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ICD-10: Defeat the deadline


With less than three months remaining until the conversion to the ICD-10 coding system, your planning should be well under way. Whether you are at the early stages or in the home stretch, here are some strategies to be prepared.

With less than three months remaining until the conversion to the ICD-10 coding system, your planning should be well under way. Whether you are at the early stages or in the home stretch, here are some strategies to be prepared for October 1, 2015. 

The first step, according to experts, is to stay calm. “Yes, it’s a big deal and a big change,” says consultant Mary Pat Whaley, FACMPE, CPC, “but it’s doable.”

Download: Focus on Technology: The Ultimate ICD-10 Checklist

Based on results from an exclusive poll conducted by Medical Economics, many physicians remain unprepared for the transition, and concerned about the impact on their practice’s finances and workflow. According to the poll results, only 38% of physicians surveyed said their practice will be ready by the October deadline, and 65% of those surveyed believe ICD-10 should be delayed again. (See complete results on page 27.)

Yet such a delay looks increasingly unlikely, so with no further ado, here are the five key areas your team is more than ready to tackle this summer.

Physician readiness

In most small or independent medical practices, physicians are likely selecting their own diagnosis codes for ICD-9 and will continue to do so for ICD-10. There is significant benefit to having coding happen as close to the point of origin as possible, meaning that the person who provides the care is usually best suited to code the encounter, says Whaley. However, clinicians who do their own coding may need more preparation than those who don’t.

Fortunately, physicians needn’t worry about memorizing all 68,000 codes or poring over every chapter of the codebook. Instead, experts recommend focusing on just the 50 to 100 codes a physician will use on a regular basis.

To do so, create a list of the top ICD-9 codes used in the practice, by provider, for the past 12 months, and compile a list of corresponding ICD-10 codes. While there are a few codes that are the one-to-one equivalent of each other, most ICD-9 codes will have multiple, more specific, ICD-10 codes with which to become familiar.

Related:9 strategies to prepare your practice for ICD-10

Once you narrow down the codes you’ll focus on, you can create tools such as cheat sheets, or load pick lists into your software to help physicians. Multiple training modalities exist, from webinars to on-site consulting to having your internal coders meet with doctors. Regardless of your approach, it’s important to keep physician training as focused and relevant to a physician’s particular practice as possible, says physician coding educator Betsy Nicoletti, MS, CPC. “Don’t purchase a huge training program that goes chapter by chapter. That’s deadly for doctors. They just want to know about the codes they need to know about,” she says.

But if you haven’t yet begun this process, beware of waiting much longer, she adds, noting that August is a popular vacation month. “Also remember that people don’t hear everything the first time, and that you probably will want time to repeat the training you’re doing for your clinicians.”

Finally, whether or not physicians do their own coding, it’s essential that they learn to document sufficiently to support the more granular diagnosis codes. To do so, doctors should get in the habit of including the phrases “due to” or “manifestation of” in their notes, says Whaley.

“There’s no question that staff are not going to be able to choose the code if the documentation doesn’t reveal the level of specificity of ICD-10, whereas in ICD-9 things were much more broadly categorized,” Whaley says. “If it’s not in the documentation, no coder is going to be able to read the physician’s mind and figure out what really went on during that visit and what the diagnosis is going to be.”

Nevertheless, it can be a challenge for practice managers and administrators to persuade doctors to take time away from patient care to learn ICD-10 and its documentation requirements. When meeting such resistance, remind physicians that coding snags will directly impact their profitability, suggests Kathy McCoy, MBA, a health IT blogger and social media contributor with experience in the electronic health records industry.

In addition, remind them of the long-term value of the conversion. “The goal of ICD-10 is to help population management by being better able to track diseases and diagnoses, so appeal to the physicians’ concerns that it will ultimately help patients,” McCoy says.


NEXT: Staff involvement


Staff involvement

The individuals who actually assign codes on payer claims aren’t the only ones who need to learn about ICD-10. If you haven’t done so already, sit down with the entire team and talk about who needs to know the codes, McCoy recommends.

