Coping with ICD-10

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Physicians will need to meet with staff to discuss their new responsibilities.
Physicians will need to meet with staff to discuss their new responsibilities.

The move from ICD-9-CM to ICD-10 is enough to strike fear into the hearts of physicians and staff alike. Making the leap from 14,000 codes to almost 69,000, topped with the huge cost to make that change, is understandably daunting. The more you know, the better off your practice will be. Following is some information about the new system and tips for preparation.

ICD-10 is a diagnostic classification that has been used since 1994 by many World Health Organization Member states. Aside from being a way in which insurance companies determine billing, it is used for health management and epidemiologic purposes.

The Centers for Medicare & Medicaid Services (CMS) says the move to ICD-10 is being made because its predecessor is outdated, lacks specificity, and does not provide enough details regarding health data (such as disease severity and complexity), thus making it difficult to reimburse accurately.

Possible delay

The original date for the transition to ICD-10 was set for October 1, 2013, but the Department of Health and Human Services is considering extending the deadline. This should not halt the switching process if providers are already working on the transition, said Rhonda Buckholtz, vice president of ICD-10 training and education at AAPC (formally the American Academy of Professional Coders), a credentialing and certification organization.

“We don't know when it will be – it could be months or a year,” she said. “We are in a waiting game right now, so one of the things that we have been telling everyone is that if you have begun preparing, you shouldn't stop.”

Preparation

According to CMS, this process can be broken down into the following stages:

Planning. CMS recommends creating a project management structure, a plan to communicate with vendors and other partners and understanding risk management. 

Communicating with staff. Physicians will need to assess what kind of training is required and develop a training plan. Then they will have to meet with staff to discuss their new responsibilities.

Assessment. Aside from the new staff impact, providers will need to understand how the change will affect their business policy, operations, technology, vendors, and so forth.

Implementation. This includes system migration strategies, business and technical changes, and training. AAPC recommends waiting until late 2012 to begin training so staff will retain the information.

Additionally, there is internal and external testing and the transition to the live environment, which includes ongoing support.

Cost

One consideration for switching over is cost. According to a report by the Medical Group Management Association, small practices can expect to spend about $83,000; medium groups will spend $285,000; and large practices can expect to spend $2.7 million to comply with the mandate. The cost will come from six areas: education and training for the staff; analysis of insurance contracts and documentation; superbill changes; IT changes; documentation costs; and cash flow disruption.

Vendors

Buckholtz has seen with both HIPAA and 5010 that some vendors waited until the last minute and told providers they weren't ready. Don't let this happen to you.

Both hardware and software have to be compatible with the new system. Because ICD-9 may still be around for some time (some entities like worker's compensation are not required under HIPAA to switch), a system needs to have the capacity to accommodate both codes.

Other than compatibility, accommodation for both systems, cost, and system availability, providers should ensure that their vendor will also be available for testing, implementation, training, and customer support.

The good news

The transition for nephrologists and urologists won't be as bad for them as for some other specialties, Buckholtz said. “Their codes are straightforward and they will run into new combo codes for those with comorbidities like diabetes,” she said. “Once they get accustomed to those codes, the rest are pretty straightforward.”

Where ICD-9 would have had two or three codes for a patient with diabetes and renal failure, there will be only one in ICD-10.

Resources

Physicians can look to practice management organizations and vendors, many of whom are providing free training and webinars on the topic. Researching now will avoid a last-minute crunch to prepare. Following are some places to start.

  • CMS provides timelines, vendor information, and handbooks here.
  • AAPC provides a free online newsletter on the switch. You can sign up by going here.
  • Everything you need to know about choosing a vendor can be found on AHIMA's Web site here.
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