In just a little more than three months, ICD-10 will be upon us. Though proposed legislation and rumors of further delays or extended transition periods abound, now is not the time to sit idly by. When October 1, 2015, comes, will you be ready for ICD-10?
To start preparing for ICD-10, ensure that any instance where you currently use ICD-9 codes will be updated to the new ICD-10 code set on October 1. So readiness means reviewing and updating the following:
- your EMR system (or ensure the hospitals and ambulatory surgical centers you work with are making the changes to their EMR system),
- your appointment scheduler (or ensure the hospitals and ambulatory surgical centers you work with are making the changes to their appointment scheduler),
- your superbills, preauthorization and precertification forms, prescription or order forms, and any other paper or digital correspondence that contains diagnosis codes,
- your billing and claims submission software (or ensure your billing company is making the changes to their system),
- your practice management or clinical reports by diagnosis,
- your vendor or payer contracts with any diagnosis-specific provisions,
- and any other documents, programs, or tools that utilize diagnosis codes.
Make Sure Everyone Is Onboard
At this stage in the game, you, your facilities, your vendors, and your payers have probably already begun working on updating these electronic or paper tools. To be certain, though, contact each individual or organization you work with about their readiness for ICD-10, including the following:
- hospitals and ambulatory surgical centers,
- billing companies,
- EMR providers,
- appointment scheduling software,
- ePrescribing software,
- private and government payers,
- claims clearinghouses,
- data repositories or reporting software vendors,
- and others.
What About Non-HIPAA-Covered Entities
Remember, all HIPAA-covered entities (health plans, healthcare clearinghouses, and healthcare providers who conduct certain financial and administrative transactions electronically) are required by federal law to transition to the new code set. However, some insurance companies are not HIPAA-covered and therefore are not required to convert to or accept ICD-10 codes, including long/short term disability, workers’ compensation, and automobile liability. However, some of these entities may convert to ICD-10 anyway in order to stay current with the HIPAA standards. Contact any entities you work with from this category to see how you should submit diagnosis codes on claims after October 1.
All Aboard the Training Train
Next, ensure you and your staff have proper training in the new code set.
- Not everyone on your staff needs the same level of training. Of course, your coding staff will need the highest level of training. Consider enrolling them in one of the AHIMAor AAPC ICD-10 training courses.
- Once your coders become more familiar with the new code set, enlist one of them to become a trainer for the rest of your team, providing only the level of information necessary for each member of your team.
- Make sure all physicians in your practice understand the basics of ICD-10, even if they are not choosing diagnosis codes themselves, because of the need for improved documentation.
Clinical Documentation Improvement
Which leads to the next step: begin evaluating your clinical documentation. Remember that the giant leap from 13,000 to 68,000 diagnosis codes in ICD-10 results largely from an increased level of specificity in the new code set. In order to properly assign ICD-10 codes, you and your coders will need many more details documented in the medical record in order to effectively assign codes.
- Review your top 50 ICD-9 codes (or top 25 percent of codes) to see how they will convert to ICD-10. What additional documentation would be needed to code them under the new code set? (AAPC offers an ICD-9 to ICD-10 Crosswalk for the Top 50 Codes in Anesthesia at a small cost.)
- Perform an internal chart audit with your physicians, coding staff, or outsourced billing company. Can ICD-10 codes be accurately assigned based on the current level of information being documented?
- Begin exploring the types of additional documentation that are required by type of injury or illness. The Crozer-Keystone Health System in Pennsylvania has created anexcellent tool to help determine what types of information need to be documented according to body system. Also, CMS has a helpful overview of how ICD-10 codes are compiled that provides insight into the information needed for documentation. Remember, the first three characters of each ICD-10 code provide the category of the illness or injury. The final three or four characters provide information like etiology, anatomical location (including laterality when applicable), severity, and frequency of occurrence.
Finally, as the October 1 transition date approaches, keep in mind the specific instructions from the Centers for Medicare and Medicaid for anesthesia cases that cross over midnight from September 30 to October 1: “Anesthesia procedures that begin on September 30, 2015, but end on October 1, 2015, are to be billed with ICD-9 diagnosis codes and use September 30, 2015, as both the FROM and THROUGH date.”
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