The ICD-10 Switch: A Last Minute Guide

“Only 10% of physicians are very confident that they will be able to navigate the October 1, 2015 ICD-10 implementation successfully”

A study1 released by the Texas Medical Association surveyed approximately 36,780 medical professionals, with ninety-seven percent of respondents currently treating patients in an active medical practice. Of the medical professionals who participated in the survey, only 10% of physicians reported that they were very confident in their plans to implement the new system, 25% were somewhat confident, 23% a little confident, leaving 42% of physicians not at all confident in the transition.

Why aren’t physicians ready? Despite all assurances that the implementation would indeed take place on October 1, many have been holding out in hopes that one of several bills2 introduced into the U.S. House of Representatives this year would result in some extra time or a complete stop to the transition. It’s understandable that many would hold off since the United States has postponed the transition twice already.

Though the change has been critiqued by many bloggers and internet docs for including “excessive” or “bizarre” codes, like code W55.21: Bitten by a cow, or code Z63.1: Problems in relationship with in-laws, providing little or no benefit to the physician, the fact is that the United States is a little behind compared to other countries. For example, Canada made the switch to ICD-10 in 2000, China in 2002, and France in 2005. On top of that, the WHO expects the 11threvision to be ready in 2018, and our current code set, ICD-9 is more than 30 years old.

Why the hold-up? The United States is the only country that couples the ICD coding with physician reimbursement. It is understandable that physicians would find this change, which provides limited known personal benefit to the physician and will impact productivity and reimbursement, nothing more than a thorn in their side. There are several hurdles involved in making the switch: human knowledge, both physicians and office staff need to know what needs to be documented; changes in technology, including updates to office systems; and process change to make it all happen efficiently.

CMS has announced a 1-year grace period for claims made with ICD-10 diagnostic codes. This grace period is intended to keep physicians from having claims rejected solely on the basis of code specificity. CMS will allow payments as long as the code submitted is in the correct ICD-10 family. In other words, claims with the correct M1A part of the code will be paid regardless of cause, body location, or severity of illness. CMS will also allow for partial advance payments if claim-processing contractors are unable to process Medicare claims bearing the new codes because of problems on their end. Even with these safeguards in place, medical offices need to make some changes to prevent lags in payment for the next 12 months.

Countdown to ICD-10, What do we do?

A valid ICD-10 code will be required on all claims starting on October 1, 2015. There are steps you can take to prevent excessive financial burden during this period of transition. Following this guide will get you started:

  • Establish a budget. You will need to consider how much time and money will be necessary to make the transition. While planning ahead can help save money (maybe a little late to say we’re planning ahead at this point), correctly identifying the resources you need and setting a budget will help to keep costs realistic. You will also want to prepare for potential cash-flow problems during the switch. Consider setting up or expanding an existing line of credit to mitigate any cash-flow interruptions that may occur.

  • Identify and train staff. Identify staff members who can lead the implementation, this is likely to be a coder or office manager. Training on ICD-10 fundamentals can include traditional classroom training or free resources found on the CMS website including: Road to 103, Industry Email Updates4, and webinars5.

  • Scope out impact. Identify the areas of your practice that will be affected by the switch to ICD-10. This is likely to include electronic health records, billing, practice management, referrals and contracts among other things.

  • Obtain codes as soon as possible. You will want to identify the ICD-9 codes your practice uses most often, targeting the top 25. This will enable you to create a crosswalk and become as proficient as possible as quickly as possible. You can get full lists of ICD-10 codes6 on the CMS website.

  • Update hard copy and electronic forms to reflect changes in specificity. New forms will want to include: laterality, initial or subsequent encounter for injuries, trimester of pregnancy, details about diabetes and related complications, and types of fractures. New forms are available here7.

  • Work with your vendors. Confirm that the health plans, clearinghouses, and third party billing services you work with are ICD-10 ready, and ask about testing opportunities. This is likely to be a good source of training for your staff as well. Don’t be afraid to line up some new vendors if it looks like your current ones might not be ready.

  • Test your systems and processes. You will want to test every part of your office that will be affected by the change. A checklist, or spreadsheet to track the success of implementation will help you to stay organized and ease you through the transition. Some things you might include in your list:

  • Generate a claim

  • Perform eligibility and benefits verification

  • Schedule an office visit

  • Schedule an outpatient procedure

  • Prepare to submit quality data

  • Update a patient’s history and problems

  • Code a patient encounter

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