Today, we’re tackling how to test ICD-10 externally. (We discussed testing internally yesterday. Click here if you missed it.)

The point of testing is to ensure that—come the mandatory transition deadline—you, your processes, and your systems are all working in harmony so you get paid for doing what you do best: treating your patients.

According to Carl Natale, editor of ICD10Watch and author of this article, proper testing should help you:

  1. “Verify that [your] practice can submit, receive, and process data containing ICD-10 codes.
  2. “Understand the impact that clearinghouse and payer policies will have on the transactions.
  3. “Identify and address specific problems.”

So where should you begin your external testing efforts? Well, according to this article, you should take a “multi-phase approach to testing to cover different testing objectives in a reasonable time frame...” In other words, set specific, measurable, attainable, relevant, and timely (SMART) testing goals—and then communicate your goals and completion timeline to your staff and partners. Just remember to consider where your partners are in their planning and build in “extra time...to cope with surprises and delays.”

Here are the key points in Natale’s breakdown of CMS’ external testing plan:

  • Identify (and prioritize) the stakeholders with whom you need to test.
  • Submit test data to your clearinghouse, billing service, and/or payers.
  • Review test results for the data you submitted.
  • Update your processes based on the results of your tests.

Another piece of advice, courtesy of the Centers for Medicare and Medicaid Services (CMS) and the Workgroup for Electronic Data Interchange (WEDI): Make sure that your testing includes sample cases that span every relevant code category your practice uses as well as ones that contain “common errors, such as mistaking a zero for [the letter] O, to figure out what happens when claims don’t go through.” Speaking of  test cases, if yours include real patient protected health information (PHI), the American Medical Association (AMA) has this to say: “Be sure to follow all appropriate security and privacy measures to protect the data, such as sending the transactions using a secure connection.”

If you work exclusively with a billing service or clearinghouse, your external testing process will be a whole lot simpler. According to the AMA, you need only send them “test data with ICD-10 codes” so they can “conduct the transactions electronically on your behalf.” You’ll then “receive test data back into your practice.” However, “you will also want to verify that your billing service or clearinghouse is conducting the necessary external testing with payers and other clearinghouses to ensure that they are prepared to meet the compliance deadline.” If they’re not, “your cash flow could be compromised.”

The AMA recommends providers allot six to nine months for external testing. However, just like internal testing, the more time you spend preparing, the better off you and your practice will be come transition time.


Want to test ICD-10 codes within your electronic medical record (EMR)? You can—if you’re a WebPT Member. Our new code picker now includes the option to search for and select ICD-9 and ICD-10 codes. However, if you decide to test ICD-10 before the transition deadline, please use a test patient. Test claims will not be reimbursed. For more information on practicing ICD-10 codes within WebPT, check out this user guide.

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