“How do you eat an elephant? One bite at a time.” That’s how the age-old adage goes, but aside from it being a totally messed-up saying—why are we eating elephants?—it also falls totally flat in my book. When we talk about eating an elephant, it implies that we’re devouring something. In reality, though, with any significant or substantial endeavor, we’re actually trying to triumph. And I’m not sure if anyone would count gorging on a pachyderm as a triumph—especially if that metaphorical behemoth is ICD-10. I mean, most of us already have had our fill of these new diagnosis codes, and we actually haven’t even had any yet.

So, what’s a better analogy? I’m partial to Lao-Tzu’s “A journey of a thousand miles begins with a single step.” While the ICD-10 switch—slated for October 1, 2015—will be a journey in itself, the prep work is proving to be a marathon, too. Unfortunately, many practitioners have found themselves paralyzed by the mere thought of preparation—or they’re simply procrastinating. But as we’ve stated again and again and again, you absolutely should not put off readying your practice for ICD-10. It’s 2015; T-minus seven months until takeoff. It’s time to take a page from Lao-Tzu and start that journey.

Of course, when it comes to a thousand-mile journey, there’s a lot to consider—perhaps too much—which means the route on your map might be missing a few checkpoints. Here are three that might be absent, but definitely shouldn’t be:

Triumph in the Triple-Aim Game: The Healthcare Executive’s Guide to Readmission Reduction, Patient Safety Promotion, and ACO Success - Regular BannerTriumph in the Triple-Aim Game: The Healthcare Executive’s Guide to Readmission Reduction, Patient Safety Promotion, and ACO Success - Small Banner

1. Testing with Your Payers

Communication is the key to a strong relationship, and when it comes to payers, we PTs need all the help we can get. Plus, we should never trust payers to be prepared for regulatory changes. Therefore, I recommend your ICD-10 checklist include a testing period with your payers. Medicare is already rolling out testing initiatives, which means commercial insurances might be, too—and there’s only one way to find out for sure. Contact all your major payers, and verify:

  1. That you can submit ICD-10 data and that they can receive and process it.
  2. Whether the payer has any policy changes that could adversely affect your transactions or processes.
  3. That your practice can conduct a test with the payer. If you can, then work with the payer to develop a plan to do so. Then, submit test data, review the results, and update your processes accordingly.

To learn more about testing with your payers, check out this post.

2. Considering Coders

Your knee-jerk reaction here might be, “Coders? They’re for hospitals!” That’s true for ICD-9. Typically, only large-scale organizations employ coders for our current diagnosis code set. But ICD-10 might change all that, because ICD-10:

  1. uses a new coding structure;
  2. features codes with up to seven characters (ICD-9 only has five);
  3. includes advanced anatomical terminology; and
  4. allows practitioners to code for the conditions surrounding certain injuries, including how and where said injuries occurred as well as their degree of severity.

These reasons aside, PTs most likely will use only a subset of the full ICD-10 code library, and external cause codes typically won’t be required. Thus, ICD-10 might not be as time-consuming for PTs as it will be for our physician peers. Still, as a PT, you want to do what you do best—treat patients—without worries over diagnosis coding weighing on your mind. But if ICD-9 codes are already bogging you down, bear in mind that things will only get tougher with ICD-10. For that reason, I recommend private practice owners add “Investigate coders” to their checklists. That doesn’t mean you’ll hire someone, but you should consider all your options. To learn more, check out this article.

3. Incorporating the Right Technology

With a thousand-mile journey in front of us, many PTs are clamoring for help in the form of a do-all solution. Fortunately, that kind of help is at your fingertips. Today, most private practice PTs are completing their patient documentation digitally, and the most common tool for digital documentation is an electronic medical record (EMR) software. In addition to documentation and scheduling, an EMR should have your back when it comes to ICD-10.

Of course, there’s no “magic bullet” for ICD-10, but the right EMR solution definitely can alleviate a lot of the aches and pains you’ll encounter during your preparatory travels. An EMR’s built-in ICD-10 intelligence can help you select the most appropriate—and most specific—diagnosis codes to include in your documentation. Regardless of what some software vendors will tell you, crosswalking ICD-9 to ICD-10 codes is no easy feat, and for most codes, there isn’t a one-to-one translation. Furthermore, while it’s less common in PT, some diagnosis codes require external cause codes. Thus, when vetting your current or prospective EMR partner, make sure their ICD-10 functionality is intuitive, helpful, accurate, and easy to use. As an FYI, WebPT does feature an intuitive ICD-10 translation and selection tool, so if you’re a WebPT Member, you can check this item off your list. Hooray for getting stuff done!


There you have it: Three steps that possibly weren’t—but absolutely should be—in your ICD-10 prep plan. There are more steps than that, though; it is a thousand-mile journey, after all. Curious as to what it’ll take to get to that checkered flag on October 1? I’m hosting a webinar on February 24 titled “The PT’s 2015 ICD-10 Checklist.” If you’re feeling unprepared, you’re unsure how to shake the procrastination prostration, or you want to make sure your to-do list is up to snuff, then you should attend. You can RSVP here.

And with that, I’m off to have some barbecued elephant—er, I mean, plan my next journey.

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