13 Tips to Ease the ICD-10 Switch

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It's not too early for health systems and physicians to begin training for the ICD-10 transition that takes effect in October 2014, but fortunately, it's also not too late, according to two ICD-10 experts who presented a May 22 webinar titled "The Transition to ICD-10: Roadmap to Success" hosted by accounting advisory firm CliftonLarsonAllen and Fredrikson Healthcare Consulting.

While more providers are stepping up their preparations to implement the new coding system, there is a danger that some underestimate how far-reaching the change will be in their organization or believe the start date will be delayed as it was last year, said Karla VonEschen, managing consultant at CliftonLarsonAllen. "This is a very large transition. This is not a small transition," she said.

Anne Smith, RN, principal and CEO of Fredrikson Healthcare Consulting, said while the biggest changes focus on code structure and conventions, it would be a mistake to assume only coders need training for the new system.

Here are 13 things the experts recommend providers keep in mind when drafting a preparation plan for rolling out ICD-10 in their organization.

1. Don't count on another extension. Although HHS granted a one-year extension before it will require HIPAA-covered providers to comply with ICD-10 billing, it's not likely to happen again, Ms. VonEschen said. The American Medical Association has lobbied hard for HHS to either extend the program another year or scrap the ICD-10 switch entirely, she said, but the federal agency has said it will be ready for the rollout next year.

2. The transition doesn't affect Current Procedural Terminology coding. Physicians have been slower to begin training their staffs and updating their systems for ICD-10, the presenters said, perhaps out of anxiety that doing so will upend their coding and billing process. Fortunately for them, Ms. Smith said, physicians will still be able to use CPT coding for many of their procedures without any ICD-10-related changes.

3. Memorizing is not an option. Code length will jump from a maximum of five characters in ICD-9 to a maximum of seven in ICD-10, and the codes themselves must contain much more case-specific information than has been the case since ICD-9 was adopted in 1979.

"You won't be able to memorize these codes in your head the way you might have gotten used to before, because the codes are just too long and too complex," Ms. Smith said.

4. No "crosswalking." No program can automatically "crosswalk" or convert old ICD-9 codes into ICD-10 codes, because the newer system requires information not contained in ICD-9. While some codes can be directly translated, a single ICD-9 code could represent as many as 50 different procedures with separate codes in ICD-10, Ms. Smith said.

5. Code in context. ICD-10 places a much stronger emphasis on not only a broader range of conditions and procedures, but also on the severity, anatomic site, and cause of injury and disease, as well as the setting and approach to care. Far more data is required of the patient's status, as well, including whether he or she was injured or experienced symptoms while working, volunteering or in other contexts, the presenters said.

6. Get specific. A major challenge for coders is not simply learning the new system, but also digging through and requesting far more detailed information to include within the codes. The selection of scenarios among the coding index is more specific than ever before, requiring an unprecedented level of clarity from medical staff and the forms they use to record patients' medical and procedural information.

For example, for a person who incurs an injury at home, separate coding elements exist in ICD-10 to indicate whether the person walked into furniture, walked into a lamppost or was injured with a kitchen utensil. Even the location and activity of the patient where and when the injury occurred impacts the code, such as whether a person was injured by a window in the living room, bedroom or bathroom, or if they were hurt while playing the piano, the presenters said.

Animal-related diagnoses are especially good examples of the level of specificity required in ICD-10, Ms. Smith said. Chicken-related injuries could correspond to any of 10 codes, depending whether the victim was bitten, pecked, clawed or affected in some other way. Even the types of animal matters in the new system — parrots and macaws command different codes, she added.

7. Set a realistic timeline — and budget. Troubleshooting always takes longer than expected, and providers should take advantage of the year and a half that remains before an ICD-10 mistake could cause a rejected claim, Ms. VonEschen said. Equally important is to include ICD-10 costs into the budget, including system upgrades, training sessions and vendor fees. Providers may find they need to purchase new software or incur other types of ICD-10-related expenses and must budget for those costs.

8. Save extra cash on hand. Even with extensive preparation, ICD-10 errors are likely to happen after Oct. 1, 2014. "No matter how prepared you are for ICD-10, whenever something new goes into effect, you've got to have [contingency plans] in place," Ms. Von Eschen said. She recommends providers begin saving extra cash now to have enough on hand to absorb the cost of potentially rejected claims once they make the big switch next year.

9. Phase in, specialize and expand. "[ICD-10 implementation] is an overwhelming task which is why we recommend a phased approach," Ms. VanEschen said, especially for multispecialty physician groups and hospitals.

Providers should divide the codes into groups of diagnoses and procedures performed most at their facilities, and select one group at a time to begin practicing in dual coding. Specialty groups may even decide to eliminate certain coding elements from dropdown menus in their coding systems to simplify the process for coders.

10. Tables and "cheat sheets" help, but ditch the old ones. Coders have long used "cheat sheets" as quick reminders to help them remember or verify codes they use often. Those can certainly help staff begin to familiarize themselves with the new system and translate some formerly common codes into ICD-10, Ms. Smith said, but providers must be careful to update or remove old reminder tools and guides to prevent confusion.

11. Dual coding is essential. The nationwide switch will happen all at once, but some patients and procedures may overlap from September into October 2014, Ms. Smith warned. Before Oct. 1, claims must be coded in ICD-9, but after, they must be ICD-10. "Your system will have to be able to accommodate both ICD-9 and ICD-10 for a while, since there may be crossover between the two systems," she said. At least temporarily to accommodate overlapping care and claims, providers must ready themselves and their systems to handle both coding languages simultaneously in order to ensure reimbursement.

12. Hit the whole pipeline. Because of the detail needed in the new codes, it's not sufficient for coders alone to be trained in ICD-10. It will be helpful to show physicians and medical staff what is required for appropriate coding so they can identify the information necessary in their own documentation, such as which arm was injured or where the injury occurred. A physician champion who can help rally the clinical staff to comply with the new standards will be a valuable asset in the transition as well, Ms. VonEschen said.

13. Check with payors. Unspecified codes still exist in ICD-10, Ms. Smith said, but providers must learn from payors what specifics will be required to be reimbursed.

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