Why and how must you immediately begin preparations for the ICD-9 to ICD-10 conversion?

Last year, the much debated ICD-9 to ICD-10 conversion deadline was delayed another year and set to October 1, 2015. However, numerous provider groups and stakeholders have been pushing for another delay, which would be the third in total, stating that the conversion will result in unmanageable financial pressure on the already challenged practices.

This article summarizes how ICD-10 differs from ICD-9, what the Congress had to say about the deadline, and in what way must you prepare for the conversion.

CureMD ICD-9 Into ICD-10

The new codes

The first question that most providers have is about the specific changes in the code sets. Here’s a summary:

* 68,000 diagnosis codes as opposed to just 13,000 in ICD-9

* A maximum 7 alphanumeric characters per code as opposed to 3-5 in ICD-9

* Very specific, more complex, and more flexible codes

* Lateral codes as well (different codes for right and left)

* 87,000 procedure codes as opposed to 3,000 in ICD-9

* 7 alphanumeric procedure code characters in contrast to 3-4 numbers in ICD-9

* With detailed methodology descriptions, procedure approach mechanisms, more detail, and flexibility

The Meeting

Last week, the Energy and Commerce Committee’s Subcommittee on Health held a public forum to discuss the ICD-10 deadline. The meeting panel comprised of experts and stakeholders from across the industry, and included doctors and EHR vendors.

The Response

Despite opposition from a few stakeholders who held the view that small practices wouldn’t be able to manage the new codes, the majority voted in support of the October 1 deadline.

The way forward

The response by the congress via the meeting is clearly tilted towards ensuring that the deadline holds. If you were anticipating a delay, and haven’t yet started working on the conversion; you can still manage. Here’s how:

  1. Contact your EMR and Practice Management vendor and enquire your system’s readiness for the conversion. Ensure that their software possesses the necessary updates and ICD-9 to ICD-10 conversion mapping tools to make certain that your system is ready for, and will facilitate the conversion.
  2. In the case that your vendor is not ready, immediately begin looking for a new system. This is because from October 1, your claims will not be processed on ICD-9 codes.
  3. Delegate an ICD-10 expert (from you staff, or hire a professional) to train your staff, and to devise and execute plan for the conversion in line with your practice workflows.
  4. Consider Outsourcing Medical Billing if your ICD-10 expert (and yourself) feel that your current staff will not be able to manage claims processing on the new code set.
  5. Get in touch with payers and clearinghouses to determine their readiness.

The target for completing these steps (apart from staff training which could be ongoing) should ideally be March 15.

  1. Next, you must begin internal testing of the new codes between March and April, to check how well your staff will manage the new codes. Ideally you should be done by this till the end of June at maximum; and make the necessary workflow adjustments to fix errors in which the process proceeds.
  2. After internal testing in June, you need to begin external testing with clearinghouses and payers to determine how well your test claims (with ICD-10 codes) will do once out of your practice.

It is imperative to identify and correct any slow or disruptive processes in every stage of your conversion process. Doing so will enhance the efficiency of your practice, and help make certain that you are ready and equipped for the ICD-9 to ICD-10 conversion by October 1.

Assessing dual coding costs

Healthcare organizations will have to use both ICD-9 and ICD-10 for a considerable amount of time in 2014 in order to complete a successful transition to the new system.

Health IT vendors which support dual coding will be the ones who will stand out, although care providers may not be able to afford it.

Medical coders need to be trained for ICD-10 as well. However, they are not the only ones who require training. Physicians need to be trained on documenting correct ICD-10 code specificity. If this doesn’t happen, dual coding will not be beneficial in any way.time to plan

Dual coding is a way to test medical coders’ knowledge and documentation. However, the testing process must not be hampered by mistakes that could be addressed through awareness campaigns. Dual coding must be used to locate unforeseen problems which require time and money before it can begin.

Medical coding productivity is showing a 50% decrease in initial ICD-10 testing. This means that in the time required to process two test ICD-10 claims, coders should be able to process four real reimbursement claims. But it is not the case. Add to this the time spent to clarify queries from physicians and coders find themselves unable to prepare ICD-9 claims.

It really depends on a healthcare organization to do a cost-benefit analysis to see whether it needs extra medical coders to accommodate ICD-10 testing or is okay with longer reimbursement cycles. It is also important to realize that medical coders are not sure if they are using the right ICD-10 codes since the system is new for them as well.

The Hospital of the University of Pennsylvania has formed a team of 10 ICD-10 superusers to ensure coding accuracy. Each member uses the same records for coding and then all of them compare results with each other to discuss possible variances and the reasons for them. After the discussion, they reach a consensus on the correct ICD-10 codes required for the procedures and how they can unanimously agree to it.

But while it may sound great, it is adding more time and cost to the dual coding process. Compare this to the financial hit health organizations will have to take after October 1 if they are unprepared and it looks negligible.

It may be a good investment to allow medical coders to play with the ICD-10 system before the deadline to improve documentation. Care providers have real cases to test for ICD-10 through clearinghouses and payers and which will automatically tell them a lot about their HIT resources.

But once care providers have the much discussed ICD-10 data, what will they do with it? They can use it to add to internal medical research, assess financial impact, predict DRG shifts and reimbursements after the October 1, 2014 deadline.

Someone will have to invest time and resources in analyzing dual coding data. The Healthcare Information Management (HIM) department might be able to do that or consultants will be required for it. All of this time and money spent will be considered investments after October 1 but practices will not figure this out unless they start assessing dual coding costs right now.