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“ICD-10 is coming. ICD-10 is coming.” You might be tempted to turn away, go back to work, and ignore this Paul Revere-style warning. But that would be unwise. Sure, October 1, 2015, might seem far, far away, but we all know that time flies, and this ICD-10 implementation deadline will be here before we know it. So let’s put a big X on the calendar, and begin our countdown to preparedness. Today, we’re talking about the importance of ICD-10 testing.
ICD-9 vs. ICD-10
Yes, both ICD-9 and ICD-10 consist of diagnostic and procedural codes, but ICD-10 is significantly more complex. In fact, there are almost five times as many ICD-10 diagnostic codes (68,000) as there are ICD-9 ones (14,000). Plus, the new codes are alphanumeric and can contain seven characters. (For comparison, the old ones are mostly numeric and have just three to five digits.) Want an example of the new code complexity? Check out this one.
In her article titled Roadmap to ICD-10, Brooke Andrus wrote about Advanced MD’s three-part test plan:
“Test that your office staff can competently work with the [new codes and] redesigned workflow.
“Test each redesigned process.
“Test integration with partners.”
The first two are examples of internal testing; the third is external. They’re both equally important, and we’ll go into greater detail about each in just a moment. But before we do, consider your internal coding processes. Here are a few good questions to get the ball rolling:
Who in your clinic touches your codes? Your clinicians, billers, front-office staff, directors?
What ICD-9 codes do you use most frequently? What are their ICD-10 equivalents?
Where and how does your staff locate correct codes currently?
Will your processes still make sense after the codes change?
After you have the answers and fully understand the ways in which your clinic codes today, you can begin internal ICD-10 testing.
If you’re using an EMR that’s building you an ICD-10 solution (like WebPT is), transitioning to ICD-10 will be a whole lot easier. But you won’t be able to start testing within the system until the solution is ready. And that’s okay, because a custom solution will be worth the wait. In the meantime, you can practice with the new codes manually and become really familiar with the ones you’ll be using most often. If you’re not using an EMR like WebPT, you’ll want to start dual coding (i.e., recording the ICD-10 equivalent to the ICD-9 codes you submit) soon because you won’t have the extra help come October 1. Either way, though, working with ICD-10 early will help you and your staff get comfortable with the new code structure and check for any snags in your processes. If you identify challenges, which you most likely will, you’ll have plenty of time to redesign your processes, implement the changes, and test them again. Remember, though, CMS and other payers will not process ICD-10 codes prior to October 1, 2015, and most won’t process ICD-9 codes after, so timing is everything.
By the end of your internal testing phase, you should feel confident enough to check numbers one and two above off your testing plan. And that means your staff and your processes are in tip-top ICD-10 transition shape.
Feeling overwhelmed before you’ve even begun? Don’t, because Mark Lott, CEO of Lott QA Group and coordinator for the HIMSS WEDI National Pilot Program, has some good news. The author of a Healthcare IT article, titled “Neglect to Test for ICD-10 at Your Peril,” quotes Lotts as saying: "You don’t need to know all the ICD-10 codes well, you just need to know the diagnoses codes for your specialty well." That should take a lot of the pressure off.
Once everyone in your clinic is an ICD-10 rockstar, you can begin external testing. That is, ensuring that every one of your external partners is ready and able to process the new codes.
According to this EHR Intelligence article, to survive the ICD-10 transition, “you have to be flexible, proactive, and prepared,” especially when you begin testing with external partners. Part of being prepared and proactive includes following this piece of advice from CMS: ensure that testing includes sample cases that span every relevant code category and make a point to “consider common errors, such as mistaking a zero for [the letter] O, to figure out what happens when claims don’t go through.”
The same article also recommends that practice owners and directors take a “multi-phase approach to testing to cover different testing objectives.” In other words, set testing goals and make sure they’re specific, measurable, attainable, timely, and, of course, relevant (SMART). Then, communicate your goals and your timelines to your staff and your partners. Finally, follow through. Just remember to be flexible “and build in extra time in your implementation plan to cope with surprises and delays.”
By the end of your external testing phase (i.e., September 30, 2014), you’ll be able to check number three above off your testing plan. And that means your partners are ICD-10 rockstars, too.
How are you feeling about the ICD-10 transition? What steps has your clinic taken to begin ICD-10 testing? Tell us in the comments below.