A Primer for Managing the ICD-10 Transition

The healthcare industry is justifiably apprehensive about the impending transition from ICD-9 to ICD-10. Between claim denials from incorrect coding and coders taking more time to deal with the new system, billing is more than likely to slow down considerably. However, The Centers for Medicare and Medicaid (CMS) officials are saying that preparation and planning should keep providers’ accounts receivable from collapsing completely. The agency knows there are going to be claim denials, but they also contend there are ways to avoid many of them.

Two major challenges are going to impact billing after the transition begins. The first will be that ICD-10 requires a much more in-depth level of documentation.  A simple ED treatment such as a cut on a patient’s arm will require much more specificity in order to code and bill for the visit. For a simple open wound that requires a few stitches, coders will now have to drill down to whether it is a bite or other kind of wound, if there is or isn’t a foreign body involved, and exactly on which part of the body the wound is located – left or right arm.  As one can see, not only will the granularity of the coding increase, but the time to code will also increase.

Another challenge is that coders will have to spend more time examining documentation. Simply skimming a document will no longer suffice. The descriptors required for ICD-10 will be longer and include words like “with” or “without” which could easily be missed without an in-depth examination of the documentation. This is definitely going to impact a coder’s time and productivity will suffer.

However, this increased specificity will also bring advantages. ICD codes are also used for disease surveillance, monitoring and quality reporting.  Occurrences such as disaster recoveries, disease outbreaks and clinical trials all use ICD codes.  The increased specificity of ICD-10 data will provide more meaningful and useful data for these activities.

How can you be assured you are ready for ICD-10? The best way to defend your facility against the financial risks of this new mandate is to use the old sports adage: “The best defense is a good offense.” Following are some offensive tactics you should consider using:

* Plan

* Prepare

* Put new processes in place

* Have a financial contingency

* Test

Taking the offense with early planning and preparation can be your keys to a successful ICD-10 transition. If you have done everything you can to be prepared for the 2014 deadline, the chances are very good the transition will have a minimal impact on your organization and its revenue stream. Hope for the best and good luck!