system driven exclusively by specificity, a tailored approach is your best bet to a smooth and catastrophe-free transition. Reviewing and planning now, eliminating stressful moments in the future, knowing where your team’s strengths and weaknesses are, and knowing where to allocate training resources are key.

References

Kuehn, Lynn. "Preparing for ICD-10-CM in Physician Practices"
Journal of AHIMA 80, no.8 (August 2009): 26-29.

Law, Lindsay, and Ann Porucznik. "Switching to ICD-10: The Impact on Physicians."
Switching to ICD-10: The Impact on Physicians. AAOS.org, Feb. 2009.
Web. 17 Jan. 2013.

Malin, Dena K. "Get Ready Doctors, ICD10 Compliance Date Is Coming October 1 2014."
Physciansnews.net. Physicians News, Jan. 2013. Web. 17 Jan. 2013.

Dylan J. Chadwick

 

Dylan Chadwick is a graduate of Brigham Young University where he earned a Bachelor of arts in English and a minor in Spanish. Though spending his formative years in Cardiff Wales, he came to adolescence in Elizabethtown Kentucky, and considers it his home. He received the Eagle Scout Award, served a voluntary humanitarian mission to inner-city Los Angeles from 2007 to 2009, and once met Alan Alda on a golf course. He's an avid writer who cut his teeth contributing to student papers and continues writing for various print magazines, blogs and web resources. A ravenous fan of baseball, rock music and Dan Aykroyd-era Saturday Night Live, he plans on one day utilizing these interests in a Masters degree in American Studies and Literature. He also maintains a freelance illustration company on the side.