ICD-10 represents a radical change in the way medical coding will be conducted, using nearly five times as many codes as ICD-9.
The enhanced specificity of the codes will add greater detail to documentation in the patient record than we currently have with ICD-9, resulting in more precise billing. Symptoms, illnesses, and procedures will have more detailed descriptions, requiring providers to make considerable changes in the way they handle coding and billing processes.
Although the deadline has shifted again, all health organizations must get ready to incorporate ICD-10 into their revenue cycle processes, having made all the required technological and workflow updates and provided sufficient training to physicians and administrative staff. ICD-10 implementation projects and plans should have been already well under way. However, multiple surveys show that many organizations have not formulated a plan and begun implementation efforts.
Becker’s recently reported that 75 percent of physicians and associated groups have yet to address the transition. Further, it is estimated that coder and physician/provider productivity will decrease by 50 percent initially but rise back to approximately 85 percent after the initial nine-month implementation period.
For HIPAA-covered entities, transition to ICD-10 is not an option. Without ICD-10, providers will experience delayed payments or even non-payment; increased rejected, denied or pending claims; reduced cash flows; and, ultimately, lost revenues. Once the deadline arrives, claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before the compliance date must use ICD-9 codes.
A smooth transition to ICD-10 requires careful planning. A successful implementation plan should include performing an impact assessment to determine the people, processes, and technologies affected by ICD-10 implementation. It is imperative that you communicate with your vendors, payers, clearinghouses, and billing agency to determine their implementation plans.
When communicating with software vendors, you will need to ask if there is a cost involved in upgrading to ICD-10. This would also be a good time to ask if they will allow sending test claims before the go-live date.
Communicate with payers, regarding how ICD-10 might affect provider contracts. Due to the increased specificity of the ICD-10 codes, payers might modify the terms of their contracts for billing. Payers could require coding of illnesses and procedures to the highest level of specificity. They might alter their payment schedules or reimburse differently for higher acuity codes vs. less detailed codes. It is critical to understand your payers’ payment schedules and billing requirements. In addition to reimbursement, the change to a higher level of detail found in ICD-10 codes might affect payers’ medical review, auditing, and coverage determinations. Learning of any changes by your payers early on will be valuable in analyzing how the changes will affect the processing of claims.
Identify potential changes to workflow and business processes using information gathered during the impact assessment. Areas where changes to existing processes might be needed include clinical documentation, encounter and pre-authorization forms, quality and infectious disease reporting, claims submission, and orders and referrals.
Using the completed impact assessment, evaluate staff training needs by identifying what level of education and subjects are needed for each set of staff members. Different staff within your organization will require different levels of training based on their interaction with the diagnosis codes. Training should focus on learning the ICD-10 code set and any workflow changes. Clinical staff will need to learn about ICD-10 to understand how their documentation will affect the ability to code and bill accurately. Coding staff will need the most training to learn how to use the new code set and correctly capture the diagnosis using ICD-10.
The final step before going “live” with the ICD-10 codes will be to complete testing with your trading partners by sending ICD-10 codes in test transactions through the channels you use today, such as to the clearinghouses or payers.
The implementation plan should include budgeting for time and costs related to ICD-10, including expenses for system changes, resource materials, and training. When budgeting, it is important to take into account that any new process takes time to learn and could result in a slower turn-around time during the revenue cycle. It is recommended that entities take out a line of credit to cover expenses during this learning curve.
Jenny Harvey is a coding consultant for Lattimore, Black, Morgan & Cain, PC. (LBMC), which has offices in Nashville, Knoxville and Chattanooga. Harvey’s experience includes implementing education for physicians and other providers, regulatory and payer compliance, fee schedule analysis, and billing review for compliant reimbursement. During her career, she has worked in coding in inpatient and outpatient setting. Harvey’s professional memberships include the American Academy of Professional Coders (AAPC), and the American Health Information Management Association (AHIMA).
