What to Expect From ICD-10
By Paul Lynch, MD, Tory McJunkin, MD, Maireen Miravite, BA, BS, Edward Swing, PhD
Dear Boost Medical,
I have a small pain practice and like everyone else I’ve been using ICD-9 codes for years. In a few short months, I will have to switch to ICD-10. I’m feeling overwhelmed by this change. How can I manage this transition and learn the new codes?
Overwhelmed by Change
Dear Overwhelmed by Change,
This is a great and timely question for all of us with the implementation of ICD-10 looming on the horizon. The transition from using ICD-9 to ICD-10 may be overwhelming for many, but you can prepare and be ready for the change. It is important to note that transition from the ICD-9 to the ICD-10 is not optional. This applies to all “covered entities” as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). All entities are required to use the ICD-10 system when completing HIPAA transactions beginning on October 1, 2014.
Key Changes in ICD-10
The ICD-10 CM was published by the National Center for Health Statistics (NCHS) with input from physician groups, coders, and a technical advisory panel to ensure clinical accuracy and usefulness.1,2 ICD-10 is intended to more accurately reflects current medical practice as compared to the ICD-9. The ICD-10 maintains a similar organization for disease classification using chapters as the basic framework for categorization. However, there is increased granularity with the use of ICD-10, permitting up to 7 characters in each code, which allows for more specific diagnoses and ideally better information sharing. There are approximately 68,000 codes that encompass specific details within them, such as disease laterality, anatomic site, etiology, complications, comorbidities, staging information, and more – details which could not be taken into account by the ICD-9, which contained approximately 13,000 codes.
The new coding system is also supposed to permit more precise billing and more accurate reimbursements. In addition to this, ICD-10 is also intended to allow for faster claims processing and improved research capacities due to the ready availability of pertinent details within each code. The documentation requirements are such that practices or other outside bodies can use the codes to conduct detailed health reporting and analysis on costs, utilization, and outcomes.
Table 1. An example of ICD-9 to ICD-10 code mapping for unspecified neuralgia, neuritis, and radiculitis. With ICD-10, this is now captured by two codes, one for neuralgia or neuritis and another for radiculopathy.
|Neuralgia, Neuritis, and Radiculitis, unspecified|
|Radiculopathy, site unspecified|
|Neuralgia and neuritis, unspecified|
How to Implement ICD-10
The planning and effort necessary for the successful implementation of the ICD-10 largely depends on the practice size and the amount of codes currently used. In practices where physicians and coders primarily perform coding functions, such as in small practices and some medium-sized practices, the transition process may be simpler. In larger practices, the transition process may be more complicated.
The ICD-10 Implementation Guide for Small and Medium Practices outlines 6 phases of implementation to assist groups through the transition into the new coding system.2
Phases 1 and 2: Planning and Communication/Awareness. In the beginning phases, practices must determine a transition plan. This includes outlining a project structure, timeline, communication plan, budget, and identifying training needs. A timeline of implementation should be developed in order to keep the project on track to meet the current compliance deadline of October 1, 2014. Communicate your plan to the members of the practice as well as any vendors or affiliates to ensure that all responsible individuals are aware of what changes are taking place and fully understand the scope and impact of the ICD-10 conversion. This is the time to decide on a budget for software updates/upgrades and training needs.
Phase 3: Assessment. The goal of this phase is to assess impacts of the transition on business, policy, and technology. On the business end, the practice should identify the processes that require the use of ICD codes. ICD codes are likely to affect processes such as referrals, authorizations, intake, clinical encounters, orders, research, and risk management.
Develop a training and internal certification schedule for your staff. Determine the most appropriate method to deliver training materials. For example, ICD-10 training is available in conferences, boot camps, online training courses, local courses, or through on-site training (see http://www.aapc.com/icd-10/index.aspx). On-site training takes place over three or more days at your site. This option is typically used by larger practices training 10 or more employees at a time. For a smaller practice like yours, other options such as online training courses may work better. Separate online courses are available for coders and physicians.
Contact your vendors, such as software vendors for billing and EMR software, and find out if they will be able to keep up with your implementation plan. If they are not able to meet your deadlines, you may have to seek out other vendors. Some EMR systems already use ICD-10 codes for their clients in other countries such as Canada. Additionally, some software supports both ICD-9 and ICD-10 codes simultaneously.
Phase 4: Operational Implementation. During the implementation phase, data from old systems should be updated using the new ICD-10 coding system. Implement the training plan that you developed to ensure that your staff is ready. It would also be wise to write down your twenty most commonly used ICD-9 codes and scribe over their newer ICD-10 versions. Share this list with other members of your staff who use ICD codes.
Phase 5: Testing. Create a testing strategy to observe the efficacy of the transition and implementation plans. After staff have been trained and health records updated, conduct internal testing to identify any problems with the transition. If you identify any issues, resolve them before the new system goes live in the transition phase.
Phase 6: Transition. Now you’ve implemented ICD-10. The success of this transition in your practice depends on cooperation between staff, vendors, payers, and other affiliates. There are many challenges that can arise and it is important to anticipate these during planning. For example, it is likely that not all carriers will be ready for the change. Some, such as worker’s compensation, may continue to ask for ICD-9 codes. Also, if you have to re-bill for services provided before October 1, 2014, you will likely have to provide ICD-9 codes.
Provide ongoing support to staff by means of accessibility to resources and further training. Ensure that vendors are available to provide rapid support and troubleshooting and encourage frequent system audits to enhance the quality of the new system based on ICD-10. In the transition phase, it would be wise to monitor business operations and revenue to determine the impact of the ICD-10 coding. You should expect changes in business operations and should be ready to take corrective action and make adjustments as necessary.
Failure to complete the transition prior to the compliance date could result in increased fragmentation of patient data, limited code space, and delayed payments and reimbursements. Therefore, it is imperative to have completed the transition by October 1, 2014. Your practice should plan this transition as soon as possible and follow the suggestions outlined in the six phases of implementation to make sure that your practice navigates this transition.
Dr. Lynch and Dr. McJunkin own and operate Arizona Pain Specialists, a comprehensive pain management practice that provides minimally invasive, clinically proven treatments, with five locations in the greater Phoenix area. Dr. Lynch and Dr. McJunkin also provide consulting services to other pain doctors around the country through their partner company, Boost Medical. For more information, visit ArizonaPain.com and BoostMedical.com.
- Duvall, DJ. ICD-10: A guide for small and medium practices: From planning and assessment to implementation and testing. Medscape Education. Retrieved from: http://www.medscape.org/viewarticle/766192_transcript
- ICD-10 : A Guide for Small and Medium Practices. Retrieved from: http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10SmallandMediumPractices508.pdf