The switch to ICD-10: Are you ready?

The switch from ICD-9 to ICD-10 for diagnosis and inpatient procedure coding becomes a requirement on Oct. 1, 2013. That gives private practice physicians over a year to prepare. But brace yourself: ICD-10 contains 51,000 more codes than ICD-9 did.

Better Analysis

ICD-10 contains more than 68,000 codes altogether and accommodates a host of new diagnoses and procedures. This greater coding detail enables better analysis of disease patterns and a wider variety of potential treatment outcomes that can improve care.

In addition, ICD-10 will help you streamline claims submissions, which means initial claims will be easier for payors to understand. The ability to report laterality might actually decrease denied claims. The challenge is to train clinicians to document the highest level of specificity to code accurately, and for your staff to accurately process all ICD-10-based claims.

Transition Team

Your top priority: Create an ICD-10 transition team, even if it only one or two people. Appoint a lead person who has credibility among all the functions likely to be involved in the effort, such as clinical, administrative, IT and billing.

Then assemble a team of practice members who can prepare, use and transmit ICD-10 coded data. When the team has defined its objectives, it should develop appropriate metrics for measuring progress.

One of the first tasks should be to conduct a gap analysis that answers the questions Where is the practice now? and Where do we want it to be on Oct. 1, 2013? The difference between those answers will define what must be accomplished.

The analysis will require several subtasks, such as identifying the systems, software applications and vendors affected by ICD-10 and detailing how they're affected. In addition, the team should look at ICD-10 impact on the practice work processes and flows.

Third Parties

Another key task for the team is to acquire information from pertinent third parties about their roles in the ICD-10 switch. Don't acquire the necessary software and hardware until you've contacted everyone involved. Major players include:

Software vendors. Will they be upgrading applications to accommodate ICD-10? To facilitate the transition, will they support ICD-9 and ICD-10 simultaneously for a while? Are the software upgrades likely to require hardware or network upgrades, such as more powerful computers or file conversions? How much lead time will there be for testing the upgrades before the 2013 compliance date?

Clearinghouses and billing services. What are their plans and schedules for conducting ICD-10 testing with payors? By what date will they be able to accommodate ICD-10? How soon will they be able to receive test transactions from providers and what will the process be?

Payors. A few payors usually represent the bulk of a practice revenues. Ask them about their ICD-10 conversion plans and what their implementation timelines look like.

Testing and Training

Consider conducting a short training session immediately to introduce practice staff to the ICD-10 deadline and its implications. Then gather the relevant information and prepare a step-by-step implementation plan tied to a timeline and backed up with sufficient resources of money and personnel. And don't delay: Putting off these tasks will only make the transition more difficult and expensive.

When your software is eventually upgraded or replaced, new hardware is installed, and work processes are reshaped, test the system to ensure it can generate ICD-10 codes, claims, and data accurately and reliably. Once you're confident in its ability to generate ICD-10 codes as regularly as ICD-9 codes, work with your reimbursement partners to begin external testing. Its purpose should be to determine the ability of clearinghouses, billing services and payors to receive ICD-10 coded test claims from the practice. All partners should be willing to confirm receipt of compliant claims and report any deficiencies in the transaction.

When conducting the testing, provide extensive, job-specific training of physicians and staff, particularly those whose positions entail extensive use of coding data. Make sure you include a general training program for reminding all staff of the importance and practical details of ICD-10 coding.

Ready or Not

All physician practices must develop a forward-looking strategy to meeting the ICD-10 deadline. If you're not ready to make the change by Oct. 1, 2013, you won't be able to file acceptable claims and may not receive timely reimbursement for services. As a final safeguard against transition troubles, consider setting aside cash reserves or expanding your bank line of credit.