Don’t Forget to Budget for ICD-10 in 2011

Yes, we have until 2013.  However, the more I take part in ICD-10 planning committees, the more I realize that this is going to take a huge amount of preparation time.

It’s time to get started now.

Obviously, since we’re still in the process of training the trainers on ICD-10, I’m not referring to training your team on the actual ICD-10 codes.  But, since ICD-10 will place a significant emphasis on specificity and anatomy, I do believe that it is time to start training your providers and coders on:

1. Documenting every detail  (providers)
2. Understanding what they will be reading (coders)

This means some form of Clinical Documentation Improvement (CDI) program across your organization.  It also means training or retraining your coders on Anatomy.

These things take tremendous amounts of time, and the time to train on the actual codes is quickly approaching.  The best way to avoid a training logjam at the end is to begin soon.  (Logjams in coding tend to be a major financial problem)

The time is now.  Don’t forget to budget for it.

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About the Author:

Aaron is one of the leaders of the HIM Circle movement and former HIM Director at multiple hospitals.  Join the free HIM Circle for further discussion about ICD-10 on these various forums:

• http://facebook.com/HIMCircle
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An Abridged Guide to ICD-10

As you probably have heard by now, on October 1, 2013, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.  We’ve compiled information directly from the CMS website to help provide a basic introduction and some steps to help prepare for ICD-10. 

In the future, we’ll be posting more updates.  If you’d like to have those updates sent to you, simply subscribe on the right side of blog’s home page (Click the word “Clear” above to get there).

ICD-10

ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

1. ICD-10-CM for diagnosis coding
2. ICD-10-PCS for inpatient procedure coding

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

 

Why?  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 is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. 

 

Steps to Prepare for Version ICD-10

• Begin preparing now for the ICD-10 transition to make sure you are ready by the October 13, 2013, compliance deadline. The following quick checklist will assist you with preliminary planning steps.
• Identify your current systems and work processes that use ICD-9 codes. This could include clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.
• Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.
• Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, the HIM Circle, online courses, webinars, and onsite training. If you have a small practice, think about teaming up with other local providers. You might be able, for example, to provide training for a staff person from one practice, who can in turn train staff members in other practices.
• Coding professionals recommend that training take place approximately 6 months prior to the October 1, 2013 compliance date.
• Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, training and related expenses.
• Conduct test transactions using ICD-10 codes with your payers and clearinghouses. Testing is critical. Check to see when they will begin testing, and the test days they have scheduled.

See the “Compliance Timeline” below for important stages of implementation for ICD-10 and the Version 5010 that goes with it.

 

DECEMBER 31, 2010

• Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance

JANUARY 1, 2011

• CMS begins accepting Version 5010 claims
• Version 4010 claims continue to be accepted

DECEMBER 31, 2011

• External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance

JANUARY 1, 2012

• All electronic claims must use Version 5010
• Version 4010 claims are no longer accepted

OCTOBER 1, 2013

• Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures

  

To discuss ICD-10 with your peers, visit http://www.HIMfacebook.com