Like yet another season of Survivor, ICD-10 is inevitable, and while the Department of Health and Human Services (HHS) won’t drop you on a remote, hostile island when the ICD-10 switch happens, the new coding terrain may be just as unfamiliar, uncomfortable, and treacherous—unless you’re ready. Here’s how to win at ICD-10 (no shelter-building or fire-making required).
Hit the Books
Switching from a code set with roughly 13,000 codes to one with about 68,000 codes is a pretty daunting task—and crosswalking from one set to the other won’t be as simple as you might think. According to CMS, there’s no straightforward mapping from the five-character ICD-9 codes to the much more specific seven-character ICD-10 codes: “There are some one-to-one correspondences, but often there are one-to-many, many-to-one, many-to-many, or no correspondence at all.” So while you may not need to complete a memory challenge, you and your staff will need to understand how ICD-10 works so you can successfully crosswalk your codes and select the right ICD-10 code for each patient condition.
So, what’s with the extra characters? The updated, specific, and adaptable ICD-10 coding set requires more characters to designate:
- the category of diagnosis
- crucial clinical details—like related etiology, anatomic site, or severity
- information on the episode of care
You also may need to record multiple codes for one condition. Sound complicated? It is, which is why you should start educating yourself now. To keep your staff up-to-date, designate an ICD-10 guru or two who can sift through the vast library of information and educational resources and share them with the rest of the team in manageable chunks.
A good place to start: learning the coding structure itself. For help with that, check out this blog post.
Test Your Processes
You won’t know if your clinical and operational processes have any issues to address if you don’t test them first—and trust me, you don’t want to wait until October 1, 2015, to find out one way or the other. To ensure your clinic doesn’t get voted off the ICD-10 island, take the time to test your internal and external coding processes.
Practice doesn’t make perfect—it makes permanent. Make certain your staff knows how to correctly handle the new diagnosis codes so your claims are processed—and reimbursed—the first time, every time. To properly test your staff, you’ll first need to identify those folks in your clinic—like front office staff, therapists, and billers—who interact with diagnosis codes; then pinpoint the ICD-9 codes you use most often and find their ICD-10 equivalents.
Once you have that information, establish the processes your staff uses to determine the correct ICD-9 codes and test them for efficacy with ICD-10 codes. One suggestion: Start dual coding to identify areas that need attention. Your current processes might apply to the new ICD-10 codes as-is, but if not, you’ll have to make adjustments or come up with new workflows that appropriately accommodate the new coding system. Keep testing until your clinic’s workflow aligns with ICD-10, and you and your staff are comfortable with the new coding set.
External testing is just as important as internal testing, and with the October 1 deadline quickly approaching, you need to begin testing as soon as possible to ensure that your outgoing and incoming data transmission processes—which ensure you get paid—are on point.
To perform external testing, take the following steps:
- Identify external entities with whom you’ll need to test.
- Establish a reasonable time frame.
- Break up testing into smaller portions.
- Set specific, measurable, attainable, relevant, and timely (SMART) testing goals.
- Make the appropriate adjustments to your process before the deadline.
Keep in mind that your processes are only as strong as their weakest link, so it’s crucial that you find out where your business partners and vendors are in their own ICD-10 preparations—and keep the communication lines open. If these folks aren’t ready or haven’t even begun preparations, that should be a big ol’ red flag to take your business elsewhere.
Take advantage of CMS’s claims-testing opportunities. Providers, suppliers, billing companies, and clearinghouses can participate in the upcoming rounds of end-to-end testing, or they can choose to submit individual test claims up until the date ICD-10 goes into effect. Contact your Medicare Administrative Contractor for more information on the testing process or to learn how to participate.
Additionally, I recommend developing a plan to address any claim denials you experience following the transition, so you can quickly get the problem under control and prevent future denials.
Switching diagnosis code sets probably sounds as appealing as eating bugs or drinking cow's blood, but keep in mind that the benefits far outweigh the drawbacks. As CMS explains, “The ICD-10 code set is much better at describing the current practice of medicine, and has the flexibility to adapt as medicine changes”—meaning it can outwit and outlast the antiquated, inconsistent, and limited ICD-9 codes. And while preparation won’t grant you immunity (or help you win a million bucks), taking these steps to get ready for the ICD-10 transition will help you survive the challenges ahead—and come out on top.