Apr 22 , 2014

7 Things Providers Should Know and Do for Transitioning to ICD-10

If you are covered by the Health Insurance Portability Accountability Act (HIPAA), and all medical providers are, then you will be required to transition to ICD-10 on October 1, 2014. Now is the time to begin the planning process. The process to transition will vary depending on the type of organization you are. Here are 7 things you should know and do as you plan for the ICD-10 transition.

1. WHY THE CHANGE TO ICD-10?

The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and does not reflect the advances in medical knowledge and technology in today’s current medical practice. With ICD-10 additional detail will help distinguish diagnosis. With ICD-9 you may have required additional documentation to explain the treatment for a claim. The greater specificity will help reduce the need for additional documentation and will also allow codes to be added and incorporated much more quickly to reflect the advances in medicine.

Greater specificity, reducing need for additional documentation, or use combination codes
Flexible code structure, making it easy to accommodate new codes

2. ICD-10 CODE CHANGES ARE DIFFERENT FROM THE ANNUAL CODE CHANGES TO ICD-9

ICD-10 codes have a completely different structure from ICD-9 codes, therefore the impact is much greater and a transition plan will minimize disruption to your practice.

The following provides a comparison to describe the differences in the diagnosis code set

ICD 9	ICD 10
Aproximately 13,000 codes	Approximately 68,000 codes
3-5 characters	3-7 characters
Limited space for ading new codes	Flexible for adding new codes
Lacks detail for anatomic site, disease etiology, and severity	Very specific

The following provides a comparison to describe the differences in the procedure code set

ICD-9	ICD-10
Approximately 3000 codes	Approximately 87,000 codes
3-7 numbers	7 alpha numeric characters
Limited space for adding new codes	Flexible for adding new codes
Based on outdated technology	Reflects current technolog
Lacks detail to define for laterality, terms for body parts, descriptions for methodology and approach	Precisely defines procedures with detail regarding body part, approach, device used

Note, this change does not affect Current Procedural Terminology (CPT) codes, which will continue to be used for office and outpatient services.

3. TIMING OF YOUR TRANSITION IS VERY IMPORTANT TO THE PROCESSING OF INSURANCE CLAIMS.

The word “transition” is about your preparation to fully use ICD-10 prior to October 1 2014. You may not use the ICD-10 codes until the compliance date. On October 1 the light switch is flipped.

Claims for all services and hospital inpatient procedures performed on or after the compliance deadline must use ICD-10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed.

Claims for services and inpatient procedures performed before the compliance date must use ICD-9 codes.

Continue to use ICD-9 diagnosis codes for services and inpatient procedures performed through September 30, 2014. All services or inpatient procedures performed on or after the compliance date of October 1, 2014 must use ICD-10 diagnosis codes.

4. CREATE A PLAN TO TRAIN YOUR STAFF

Training for your staff should begin about six months before the compliance deadline. Training varies for different organizations. CMS projects to plan 16 hours for coders and 50 hours for inpatient coders. The significant difference in hours reflects the difference in use. Physician practice coders will need to learn ICD-10 diagnosis coding only, while hospital coders will need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding.

5. REQUEST AN ICD-10 COMPLIANCE PLAN FROM YOUR VENDORS

Check with your billing service, clearinghouse, practice management, and EMR/EHR vendors to learn what their compliance plans and timelines are. The vendor should be able to provide answers to the following.

Will an upgrade to software be required to accommodate ICD-10?
How will your product accommodate both ICD-9 and ICD-10 as you work with claims during the window of transition?
Will there be a cost to upgrading the software?
When will the system be ready for testing ICD-10?
Will training or support be provided?

See ZH OpenEMR ICD-10 FAQ for answers to these questions.

6. COORDINATE WITH PAYERS AND ASSESS THEIR READINESS

If you work with a Billing Services company, request a plan for how they will be working to ensure a smooth transition. If you do your own in-house billing, request from your payers their plan for to be readied to process claims with ICD-10 codes. Your payers should be able to provide answer to the following:

Where is your organization in the transition process?
Will we need to test with you? If so, when will you be ready to test transactions from my practice?
Do you anticipate any changes in policies or delays in payments as a result of the switch to ICD-10

7. BEGIN YOUR PLANNING EFFORTS NOW.

The impact of the IDC-10 transition will be felt by the majority of organizations in the health care industry, from large national health plans to small provider offices, laboratories, medical testing centers, hospitals, and more. Organizations that begin their planning efforts now will have the greatest ICD-10 success and lower the impact and potential disruption of the transition. Taking the time to plan now will save your organization time, money and frustration as the industry leads up to the October 1, 2014 cutover.