7 Steps to Ease the Transition to ICD-10 for Physicians, Specialists and Groups

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While much has been published about the implementation of ICD-10 for hospitals, the body of knowledge for physician practices and medical groups is sorely lacking. Vendor upon vendor is assisting hospitals, but who is helping the single practitioners, specialists and groups? Now is the time for providers to take matters into their own hands and ensure they are ready to take the leap from ICD-9 to ICD-10.

ICD-10 — the World Health Organization's 10th revision of the International Statistical Classification of Diseases and Related Health Problems — is a huge undertaking for any medical practice. Under this revision, only diagnosis codes — not procedure codes — change for practices and groups. And although physician payment is not driven by diagnosis codes, physicians are still required to show medical necessity, which is where practices must be thoroughly prepared to bridge the gap to this new code set.

Because CMS delayed the deadline for compliance with this diagnostic code set from Oct. 1, 2013 to Oct. 1, 2014, practices now have some leeway to take time and do it right. Here are several tips to ease the transition from ICD-9 to ICD-10, whether you are a single practitioner, group or specialty practice.

1. Reach out

In today's world, physicians and groups are affiliating with hospitals left and right. This trend can offer an enormous advantage when it comes to understanding ICD-10. Owned, managed or affiliated with a hospital, practices should reach out for guidance and resources from their hospital partners. Hospitals want their physician partners to be successful in this transition because any delay in reimbursement to affiliated practices and groups will eventually affect them. And, chances are good that hospitals already have a team that has been working for months on understanding and perfecting the transition to ICD-10.

2. Zoom in

A targeted, specific training approach is the most cost-effective and practical strategy for specialty practices. Choose a few key stakeholders in your practice to decide which changes will have the deepest impact. Each leader can choose one or two diagnoses to study and then educate the rest of the core group regarding the ICD-10 impact on diagnosis, treatment, documentation, billing and revenue.

Groups are encouraged to meet on a regular basis and create a thorough training manual for the entire organization. Hold regular mandatory training sessions to ensure that everyone is abreast of upcoming changes and their impacts.

3. Take small bites

The October 2014 deadline seems far into the future, so it may be easy to relegate ICD-10 training to the back burner until next year. Instead, think of this extended deadline as a gift that allows you to train employees in small increments. In this way the entire transition isn't so overwhelming.

If possible, engage another physician in the training for peer-to-peer support. Right now, create a calendar of regular training meetings with a list of topics to tackle at each gathering. Stress the importance of practice-wide attendance. Be sure to keep track of questions and concerns from staff members, and work to have answers at the following meeting to keep everyone engaged and on board.

4. Soak it in

Your physicians and nurses may be experts on the body systems that your practice treats, but what about the professionals in your human resources, billing, marketing and technology departments? Look at ICD-10 as an opportunity for everyone to learn more about each facet of the healthcare services your practice provides.

The entire team works together every single day to take the best possible care of patients. It is equally important to deepen each and every staff members' biomedical knowledge of the body systems treated by your practice or group. Keep in mind that family practices, hospitals and internal medicine groups may have a more difficult time converting from ICD-9 to ICD-10 than specialists.

Because generalists see a large variety of patient conditions, their documentation and support staff must be educated in all anatomy, physiology and disease processes. Specialists, on the other hand, treat a limited subset of the patient population, so their documentation needs to be refined in only a few key areas. As a result, staff members at specialty practices only need to focus on one or two body systems.

5. Jump start

Before you worry about changing the way your practice codes everything, take a moment to assess your practice as if ICD-10 were being implemented tomorrow. Where are you now? Do you have a lot of work to do, changes to make and procedures to rework? Or are you already well on your way to compliance? In addition, take some time to review each staff member’s knowledge of coding procedures. You may find that some team members will need more training than others in order to fully understand ICD-10’s impact. By analyzing your situation early, you will have plenty of time to take a methodical step-by-step approach to transitioning to ICD-10.

6. Test yourself

A period of parallel testing with both I-10 and I-9 codes is recommended, if at all possible. Dual coding of cases will identify gaps in clinical documentation where medical necessity under ICD-10 may fail and cases will be denied. Additionally, dual coding supports end-to-end testing with clearinghouses and payors — even if technologies are not quite ready for ICD-10.

ICD-10 testing is another area where hospital partners and regional peer-to-peer discussion groups can help. HIMSS has also partnered with the Workgroup for Electronic Data Interchange on a national ICD-10 testing project: the HIMSS/WEDI ICD-10 National Pilot Program. The goal of their combined efforts is to avoid many of the issues providers faced when Medicare's 5010 standard was implemented. Additional information can be found in the library of the Health Information Management Systems Society.

7. Join in

Sometimes other practices are your competition in the community. But ICD-10 offers an opportunity to work with like practices, payors and hospitals as a regional consortium on common issues. Reach out to your regional community and create an ICD-10 forum. Be forthcoming about how you are handling specific ICD-10 issues and listen to other members' help, ideas and support.

The above list of seven transition tips is not exhaustive, but it will help perfect the ICD-10 implementation roadmap for physician practices and medical groups. If necessary, seek help now versus postponing until October 2014. When taken in small steps, all practices ensure a smooth transition to ICD-10 — and an even cash flow when the deadline occurs.

Deborah Robb is a physician management consultant for TrustHCS, where she is responsible for the company's Physician Practices business. Ms. Robb has more than 30 years of experience in healthcare and extensive experience in clinical settings including, but not limited to, hospitals, clinics, long-term care facilities and freestanding home health agencies. For more information about TrustHCS, visit www.trusthcs.com.

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