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Your Questions Answered: All About ICD-10

The process of preparing for and converting to ICD-10 has many moving parts. As practices, health plans, and other vendors work toward the October 1, 2013 deadline, I have been hearing lots of questions about how to successfully manage the conversion. Today, I will answer a few of the more commonly asked questions pertaining to the conversion.

At this point, what stage should our payers be in regarding ICD-10 implementation? Should they be ahead of us?

Since payers and vendors will lay the technology groundwork for what practices must do to successfully transition to ICD-10, they should be well into their ICD-10 work plan and ahead of where practices are today. Most large health plans are in the midst of readying themselves for the new code set and may be starting small tests. It is a good idea to reach out to your payers to understand their progress to date, as well as how you can work with them to make the ICD-10 transition as smooth as possible.

Is it true that some payers will not accept ICD-10 and will continue to accept ICD-9 codes only?

No, that is not true (assuming the payer wishes to be in compliance with the law). Every payer processing electronic healthcare transactions is mandated by HIPAA to accept ICD-10 codes come October 1, 2013. With that said, some small health plans may have trouble converting to the new code set and, for a period of time, may accept ICD-10 codes and then internally map them back to ICD-9 codes. This may create a few problems for providers going forward. To prepare for this possibility, it is critical to work early and often with small vendors and identify how they are going to be interacting with the ICD-10 code set, because they may need more management on your part to ensure codes are processed correctly.

In smaller clinics where the physicians do their own coding and there is no “certified coder,” how do you recommend educating the physicians and business office staff on ICD-10?

One of the best places for physicians and administrators to start learning about the impact of ICD-10 is with a boot camp (the AAPC offers one; click here for more details). Physicians who participate in this opportunity will see what to expect regarding ICD-10 and how the new code set will impact their day-to-day work. In the coming months, organizations like the AAPC will be offering training sessions that are customized to a practice’s specialty. In addition to the training, I would start working with physicians early on their documentation to ensure they understand how that will need to change as the new code set comes into play.

Do we need to buy the ICD-10 books this year? I heard from other practices that they are using the new books to match ICD-9 codes with ICD-10.

I would recommend waiting to purchase ICD-10 books until after the “final” ICD-10 codes release in March 2012. Books purchased after this date will hold you until 2014, with the only changes being new or emergent diseases or technologies that present themselves. If you want to get a sense of the codes now, I would suggest looking at them on the CMS website.

Do you have an ICD-10 or other practice management question that you would like answered? Leave us a comment or submit an idea in the column box on the right side of the blog and we will answer it in an upcoming post.