Jackie Stack, CPC

Many people focus on differences between ICD-9 and ICD-10 and the problems that ICD-10 may cause. However, there are many benefits of moving to ICD-10. Here are some of the biggest:


Appropriate clinical documentation will be critical to selecting the correct diagnosis code in ICD-10. This more specific documentation will improve medical decision making, and it will ensure that the medical decision is supported by a clear picture of the encounter with the patient. This will reduce the amount of denials a practice encounters, thereby reducing the amount of time practice staff needs to spend addressing denials.


ICD-10 has many combination codes used to classify two diagnoses, a diagnosis with an associated sign or symptom, or a diagnosis with an associated complication. The benefits of assigning one combination code versus separate codes is the use of fewer codes, therefore reducing the amount of time associated with using multiple codes. For example, when coding for pressure ulcers in ICD-9, two codes are required, one for the ulcer and one for the stage. In ICD-10, one combination code includes the site of the ulcer as well as the stage.

3. More opportunities to demonstrate need


In ICD-9, the codes for otitis media do not have an option for recurrent. ICD-10 has codes for acute, chronic, and recurrent, in addition to type and laterality. Using the recurrent code will show medical necessity and assist in getting approval for surgery.


The preventive codes in ICD-10 include the specificity of “with” and “without” abnormal findings. Preventive services vs. acute visits can be clearly defined with the use of the new preventive codes in ICD-10. For example, a patient comes in for a well-child check and, during the exam, the provider discovers the patient has an ear infection. The provider treats the patient for the ear infection. The provider would code with abnormal findings and the otitis media. The provider codes for the preventive visit with an E&M visit with the 25 modifier.


The non-compliance codes have been expanded in ICD-10. These codes protect physicians legally by documenting when patients are not taking their medication as prescribed or are not being compliant with their treatment. Reporting the non-compliance codes will help track and trend how many patients are not taking their medication correctly and why. For example, there is a code for non-compliance of medication regimen due to financial hardship. This may show a need to decrease the cost of prescriptions and a need for programs to help patients secure necessary medications.

Seeing the benefits in ICD-10 will help you and your staff members embrace and prepare for the upcoming transition.

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Seeing the benefits of the ICD-10 transition will help you and your medical practice staff members embrace and prepare for the upcoming transition. 

Five Often-overlooked Benefits of the ICD-10 Transition 

There are only months left until ICD-10 implementation, but nearly 75 percent of physician practices haven’t even started their transition plan. According to a recent 

 of practice administrators, executives, managers, billers, and coders, 27 percent of the respondents said they didn’t even know where to start preparing for ICD-10.

ICD-10 preparations should begin with some simple analyses. The effects of implementation will ripple throughout the entire office. Think of how your facility runs today as we look at some of the different areas of the office and how they will change.

When patients make appointments or show up for visits, the front-desk staff will need to explain that the status of participation in certain plans may change. HIPAA policies will need to be revised. The front desk staff should explain the new policies to the patient and have the patient sign the new forms. Systems will also need to be updated, which may impact patient encounters. The front-desk staff will need to receive training on any changes that are made to current systems.

Patient coverage may be affected by elements such as health plan policies, payment limitations, and new Advanced Beneficiary Notice (ABN) forms. Clinical staff must be aware of these changes. Any superbills currently being used will need to be revised, and paper superbills may not even be a viable option in ICD-10. A one-page family practice superbill was recently updated to ICD-10, and it became a 10-page superbill. Health plans will revise all policies linked to local coverage determination (LCDs) and national coverage determinations (NCDs). ABN forms will need to be reformatted and the patients will need to be educated on these changes.

 The nursing staff may need to learn new pre-authorization formats and procedure. More ABNs may need to be signed by the patients under the more specific code set. Every order must be revised or recreated. Documentation must meet the increased specificity requirements, which will necessitate some code set training and an understanding of the areas where more specific documentation is needed. Nurses may be called upon to assist providers with ICD-10 questions, and they may need to revise how they perform intake operations. Nurses may also be affected by systems updates, which would require specific training on these changes.

The need for increased specificity within the physician documentation will dramatically increase after ICD-10 implementation. ICD-10 codes will require documentation of laterality, stages of healing, weeks in pregnancy, episodes of care, and much more. Providers will need to understand all changes (within their specialty) resulting from the new code set. They will undoubtedly need training to learn how to adjust their documentation to meet the new requirements. Since the code set increases from 17,000 codes in ICD-9 to 140,000 codes in ICD-10, provider training may be needed on the general code set, too. They will also likely need training on systems changes, especially if changes are made to their EHR systems.

The lab is another area where increased specificity must be used. Health plans will have new requirements for the ordering and reporting of services.

Coding staff will need to evaluate a larger code set to assign a code, or assess the code assigned by the provider. With the dramatic increase in codes, code books and styles will completely change. Coders may be relied on to educate others about the new code set-which means they will need extensive training. Medical coders will also need a more detailed knowledge of anatomy and medical terminology, given the increased specificity and additional codes. Coders will need to use ICD-9-CM and ICD-10-CM concurrently for a while, until claims are resolved.

Billers will need to understand the new payer policies that will be revised under ICD-10. The billing department must be trained on new policies and procedures, as well as the ICD-10-CM code set itself. The appeals processes will likely change. Coders and billers will also be affected by system upgrades and will require training on the changes.

Apart from overseeing ICD-10 implementation across all other departments, managers will see many changes themselves as well. Any policy or procedure associated with a diagnosis code, disease management, tracking, or PQRS must be revised. All vendor and payer contracts must be evaluated and updated. Budgets will need to be created to account for software changes, training, new contracts, and new paperwork. Managers will need to create a training plan for other staff members, since everyone in the practice will need some formal training in the area(s) that most directly pertain to them. Managers should consider the best medium of training (in person, online, on-site, etc.), as well as which departments and individuals need to be trained.

