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ICD-10-CM: Have you mapped out your transition plan?

Even if you’ve worked in healthcare only a short time, you’ve probably noticed that many providers are overwhelmed by the idea of ICD-10-CM and may not know quite where to start. In addition, transition to these new code sets has been pending for so long that healthcare professionals still aren’t convinced these deadlines are “really real.” The common quip for years now: “I’ll be retired before it happens!”

But the truth is that you already lag behind suggested timelines if you haven’t mapped out your transition plan.

The Oct. 1, 2013, implementation date seems a long way off. But you can expect the compliance deadline to hold firm; many of the current administration’s new value-based purchasing initiatives depend on the level of detail available in ICD-10 codes.

Time is of the essence. One study by the Workgroup for Electronic Data Interchange (WEDI) and the North Carolina Healthcare Information and Communication Alliance (NCHICA) suggests providers need nearly 1,286 business days to complete the transition – roughly 4.9 years. At the very minimum, you already should have conducted an impact assessment of stakeholders across all functional areas of your practice, as well as plotted high-level cost estimates. You should have assessed staff educational needs, and – perhaps most important – evaluated information/technology requirements and implementation plans.

Informed providers and vendors understand that ICD-10 is not just a “routine” coding update. Practice management systems and applications throughout the claims management cycle must be altered to the new data format – or you risk facing delayed or denied reimbursement once the compliance date rolls around.

Here’s one example: ICD-9 diagnosis codes are 3-5 digits long, and while the first digit is either alpha (E or V) or numeric, digits 2-5 always are numeric. To accept ICD-10 diagnosis codes, however, systems must be restructured to accept codes 3-7 digits in length, of which digit 1 is alpha, digit 2 is numeric, and digits 3-7 are alpha or numeric.

It’s not a quick or easy change: the WEDI/NCHICA study estimates that vendors will require nearly a year longer than providers to successfully upgrade their various products – 1,521 business days (almost 5.9 years).

Remember the problems caused by the transition to National Provider Identifiers (NPIs)? Fortunately, lessons learned from that transition can be applied to help avoid the massive 6%-10% claims-error rate CMS predicts could occur right after the switch to ICD-10.

Foremost is the need to keep in contact with your payers and clearinghouse about their implementation timelines and testing plans. Build ICD-10 requirements into any technology upgrades you’re considering, whether for EMRs, practice management systems or revenue cycle management solutions. There are certainly resources out there – including partners like Navicure that successfully navigated the NPI waters – which can help ease the transition.

Where do you stand in your ICD-10 transition? Post your response here and contribute to the dialog about how to make the process as pain-free as possible.