How to Prepare for ICD-10 (Education, Costs, Preparedness, Revenue)

How to prepare for ICD-10ICD-10 is the 10th revision for the International Statistical Classification of Diseases and Related Health Problems and is set to replace ICD-9 on October 1, 2014 due to a one-year delay.  That extra 12 months allows time to figure out how to prepare for ICD-10 and the changes that will come as a result of the update.

The Differences

The differences between the current ICD and future codes are significant.  There are two types of codes: CM and PCS.  The CM is the Clinical Modification or the diagnosis codes while the PCS is the procedure codes that are used to describe the type of treatment being given. 

The current ICD-9 CM codes have between 3-5 digits and total over 14,000.  That will change with the new implementation to 3-7 characters and total over 68,000.  The PCS codes will have 7 characters whereas currently they have only 3-4 characters.  The total will increase from around 4,000 to 87,000.

This drastic change will impact costs because software will need to be updated to accommodate the change in characters and total codes.  It will also require training on how to prepare for ICD-10 and how to use the new codes.  Therefore, it will affect every aspect of a physician’s practice.

The Challenge on How to Prepare for ICD-10

It is essential that clinics and physician’s offices transition smoothly to the new ICD-10.  Issues from either software problems or training can result in denials and delays in claims reimbursement.  Insurance carriers have indicated that they may transfer the ICD-10 codes back into ICD-9 codes for payment purposes.  However, hospitals and physician practices will have to be on board by next year.

Everyone will be impacted from the physicians documenting the patient encounter, to the claims representatives completing the paperwork, to the customer service representatives explaining the codes to patients.  Thorough training will be required to ensure all parties have learned the new codes and understand their impact.

Documents will also be affected and office managers will need to keep a supply of both the old forms and new ones on hand for paper-based offices and duplicate eforms for EHR based offices, to be ready for the transition.  

Because there will be more codes when the transition takes place, physicians will have to be more specific in their designation.  Physicians may need to use coding software and provide more documentation to allow coders to designate the correct codes to the patient.  The coders, themselves, may need to utilize a General Equivalency Mapping (GEM) program to help in identifying correct codes as well.

Numerous risks and issues can result from this change if the office is not prepared.  They may experience delays in authorization and payment, rejection and denial of claims, a backlog of coding, and decreased cash flow. 

The answer to this situation for clinics and medical offices may be to work with an outside partner to implement these changes.  A company that specializes in revenue cycle management will be trained and prepared to handle the changes that this transition brings about.  They can ensure fewer delays in processing and payment as they work with companies to implement the new codes.  This can allow physicians’ offices to spend more of their time focused on patient care.