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Updated on: March 14, 2016

ICD-10: Where Do We Go From Here?

Original story posted on: December 15, 2014

It has been a very challenging 2014.

There have been many starts and stops associated with the implementation of ICD-10, as much confusion arose when it was delayed yet again in the spring of this year. How can you prepare and get ready for such an important transition when the government keeps postponing it? How can we realistically ever be ready?


Many hospitals and physician practices, including many of my clients, stopped in their tracks and averted their ICD-10 funding to other projects. Why? Because some organizations believed that ICD-10 would never be implemented. But some of you stayed the course and continue to move toward achieving successful implementation.

A few state medical associations (as well as other associations led by the American Medical Association/AMA) have been desperately trying to delay or even repeal the ICD-10 mandate. By doing this, they are risking the financial health of all healthcare facilities. If we are not ready to go on Oct. 1, 2015 and ICD-10 is not delayed yet again, many hospitals and physician practices will not be able to operate, financially speaking. Do you want to take that risk?

Currently we have a set ICD-10 implementation date of Oct. 1, 2015. But will ICD-10 be delayed yet again, perhaps until 2017? Many of the aforementioned organizations are fighting to delay ICD-10, which would not benefit anyone. It is no wonder so many healthcare facilities are hesitating in moving forward and are filled with confusion. But by not moving forward, you are gambling with the financial future of your organization. What we know now is that ICD-10 is still scheduled to be implemented on Oct. 1, 2015. We also know there is still much work to be done. Physicians who have not begun to get ready now have to move very quickly. Most electronic health record (EHR) vendors have already prepared for ICD-10 with system upgrades. In most cases, many providers will have the opportunity to dual code, to test systems internally, and to perform end-to-end testing with payors. So much of what we have accomplished in 2014 is already completed. But what about education and training, addressing documentation deficiencies, and remedying cloning issues that are quite evident in the medical record? We must address these issues now.

So, what lessons have we learned? We have learned that you must get moving quickly, making sure you have a solid project plan that is actively progressing. You should budget for education, training, and documentation readiness audits for 2015 – and make sure you are moving toward creating a solid clinical documentation improvement process. Just as a reminder, here are some key steps that need to be accomplished before the implementation date:

1. Dust off your project plan and make sure you are completing all tasks necessary to implement ICD-10.

2. Schedule end-to-end testing with payors.

3. Make sure you have your EHR upgraded for compliance with ICD-10.

4. Review all your operational processes and make improvements as needed to ensure compliance.

5. Continue to audit and monitor for ICD-10 readiness as part of clinical documentation improvement.

6. Keep in mind that 2015 is the year of education and training. This should include the following:

a. Training coders on the new coding system (ICD-10-CM and ICD-10-PCS).

b.  Training clinical staff on documentation requirements for the most common codes used within their departments or offices.

c. Training physicians on how to document “smarter, not harder.”

d. Educating physicians on coding with ICD-10-CM and providing an understanding of ICD-10-PCS for physicians and practitioners who manage patients in the inpatient setting.

7. Develop a contingency plan if claims are suspended, rejected, or delayed following ICD-10 implementation.

8. Make certain there is a project manager within your hospital or physician practice to field question regarding ICD-10 implementation issues, to manage operational challenges that might occur, and to keep the project moving ahead.

9. Plan to provide support for physicians and practitioners who will need help with coding and documentation following implementation.

10. Remember that physicians will not use all 69,847 ICD-10-CM codes, but they will continue to use the most common diagnosis codes for the conditions they treat (they just may have a few more for specificity, such as laterality).

11. Communicate with all staff regarding progresses, successes, and challenges experienced with your implementation plan.

12. Stay focused and positive, as the transition may seem overwhelming.

13. If you have not started implementing ICD-10 and do not have the resources, staff, or expertise to assist you, consider hiring an experienced ICD-10 implementation project manager to help. The cost will be worth it in the end.

Make your New Year’s resolution to stay the course and get ready for ICD-10. Don’t forget that time is running out, and ICD-10 will be here before you know it.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner

Deborah Grider has 35 years of industry experience and is a recognized national speaker, consultant, and American Medical Association author who has been working with ICD-10 since 1990 and is the author of Preparing for ICD-10, Making the Transition Manageable, Principles of ICD-10, the ICD-10 Workbook, Medical Record Auditor, and Coding with Modifiers for the AMA. She is a senior healthcare consultant with Karen Zupko & Associates. Deborah is also the 2017 American Health Information Management Association (AHIMA) Literacy Legacy Award recipient. She is a member of the ICD10monitor editorial board and a popular panelist on Talk Ten Tuesdays.

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