Take the time now to analyze how these widespread changes will affect your facility and how prepared you are for them. After analysis, start planning how your practice will meet the various training needs and begin transitioning to the new code set. Early preparation will ultimately help protect your revenue and cash flow, which is understandably the largest concern for physician practices.

Begin ICD-10 preparations with an analysis of how the new code set will affect office work flow for each medical practice employee.

Analyze Medical Practice Work Flow to Prepare for ICD-10

The concept of testing with ICD-10 can be confusing. Knowing where to begin can be a challenge. Make a testing plan now as significant time and resources will be required to complete your testing.

According to the AMA, completing both internal and external testing will take time. Your practice should allow 2 months to 3 months for internal testing and 6 months to 9 months for external testing.

Provider practices will want to test with many entities such as payers, practice management systems, billing companies, and clearinghouses. There are many types of testing such as quality assurance, user acceptance, integration, regression, performance and end-to-end.

Internal testing involves testing your internal systems, business processes, and operational work flow. Internal testing is an important step as it allows your organization take an in-depth look at the systems, work flow and processes and resolve any issues before the compliance date. By resolving the issues early you can mitigate issues such as cash flow.

External testing includes testing with all of your external business partners and involves both sending and receiving transactions. External business partners include payers, clearinghouses, and any third-party billing services. By testing early with your external business partners you will be able to identify issues and resolve them now to avoid disruption to your claims process.

Knowing which business partners to test with and when can also be confusing. In an ideal world, you should test with all of your business partners. However, depending on the amount of business partners you have, it may be impractical to test with all of them.

Prioritize your business partners when making your testing plan. Start with the business partners that make up the largest percentage of practice revenue. Providers may use the Pareto Principle, commonly referred to as the 80-20 rule. In this case it would be applied as 80 percent of your practice revenue is derived from 20 percent of your business partners. For example, you will want to test with your largest payers and your clearinghouses.

Completing your external testing means that you have completed your "end-to-end" testing with your business partners and are ready to "go live." However, the regulation does not allow the use of the ICD-10 code set before the compliance deadline.

Many organizations have free resources available to assist provider practices with the implementation of ICD-10.

The National Government Services (NGS), under contract to CMS offers listening sessions. These sessions provide an update on the current plans toward the transition and offer a forum for feedback.

CMS has additional free resources such as an ICD-10 transition checklist and end-to-end testing checklist for payers and provider. These checklists include estimated timeframes for each task and give practices a guide of tasks to be completed.

Testing is essential to ensure that provider practices are ready for October 1, 2014. Being ready will minimize the negative impacts after implementation. The time to begin is now as testing will take significant time and resources. Begin discussion with vendors, payers, and clearinghouse as soon as possible to be included in their testing schedules.

, BSHA, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDC, CCP-P, is an ICD-10 specialist for the 

 . Prior to joining the AAPC, she worked at a large, multi-physician family care and occupational practice with two locations in northwestern Pennsylvania. E-mail her 

Early ICD-10 testing will allow your medical practice to identify and resolve issues before they disrupt your claims process. 

ICD-10 Testing: Know Where to Begin

, the official compliance date for ICD-10 is October 1, 2014. Now is the time to begin to plan for ICD-10 training and education. How to create the training plan, learning styles, and training methods were covered previously.

Depending on the size of your practice a committee may need to be established to assist the project.

The question of when to deliver training does not have a one-size-fits-all answer. Getting training too early is not recommended as it may need to be repeated if the education is not being used soon after. If you wait too long to get the education, individuals may not have enough time to work with the codes and become proficient before the implementation date.

Implementation training is currently being offered and should be completed by the first part of 2013. This type of training is ideal for those with the responsibility for their organization’s implementation of ICD-10. It is also beneficial for coders who want to understand the full implementation process.

Anatomy and pathophysiology is also currently offered and should be completed by the first part of 2013. Due to the clinical nature of ICD-10-CM, it is recommended that those without a very strong understanding of, or experience in, anatomy and/or physiology take a refresher course.

General ICD-10-CM code set training should be taken in 2013. This training will cover the complete guidelines and should include coding exercises. This training will also prepare coders for the ICD-10 Proficiency Assessment.

Specialty ICD-10 code set training should be completed in 2014. Specialty training is for those that want more detailed training for a particular specialty or more advanced multi-specialty training.

Once you decide who is going to get training and what type of training they are going to get, you need to decide who will provide the training.

• Will you have your staff complete online training or will you send them to training events?

• Will you have someone in-house go get the training and come back to the office and train others?

• Will you bring the experts to you, to cater to and train your staff specifically?

These are all are good options. If you are having one or a few people training the others in your office, you need to make sure they are comfortable with conducting the training and are proficient with ICD-10.

Verifying that the training was successful is a vital step. Measure the productivity before and after the training. Design a survey to evaluate the trainee satisfaction and knowledge obtained. Talk with the trainees and get their perspectives on their training.

If the trainee does not feel that they are comfortable or proficient with ICD-10, get them more training! They may need a different type of training or just additional time to work with the codes.

As you can see now is the time to begin to plan for ICD-10 training and education. The size and scope of ICD-10 education must not be underestimated. With a good education plan, the education and training will be a success.

Jackie Stack, CPC, is an ICD-10 specialist for 

Here's some food for thought on when to deliver ICD-10 training to your medical practice staff, where you should go for it, and how to evaluate it.