For example, employees who handle preauthorizations for diagnostic tests, such as an MRI or a sleep study, would need to learn about the specific codes for which they are authorized, says Nicoletti. Figuring this out will mean looking at some coverage determinations, reviewing coverage indications for tests you recommend, and learning whether your payers have mapped those from ICD-9 to ICD-10. “You don’t want to be looking this information up for the first time on October 1,” she says.

Overall, experts say that preparing for the conversion should not be nearly as daunting as many practices have been led to believe. For starters, abundant free resources are available on the web and through organizations that are eager to help ensure the ICD-10 transition goes smoothly. Practices needn’t even be members of the American Health Information Management Association (AHIMA), for example, to reach out to their state AHIMA chapters for guidance, notes Robert L. Nevin, Jr., MPH, MBA, a certified revenue cycle representative and registered health information technician.

Related:ICD-10 documentation: The key to getting paid

“It’s not going to be as bad as it’s been blown up to be. There’s a logical structure and you only need to learn the codes you’re going to use,” McCoy says. “There will be a learning curve, but if you jump in now-even if you only spend 15 minutes a day-when October 1 gets here you’ll be set.”

Nicoletti offers similar reassurance, noting that although the codes have changed, the system of selecting them has not. “If you’re a good ICD-9 coder, you’re not going to have any trouble with ICD-10,” she says. “Physicians may have a bit more trouble, though, because the level of specificity may at first slow them down.”

One of the best ways practices can ensure a smooth transition is by promoting strong communication and teamwork between physicians and coding staff, says Melanie Endicott, MBA/HCM, RHIA, FAHIMA, senior director of HIM practice excellence for AHIMA. “A nice model is when physicians can help the coders with the clinical aspects of some of the coding terminology, what it means, what’s included in the disease, and so on-while coders can say to physicians, ‘This is your clinical language, but when we translate it into coding, this is what we get and we need to have more specificity,’” she says.


NEXT: Financial planning


Financial planning

It’s difficult to predict the extent of interruption to cash flow resulting from the ICD-10 conversion, so experts advise practices to hope for the best and prepare for the worst. While preliminary testing with Medicare and other payers has yielded positive results so far, for example, glitches or delays in payments could still occur. And even if a practices is fortunate enough not to experience problems with payers or IT vendors, it may be beneficial to anticipate that office productivity will slow during the first weeks of October.

Nicoletti suggests practices approach the conversion similar to an electronic health record (EHR) implementation, and temporarily lighten clinicians’ schedules. Coders may also need a bit more time to do their work at first, says Endicott. “You can mitigate that by making sure your coders are trained and get plenty of practice,” she says, “but with any new system change there’s likely to be some issues.”

Related:20 bizarre new ICD-10 codes

It’s not too late to take out a line of credit to prepare for financial slowdowns, and general guidelines have called for three to six months of cash reserves for small practices. But Whaley says even three months could be a challenge for small practices at this point in the process.

“Depending on the corporate structure for the small group, they may have to empty their coffers at the end of the calendar year, if it coincides with their fiscal year. So they may not be able to carry the cash over to 2016. I think three months of cash reserves will be a challenge for a small practice to achieve regardless,” adds Whaley.

Physicians may also consider scaling back on bonuses or distributions they take from independent practices at the end of the year. Although this approach may leave practices having to pay higher corporate taxes, Whaley says, it may be a safer alternative to having insufficient funds to run the practice during what for many may be a bumpy transition.

The more attention practices pay to proper ICD-10 preparation and implementation, the greater the benefit they may see to their long-term finances-especially if they belong to an accountable care organization or operate under a shared-savings model. Taking the time to perform a gap analysis of their highest-volume codes, for example, will ensure that coders select the ICD-10 codes that accurately reflect care complexity (e.g., controlled diabetes versus diabetes with polyneuropathy) and risk-adjust appropriately, Nicoletti explains.


