I find it very concerning that approximately 30 percent of physicians and physician groups have not even started to prepare for ICD-10. Right now everyone should be in the final stages of preparation. The delay is over and we all must move full speed ahead. We have five months left to prepare for the transition. Some practices are anticipating another delay; others do not anticipate that it will take much effort to get ready. Many medical practices are expecting that just upgrading their electronic health record (EHR) or practice management system is all they need to do. But getting ready for ICD-10 is much more than that. There is still time to get ready if you begin now. So, how does the medical practice fast-track ICD-10 implementation? 

 

Starting implementation now will help you focus on changes needed in documentation, processes, and other areas. Educating physicians and other staff on these changes now will ease frustration and eliminate anxiety as the implementation date approaches. It is good to begin with the following approach:

Form a team: ICD-10-CM affects many areas of your practice, and the team members should reflect this diversity. The scope of the team’s goals will vary depending on the size of the practice. Team members should include professionals in coding, billing, information technology (IT), finance, and health information, along with physicians and clinical documentation specialists.

Contact your electronic health record vendor to make certain your system is up to date. Once your system is updated, take a look at how your ICD-10 codes will flow into your work processes. Has logic been built into the EHR to allow staff to easily drill down to a few codes based on key words, or do you have a pick list to select the diagnosis code? If you have logic built into the EHR, you are halfway there. If not, it might be possible for your IT staff to build this function. If that is not possible, or if you don’t have IT in your practice, you might benefit from an electronic superbill or technology that can be used to support the logic.

Look for opportunities to test your software with your clearinghouse and largest payors to see if your claim submission is working correctly.

Inventory the practice: Find out who uses diagnosis codes to perform their job function.

What documents should be updated? Do any patient information handouts have diagnosis codes on them? What about the encounter/charge ticket? Prior authorization or referral forms? What about other forms you use in your office that may contain diagnostic information?

Also, do your templates need to be reviewed and updated, particularly if your EHR pulls information from the problem list? This is an important step.

Run a diagnosis frequency or utilization report by provider. Identify the most utilized codes per provider for the last 12 months. Focus on the top 20-25 diagnosis codes by practitioner, which will help guide your provider’s education.

After running a frequency report, it is important to review how documentation will need to change in order to match the increased specificity of the ICD-10-CM code set.Map your ICD-9-CM codes to ICD-10-CM codes for each of your top diagnoses. 

This is an example of mapping from ICD-9-CM to ICD-10-CM:

Cyst of Orbit

ICD-9

ICD-10

376.81

Orbital cysts

H05.81

H05.811

H05.812

H05.813

H05.819

Cyst of orbit

Cyst of right orbit

Cyst of left orbit

Cyst of bilateral orbits

Cyst of unspecified orbit

       

Make sure when mapping your codes that you use not only the general equivalency mappings (GEMs) mapping files but the code book as well. Some unspecified ICD-9-CM codes actually map to unspecified ICD-10-CM codes, and the goal is specificity.

Education should be a major focus in order to achieve successful implementation. Many practices have eliminated education from their budgets entirely. With the implementation of ICD-10, however, education and training should be at the top of your list of priorities. Ask the question: Who will need ICD-10-CM education, and at what level? All providers and coders will need education, and don’t forget about your non-physician practitioners. If you have a good foundation in ICD-9-CM, learning ICD-10-CM is much easier. Other staff members who might need training include:

  1. Scheduling and front office staff
  2. Nurses and other clinical staff
  3. Managers
  4. Insurance and billing staff
  5. Prior authorization and referral staff

The types of necessary ICD-10 training will range from fundamental (basic), in-depth, and documentation-centered. It is important that physicians have a basic understanding of the format and concepts of ICD-10-CM, along with how to document in ICD-10-CM, as part of your clinical documentation improvement initiatives. 

Where do you obtain training? Many specialty societies, medical associations, and professional associations offer ICD-10-CM courses. There are many seminars and webinars also available. Consultants offer ICD-10-CM training. If you are part of a hospital-owned medical practice, your system may offer ICD-10 training for both coders and providers. There are also many publications on the market that offer ICD-10-CM instructional materials. 

What Happens After Training? The following steps should be taken:

  • Analyze your current documentation.Pull chart notes that were reported with ICD-9-CM codes from the frequency report.
  • Code the note in ICD-9-CM and ICD-10-CM.
  • Review possible code options based on mapping that was completed.
  • Note where documentation is insufficient and where it meets the specificity requirements of ICD-10-CM. For example:
    • Laterality
    • Acute versus chronic
    • Seventh character requirements
    • Revised language
  • Meet with each provider to provide feedback regarding findings.
  • Perform follow-up reviews and provide further education prior to implementation and several months after ICD-10-CM is implemented in order to ensure that the documentation is maintaining sufficiency.

Practice, practice, practice: You cannot submit an ICD-10 code to your insurance carrier until Oct. 1, 2015. But start documenting in ICD-10-CM now. Create simple flashcards with the diagnosis and documentation requirements for ICD-10-CM. Take a couple of diagnoses a week, and for every patient with that condition, start documenting for the ICD-10 requirements.

Lastly, monitor payor websites for revised medical policy guidelines. Many payors have updated their payment policies to adjust for ICD-10-CM diagnosis codes.

Don’t wait until the last minute to prepare for ICD-10-CM. ICD-10 implementation takes planning. If you wait too long, you will not be ready. Preparedness is the key to a successful transition to ICD-10.

Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner

Deborah Grider has 34 years of industry experience and is a recognized national speaker, consultant, and American Medical Association (AMA) author who has been working with ICD-10 since 1990. She is the author of “Preparing for ICD-10, Making the Transition Manageable,” “Principles of ICD-10,” and the ICD-10 Workbook, among many other publications written for the AMA. She has assisted hospital systems and physician practices in transitioning and understanding ICD-10 for many years. She is a senior healthcare consultant with Karen Zupko & Associates and a clinical documentation improvement practitioner helping physicians improve clinical documentation among all specialties.

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