April 10, 2011

How ICD-10-CM will Affect Those in Ambulatory Surgery Centers?

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If you work in an ambulatory surgery center (ASC) and have started to hear about the ICD-10-CM, you are probably wondering if this will affect you. The answer is a resounding YES!  All providers who currently use ICD-9-CM diagnosis codes to bill for services provided will need to transition to ICD-10-CM.

The good news is that ASCs will not have to worry about the procedure portion of ICD-10 (identified as ICD-10-PCS) since most, if not all, surgery centers use CPT codes to bill for procedures performed. The ICD-10-PCS is much more difficult than ICD-10-CM to grasp because coders will need to be proficient in anatomy, physiology and terminology and also will need to understand how operative procedures are performed.

Before we begin to explore what ASCs should do to prepare for the implementation of ICD-10-CM, which is now set for October 1, 2013, let’s set one thing straight. Many of you have probably heard others say that the Centers for Medicare & Medicaid Services will delay implementation because the change will be too costly.

Don’t be fooled by this kind of wishful thinking because CMS’s plans and processes are rapidly moving for the October 2013 implementation date. Surgery centers can ease the pain of implementation by being prepared.

Preparing for the Transition

All providers, including ASCs, must set aside a budget for the implementation of ICD-10-CM as coders will need to be trained and software will need to be updated or purchased. For example, super bills or paper charge forms will need to be revised with the ICD-10-CM codes replacing the current ICD-9-CM codes.

This change may spur many surgery centers to move towards electronic medical records/super bills since ICD-10-CM has many more specific codes than the current ICD-9-CM coding system.  Because of this fact, paper forms will become too cumbersome.

At this point in the implementation, ASCs also should be reviewing all of their software programs in which ICD-9-CM codes are entered and begin contacting their vendors to determine their ICD-10-CM implementation schedule.  If the software vendor is not in the process of implementing a transition schedule, dialogue should take place to determine their transition program.  ASC managers may need to determine if they need to look elsewhere for software that will be ready for ICD-10-CM.

As we get closer to the implementation date, surgery centers will need to analyze their payers’ contracts and contact individual payers to determine if they will require ICD-10-CM for diagnosis and CPT for the procedures or will require use of ICD-10-PCS for procedures. As many of the surgery centers bill CPT to payers for the procedures/services performed, there are a few that also require the ICD-9-CM procedure codes.

Education is Key

Next, conduct an educational program for the physicians who practice in the surgery center to inform them about the new ICD-10-CM system and its implementation timeline. Also educate them about the need for clear, comprehensive, concise documentation. Vague or ambiguous documentation will create problems when assigning the ICD-10-CM codes.

Physicians are not the only ones who will need to be educated. Coding and billing staff in the surgery centers will need a strong foundation in anatomy, physiology and terminology. Those who are deficient in these areas should receive training (either initial or a refresher) in the areas of A&P and terminology.

The American Health Information Management Association (AHIMA) recommends that actual ICD-10-CM training of coding and billing staff begin late in 2012 or early 2013. Conducting training for staff any earlier than this is futile because they will not have an opportunity to use what they have learned and may not retain the information. The only exception to this advice would be for those coders and billers who will become certified trainers for your organization.

AHIMA estimates that each coder or biller will need approximately 40 hours of ICD-10-CM training to understand and be able to use the system.  With this kind of extensive training required, the surgery center will need to investigate how they will get their current cases coded and billed while their staff is being trained in ICD-10-CM.  Many facilities may elect to use a back-log coding company to cover for the staff while they are training.

Plan to Go Beyond the Surface

The above are just a few steps that surgery centers should be taking at this point in order to be prepared for the ICD-10-CM implementation. Keeping your head buried in the sand and saying that you have plenty of time to worry about ICD-10-CM can potentially affect your practice and its cash flow. Be proactive and prepared and your implementation should flow smoothly.

About the Author

Peggy Hapner, RHIA, CCS, CASCC, is a MedLearn consulting services manager with nearly 25 years of experience in health information management, coding, teaching, data quality and operations. She is MedLearn’s technical expert for hospital outpatient HIM services.

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Read 813 times Updated on September 23, 2013

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