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ICD-10: It’s not going away!

You’ve probably heard it before, but it is worth reiterating: Start preparing to transition to ICD-10 now. Most experts believe, with good reason, that the 2013 deadline will not be delayed. Those who are not prepared to correctly submit ICD-10 codes on the implementation date simply will not get paid.

The magnitude of the change is no small matter, either. The roughly 14,000 now-familiar ICD-9-CM codes will be replaced by about 69,000 ICD-10-CM codes; the current 4,000 or so ICD-9-PCS codes will swell to about 72,000 ICD-10-PCS codes. In all settings, physicians will need to provide much more explicit documentation.

All of this was the focus of a recent panel discussion, where industry experts discussed the transition to ICD-10 and 5010. On the panel was: Rhonda Buckholtz, Director of Business and Member Development at the American Academy of Professional Coders (AAPC); Michele Madison, a partner in the Atlanta healthcare law office of Morris, Manning & Martin; and Ken Bradley, Vice President of Strategic Planning at Navicure. All three agree time is growing short. The Centers for Medicare & Medicaid Services (CMS) essentially feels it already has delayed implementation by finalizing the current 2013 deadline. (The agency initially proposed a 2011 deadline.) The implementation date, therefore, is not likely to budge.

The panelists all liken the ICD-10 transition to the HIPAA and NPI transitions of not so long ago. It will be costly, will similarly affect reimbursement, and will probably require concurrent processes for a while. (In the case of NPI, it was provider numbers; this time, it will be ICD-9 and ICD-10 codes.)

After listening to the discussion, it’s clear to me that the transition to the 5010 transaction standard and the transition to the ICD-10 code set walk hand-in-hand with each other. While practices can rely on their vendors to take care of many 5010 requirements, they must make sure their vendors are doing so. And practices must not treat the ICD-10 transition as “just another system upgrade.” Make no mistake: it will require a fundamental change in business and business processes.

Testing of those new processes will be critical. For instance, you should know whether your practice management (PM) and electronic health record (EHR) systems can correctly exchange information in the new formats—before your reimbursement is at risk.

So, what can you do now to prepare? Here are some tips from the panel:

1) Assign staff to assess and address both 5010 and ICD-10 needs. In a small practice, this might be the office and IT managers. Larger practices (or hospitals) will need to involve more staff.

2) Ask your electronic health record (EHR), practice management, and clearinghouse vendors about their preparation plans. Questions should include: What are my hardware/software needs? Are upgrades included in my contract? What is your testing schedule—both for 5010 and for ICD-10?

3) Create a training schedule. While specific training should wait until closer to implementation, discuss the basics now. Run a report of your most-used ICD-9 diagnosis codes, then use the General Equivalency Mapping (GEM) files published by CMS (and also on the AAPC website) to map them to their possible ICD-10 counterparts. Compare the differences, see what documentation will be required, and use that information to begin crafting your training plans.

You’ve likely heard it before, but there truly is not a moment to waste. Once you take a serious look at all of the areas in your practice where ICD-10 codes will make an impact, you will see there is much work to be done, and little time in which to do it. It is vital to your organization’s future financial stability to make sure you have a full transition plan in place soon.

Does your practice have an ICD-10 plan in place? Let us know in the comments section below.