Managing the Transition to ICD-10
A Guide for Physician Practices
The coming transition from ICD-9 to ICD-10 will fundamentally change medical coding. It impacts everyone who is covered by HIPAA—not just Medicare. In addition to adding thousands of codes, ICD-10 is structurally different from ICD-9 and will require retraining of staff members who are accustomed to using ICD-9, as well as more documentation, and changes to software and information technology.
The ICD-10 transition is set to go into effect October 1, 2015. Although implementation of the ICD-10 has been delayed several times, practices should not avoid preparing in anticipation of another delay.
Here is a basic snapshot of the differences between ICD-9 and ICD-10:
|Diagnosis Codes||around 13,000||around 68,000|
|Procedure Codes||around 11,000||around 72,000|
|Code Length||3 to 5 digits||3 to 7 digits|
|Code Form||primarily numeric||alpha-numeric|
A quick note about the different types of ICD-10: The new coding system is broken down into two parts, ICD-10-CM, and ICD-10-PCS.
- ICD-10-CM is used in all healthcare settings for diagnosis coding.
- ICD-10-PCS is used in hospital inpatient settings for inpatient procedure coding.
Our focus is the impact of ICD-10-CM on physician practices.
HIPAA and the ICD-10-CM
The transition to ICD-10 will also require that healthcare facilities implement the next generation of HIPAA electronic transaction standards known as 5010. Since these standards were released in 2012, practices should already be in compliance today.
How Is ICD-10 Different from ICD-9?
The lack of specificity that has long been a problem with ICD-9 has been addressed in ICD-10, resulting in tens of thousands of additional codes. For example, if a patient has a burn on her right leg, the available codes in ICD-9 do not allow the coder to specify which leg sustained the burn. If the patient comes in a week later with a burn on her left leg, the same code would be used. In ICD-10, the code would specify on which leg the patient sustained the burn. This results in more accurate and specific diagnostic codes.
Preparing Your Practice for ICD-10-CM
Practices should already be well into preparing for the transition to ICD-10. For those that have delayed, the time to start is now. Here are some guidelines:
1: Assess Workflow & Systems
As mentioned earlier, the conversion to ICD-10 is not a simple upgrade. The implications are complex, and that means ongoing support from senior practice management will be critical. First and foremost, assess how your workflow and process may change with ICD-10. Next, evaluate your IT systems to ensure they can accommodate the new data and workflows the implementation of ICD-10 will necessitate. Analyze the capacity of existing systems to handle the new alpha-numeric codes, and upgrade where necessary.
If your practice hasn’t already adopted an electronic health records (EHR) system, make sure that any system you adopt now or in the future is ICD-10-ready. Consider the following questions:
- If you have an existing EHR, is the vendor prepared with a version that can handle ICD-10?
- Is the EHR certified, enabling you to participate in the meaningful use incentive program?
- Is the EHR equipped to handle both ICD-9 and ICD-10?
2. Budget Properly & Anticipate Ongoing Costs
The transition will not be without cost. Plan on expenses for ICD-10-CM coding classes for staff members, additional software, upgrades to your existing systems, and other costs.
The good news is that the transition may not cost as much as previously thought, according to a study in the Journal of the American Health Information Management Association (JAHIMA).1 The study surveyed 276 practices with six or fewer providers about ICD-10-related expenditures. The average per-physician cost was $3,430, which accounted for manuals, training, software upgrades and testing, and other expenses. As expected, the per-physician cost went down the more providers a practice had.
Ongoing documentation costs are where physicians may be hit hardest. A study by Nachimson Advisors, LLC found that documentation activities would likely increase by about 15 to 20 percent, resulting in a permanent increase of 3 to 4 percent of physician time spent on documentation for ICD-10.2 The increased physician workload has no foreseeable increase in payment. EHR systems were not expected to ease the increased documentation requirements either, according to the study.
3. Anticipate Issues Surrounding Reimbursements
The code sets in ICD-10 are longer and more detailed. This means physicians will have to be more detailed in their descriptions in order to be reimbursed properly. Examples of primary care conditions that will require extra information include:
- Asthma: Practices must document whether the condition is intermittent, mild persistent, moderate persistent, or severe persistent.
- Ulcers: Practices must document the specific stage.
- Seizures: Practices must document whether the seizures are general or focal, the type of seizures, and intractability.
Prior to ICD-10 Release
- Anticipate claim rejections and denials, authorization delays, improper claims payments, and decreased cash flow as a result of the transition to ICD-10. The best way to reduce the number of reimbursement and other problems is to prepare to the greatest extent possible.
- Choose an internal “champion” or committee that will oversee the preparations and transition to ICD-10. This person/group should create a schedule for project meetings and ensure those meetings happen on time.
- Identify all work processes and technologies that use ICD-9 in order to determine which staff members will require additional training and which systems will need to be upgraded or replaced.
- Become familiar with ICD-10 and, importantly, know the codes most frequently used in your practice. You can obtain code set and guidelines here.
- Practices that use an outside company for coding and billing should become familiar with that company’s ICD-10 implementation procedures.
- Review all insurance contracts, and assess the possible impact on diagnosis-based payments.
Post ICD-10 Release
- After ICD-10 implementation in October, practices should anticipate claims rejections—plan for this, and correct and resubmit any rejected/denied claims promptly.
- Monitor your cash flow after implementation until claims under ICD-10 are consistently paid.
- Monitor reimbursement accuracy and timeliness for each payer.
Practices that have not enrolled key staff members in coding classes to learn ICD-10-CM have no time to delay. The transition to ICD-10 is just around the corner—make sure your practice is prepared for this major change.