NEXT: Vendor communication


Vendor communication

But even with your best efforts for ensuring that your physicians and employees are ICD-10-ready, a smooth transition will depend partly on factors outside of your control. In particular, practices that use EHRs, clearinghouses, or other software to process their claims will depend on these systems being able to handle and process the new codes.

Therefore, communicating with your vendors is crucial, as is getting concrete answers. “Any vendor that says, ‘Don’t worry, we’ll be ready for ICD-10 on October 1’ should make you extremely nervous,” says Whaley. “You’ve got to have some time to figure out how ICD-9 and ICD-10 are going to relate in your software.”

Related:ICD-10: Fact vs. myth

Especially if you are buying any new software now, ensure that it crosswalks from ICD-10 back to ICD-9, a process that should be easy to automate, Whaley says. However, be wary of software that attempts to select any codes for you, she adds, as they’ll likely be inaccurate.

So-called mapping systems, which attempt to match ICD-9 codes with ICD-10 equivalents, have given some practices a false sense of security, says Nicoletti. “People can be lulled into thinking that mapping is the same thing as dual coding, and that they’re done,” she says. “But an unspecified code only becomes another unspecified code, and even some specific codes in ICD-9 are only going to map to an unspecified code in ICD-10, and somebody needs to be looking at those and changing them to the correct specific ICD-10 codes.”

In general, well-known web-based platforms and established clearinghouses will likely be ready for ICD-10 in time. But Endicott echoes Whaley’s warning not to just take their word for it. “The biggest question you should ask is, ‘Can I test with you?’” she says. “It only makes sense to test in advance. You don’t want to flip the switch on October 1 and have everything blow up.”

If you use software that actually sits on your computer, chances are higher that you’ll need to upgrade, says Nicoletti. “If you’re reading this in July, call your vendor today and get your upgrade if you’re not on the latest version of your software,” she says. “Don’t wait, because you know what version releases are like, and if many practices need to upgrade at the same time across a user base, that’s going to be difficult.”


NEXT: Payer preparations


Payer preparations

Nevin says that practices’ approach to payer preparation should be largely the same as with vendors. Overall, there is reason to be fairly confident that major players will be ready. “My impression is that government payers are in pretty good shape and have been doing substantial testing,” he says.

Optimism is warranted on the commercial side as well. “Big payers that have a large market share are likely very ready because they’ve been working on this for quite some time,” says Endicott. “If you have some smaller payers, you might want to check with them to be sure.”

Particularly if you have a large Medicaid population, make it a priority to test with your state program, Nicoletti says. And note that workers’ compensation carriers are not HIPAA-covered entities, so if you work with those carriers you should find out whether they will be converting to ICD-10, she says.

Related:ICD-10 supporters debunk skip to ICD-11

As with software vendors, the only way you can find out what you’re in for is to test. Trying to enter claims, for example, might reveal problems such as an insufficient field size to input a longer code, says Endicott.

Finally, when it comes time to submit actual claims using ICD-10, practices need to change their thinking regarding diagnosis coding. “In the past, all we cared about with diagnosis coding was that it didn’t cause a denial. But as healthcare changes and we add more value-based payments on the physician side, we’ve got to get much tighter about our diagnosis coding,” Nicoletti says. “And it can’t be enough that it ‘gets the claim paid.’ It has to really tell the story about that patient’s condition, whether we like it or not.”


NEXT: Questions to ask your EHR vendor


Questions to ask your EHR vendor

Q: Are ICD-10 codes available in the system now? If not now, when?

Q: Can the providers and staff rehearse using ICD-10 inside the system by dual coding and assigning both an ICD-9 and an ICD-10 to services without having the ICD-10 drop to the claim?

Q: What support, if any, does the system give for choosing the right ICD-10? Is there any type of translator or crosswalk between ICD-9 and ICD-10?

Q: After October 1, 2015, will the software have the ability to use an ICD-10 or crosswalk from 10 to 9 if the payer does not accept 10? (It should.)

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