Tick Tock: Watch the ICD-10 Implementation Clock
The one year countdown to ICD-10 has begun and here is what you need to know to be ready when the final bell rings.
The countdown clock to ICD-10 implementation is ticking. Next year at this time—Oct. 1, 2014—ICD-10 will be the code set standard used to identify diagnoses on medical claims. The Centers for Medicare & Medicare Services (CMS) recently affirmed that this implementation date will not change. There’s no turning back now, but many organizations still have a lot to do to get ready. It’s important to know where your organization stands on the road to implementation. Let’s take a look at what we must do to be ready for the big day.Understand the Impact on Healthcare
ICD-10 is used for reporting diagnosis and inpatient procedures in other parts of the world, but is new to the United States. The American ICD-10 code set contains about 141,000 codes, which is a jump from the 17,000 ICD-9-CM codes it’s replacing. Due to the specificity of the expanded code set, it’s more effective at capturing public health disease information.
According to CMS, ICD-10 is essential to healthcare reform and is part of the overall goal to create a better, more accessible, and more affordable healthcare system. ICD-10 will provide greater interoperability, easier data sharing, and better quality measurement while improving clinical outcomes and costs. It’s going to take some work on our part, though.
If you are a practice manager, there are areas in your organization you’ll need to analyze and prepare to ensure your practice is up to snuff to support the ICD-10-CM code set:
Impact Assessment – Complete an impact assessment to determine all of the areas and departments in the organization affected by the ICD-10 transition. This assessment will allow your organization to examine processes and identify deficiencies.
When performing an impact assessment, look at how your organization currently uses ICD-9-CM codes. The assessment should also identify the reports, software programs, and tools your organization uses.
Gap Analysis – A gap analysis identifies the impacts of the ICD-10 transition, as well as key areas such as strengths, weaknesses, goals, opportunities, and obstacles.
For example, one of the areas the gap analysis identifies is the strength or weakness in clinical documentation. The clinical documentation used for ICD-9-CM will not be sufficient for ICD-10-CM because the new codes require a higher level of specificity.
Documentation for ICD-10-CM is a huge issue. Readiness assessments show whether there is enough information to assign a code to the highest level of specificity. Weak documentation will have a huge financial impact on your organization. Take a look at the clinical documentation now, and see if it can stand up to coding using ICD-10. If not, your providers must be educated on the additional information necessary to code correctly.
Gap analysis also stresses the risk of not making adjustments to superbills. In fact, superbills may be a thing of the past. Depending on the case mix, a replacement superbill may turn out to be 10 pages or more. Your practice needs to look at its current superbill and decide if it’s feasible to continue using it. If not, your practice will need to look at alternatives.
Budget – Create, review, and update a budget, as necessary. The budget should include:
- Information systems – Information technology will be the biggest expense for the organization. Determine if new software and/or hardware is required.
- Auditing and monitoring – Review clinical documentation for deficiencies. Your budget should include ongoing auditing and monitoring costs to ensure documentation in the medical record supports the diagnosis code transition.
- Staffing and overtime – Consider staff issues, including possibly hiring temporary staff prior to implementation and to assist with post-implementation claims issues. For example, additional staff may be needed to complete daily work while permanent staff is in training, and to make up for loss in productivity and increased denials and delays.
Education and Training – Education and training will be a large expenditure. Everyone in the medical practice will require both. In general:
- Providers will need approximately eight to 16 hours of training.
- Nurses will need an introduction to ICD-10-CM with six to 10 hours of training.
- Coders will need 40-60 hours of training, depending on specialty.
- Ancillary staff will need six to 10 hours of training.
Conduct an assessment of your education and training needs. The type of training is also important (for examples, web-based training, interactive distance learning, and classroom-based, hands-on instruction). There is no right or wrong method for training, other than it must be effective.
Tip: To help you decide on the appropriate format, consider the learning styles of the employees who require training. According to an article originally published in Instructor Magazine in 1989, there are three basic types of learning styles: visual, auditory, and kinesthetic. You can learn more about these learning styles at:
Vendors – Communication with vendors concerning their transition plans will be key to a successful implementation. When talking to computer system vendors, ask questions concerning necessary upgrades or replacements. For example:
- How much will they cost?
- How will the system handle the new codes?
- How will it affect the workflow process?
- What are the vendor timelines?
- When will the system be ready?
- When will testing be performed?
Payers – Talk with your payers concerning their transition plans. Ask what changes will be taking place regarding policy, contracts, and testing. As a result of the increased specificity in ICD-10-CM, health plans should be able to reimburse claims in an improved, more accurate manner with less documentation scrutiny.
Work with your physicians now to make them aware of the challenges ahead. Let them know clinical documentation will need more detail. Documentation assessments must be completed either by internal staff or through outsourcing. This allows your organization to determine the current level of documentation, where documentation is lacking, and the education and training that is necessary.
Tip: AAPC offers ICD-10 Documentation Training for Physicians (www.aapc.com/ICD-10/ICD-10-physician-documentation.aspx). In a three-hour online format, healthcare professionals can choose from 20 different medical specialties to learn of ICD-10-CM documentation requirements at the physician level. Developed by physicians, each course calls out the critical documentation that will be required to maintain reimbursement when the ICD-10 transition occurs.
If you are a coder or biller, it’s time for you to update your skills, complete training, and take an ICD-10-CM proficiency assessment. Here’s how to do it:
Anatomy and Pathophysiology (A&P) – Because ICD-10-CM codes increase specificity, you must have a stronger understanding of anatomy and the disease processes as they pertain to coding. Focusing on your understanding of A&P now will prepare you for ICD-10 before the implementation date.
AAPC’s ICD-10-CM Anatomy and Pathophysiology training is offered online (www.aapc.com/ICD-10/anatomy-pathophysiology.aspx) and is an on-demand, distance learning program. The program covers all body systems in 14 modules, providing you flexibility to take the course anywhere, anytime.
General Code Set – AAPC offers General ICD-10-CM Code Set and General ICD-10-PCS Code Set training (www.aapc.com/ICD-10/training.aspx?a=tab3). This training is designed to give attendees a comprehensive understanding of guidelines and conventions of ICD-10, and to attain the fundamental knowledge of how to decipher, understand, and accurately apply ICD-10 codes.
Specialty Specific Code Set Training – In January 2014, AAPC will provide advanced code set training for coders who wish to have specialty-specific training. The course provides an in-depth understanding of specialty-specific nuances and hands-on coding exercises.
ICD-10 Proficiency Assessment – Take the AAPC ICD-10 Proficiency Assessment (www.aapc.com/ICD-10/icd-10-proficiency-assessment.aspx) to measure your ability in using the ICD-10-CM code set. The assessment is required for all certified AAPC members. It’s also recommended for anyone responsible for their organization’s ICD-10-CM coding. There is a proficiency practice workbook and practice proficiency assessments available to help prepare for the assessment.
ICD-10 will bring significant benefits and challenges (perhaps more challenges, in the early years). Well-prepared practices are those who recognize the obstacles and prepare for them early on. They are also the ones who will reap the benefits of ICD-10, rather than suffer the consequences.
Jackie Stack, BSHA, CPC, CPC-I, CPB, CEMC, CFPC, CIMC, CPEDC, is an ICD-10 specialist at AAPC.