The New Stimulus - ICD-10

The New Stimulus - ICD-10

- January 16th, 2012

By Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, COBCG, CPCD, CCS-P: Blue & Co., LLC, Senior Manager

Many physician groups, including the American Medical Association, have declared that ICD-10 will be an “onerous burden” to the industry and will cost thousands of dollars to implement during a time when physicians are facing reimbursement cuts and other changes. To the contrary, ICD-10 has many advantages for the healthcare industry and the first step in realizing these advantages is to begin the transition.

The ICD-10 mandate was finalized January 1, 2009 which gives organizations until October 1, 2013 to transition.

It is imperative that this transition begin in 2012 to have all of the necessary documentation and training in place to submit claims under the new system beginning October 1, 2013.

The most significant challenge in moving to ICD-10 is the specificity in the new codes which will require significantly more documentation than is used currently. Many physicians are under the assumption they are paid solely based on the CPT codes (procedures and services) along with the associated RVU’s.  Physicians are paid based on the CPT/HCPCS codes which is driven by RVU, however, CMS cites medical necessity as the “overarching criterion” for selection of any type of medical service.  Most insurance carriers agree with CMS.  In essence, the diagnosis code is the key driver for reimbursement.

To become familiar with ICD-10 implementation, start with “ICD-10 Basics for Medical Practices” and “Talking to Your Vendors about ICD-10. Tips for Medical Practices,” both available at: www.cms.gov/ICD10/05a_ProviderResources.asp.

Other important steps to take now include the following:

  1. Appoint a person to be responsible for successful implementation.  That person should learn what is needed to comply with the new coding system and develop the implementation plan.
  2. Conduct an impact assessment to understand how the new coding system will affect the practice.  This entails looking at what consumer systems use ICD-9 codes, what forms, and what processes involve coding.  Perform a complete analysis of all workflow and processes that could be affected by ICD-10.
  3. Contact computer vendors to start planning for ICD-10.
  4. Perform quarterly ICD-10 documentation readiness coding reviews to analyze documentation deficiencies with the new codes.
  5. Create a budget for converting to the new coding system. Depending on the maintenance agreement, a computer vendor may be responsible for the software updates. On the other hand, some computer hardware may not be robust enough to handle the new software, which could mean an additional expense. Don’t forget expenses such as education and training, and documentation readiness coding reviews.
  6. Identify the staff members who will need to be trained, and budget for their training and lost productivity. Highly experienced coders will be able to learn the new system more quickly than new coders.
  7. Physicians will need to be trained, even if they do not do their own coding, because they will have to document with the level of detail needed to support the new codes. Make sure physician training is tailored to their specific needs.
  8. Create a solutions analysis which will identify the current state of the organization, where the practice needs to be in 2013 with ICD-10, and the steps the practice will take to get there. Creating a solutions analysis with a timeline will keep the practice on track with ICD-10.
  9. Utilize a consultant to assist with ICD-10 implementation and education for providers and staff if internal expertise is not available. To receive guidance or assistance with ICD-10 implementation, contact dgrider@blueandco.com.

Deborah Grider, a senior manager with Blue & Co., LLC, is one of the top leading industry experts on ICD-10 Implementation and Training.  She has been in the healthcare industry for over 30 years and an author of many coding books for the American Medical Association including “ICD-10 Implementation Guide; Make The Transition Manageable”, “Principles of ICD-10-CM, and the ICD-10-CM workbook.  She had developed education and training on ICD-10 Implementation for hospitals, payers, and physicians for various organizations and in 2009 testified at the National Committee for Healthcare Vital Statistics meeting on the challenges physicians face with ICD-10 implementation. She is also the author of many articles on ICD-10, is the Past National Advisory Board President for the AAPC, and an approved ICD-10 Instructor with the American Health Information Management Association.

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