Preparing for ICD-10: A Primer for Emergency Physicians

In less than 100 days, 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?

Start Here

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 (work with hospital administrators to ensure their system will be ready),
your prescription or order forms and any other paper or digital correspondence that contains diagnosis codes,
your billing and claims submission software (ensure the hospital and/or your billing company are updating their systems, including any data interfaces that allow the two systems to exchange information),
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 hospitals, 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,
billing companies,
EMR providers,
ePrescribing software providers,
private and government payers,
claims clearinghouses,
data repositories or reporting software vendors, including PQRS registry and clinical registry 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. 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 AHIMA or 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 and non-physician practioners 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 Emergency Medicine at a small cost. Although you should also be aware that a study from the University of Chicago determined that “27 percent of the 1,830 commonly used emergency room ICD-9 codes had convoluted mappings that could create billing problems with reporting or reimbursement.”)
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 an excellent 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. Also, a resource from the American College of Emergency Physicians (ACEP) breaks down the most common scenarios for emergency physicians with a few simple reminders for improving clinical 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.

Need help assessing where to begin to prepare for ICD-10? Review the Centers for Medicare and Medicaid Services’ Road to 10 website for more information, or contact CIPROMS today.