The Importance of ICD-10 Prep for Medical Practices

October 22, 2012

Planning for the emotional and financial impact of ICD-10 may be a daunting task, but it is a necessary one.

Preparing for ICD-10, the alphanumeric diagnostic code set slated to replace ICD-9 in October 2014, means bracing for a shift in coding behavior and revamping existing work flow patterns. Equally important, medical practices should prepare to make a big financial commitment, and, possibly, a technological overhaul.

Those who don’t adequately prepare may experience a serious slowdown in cash flow, not to mention an increase in stress.

That was the message relayed by Shelly Guffey, Gateway EDI’s manager of premier accounts and vendor partners, to the packed “Preparing for ICD-10 Implementation” session on Monday at the MGMA12 conference in San Antonio.

The shift to ICD-10, for which medical practices and other healthcare organizations will be expected to swap 13,000 three- to five-digit diagnosis codes and 4,000 procedure codes for 69,000 three- to seven-digit alphanumeric codes and 87,000 procedure codes, is one of the biggest industry overhauls in decades. But by planning ahead now, any negative repercussions such as cash-flow disruptions will be minimized.

“Some people thought the delay was typical, but I will guarantee you ICD-10 will happen, it’s just a matter of getting everybody on board and sticking with the [October 2014] deadline,” said Guffey, the sole speaker during the hour-long session.

Guffey offered a number of tips for practices that want the transition to be as smooth as possible. Here are a few of the most important ones:

Make sure everyone is on the same page: Your practice staff should understand the magnitude of the change, and how it will affect your work flow. The influence it has on your staff and physicians may depend on your practice’s size.  “If you’re in a larger organization, make sure you have your IT person involved, make sure you have other physicians involved,” said Guffey. “Start with an inventory, and think about how implementation will transpire.” Areas to consider include budgeting, execution, and life after implementation.

Talk about money: Many practices don’t like to think about money. And that’s no surprise, considering current industry estimates say the transition to ICD-10 could range from $84,000 to $2.7 million, depending on a practice’s size. “It’s going to be difficult to get physicians to understand, too, that they have to include [more] information,” said Guffey, referring to the fact that the new ICD-10 codes will be longer and more specific, and physicians will have to submit more detailed documentation supporting them. “If you don’t get that information you need, and your cash flow dips, it’s not going to be a very positive conversation.”

Prep your credit: Because payers will also be adjusting to the new code set, practices should consider getting a line of credit ready to go in the event of a backlog in payments. The current industry recommendation is to have six months of cash reserves ready. “This is a little scary, because the industry usually recommends having three months [of cash reserves ready] just in case,” said Guffey. She also suggested practices contact their payers. “Ask if they are doing any kind of contingency plan,” she said. “Some may hang up on you, others may say, ‘Yes, we are.’”

Examine your technology: Practices need to schedule time to make IT changes, starting with taking inventory of their existing systems. “Ask yourself, ‘Can my system handle ICD-9 and ICD-10?’” said Guffey. The good news: Those who experienced a few snafus with payer testing with 5010 will probably experience fewer issues with ICD-10 testing, she added.

Even the most prepared practices, however, will likely experience at least some slowdown - in cash flow and patient visits - as they get used to the new code set. One easy way to minimize this slowdown is to identify your practice’s most high-volume diagnosis and procedure codes and do some “cross mapping”  between ICD-9 and ICD-10 (either through your technology systems, or creating manual “cheat sheets” that offer new ICD-10 options for existing ICD-9 codes).  

“Please, please make sure your organization is ready,” said Guffey. “Follow up on everything you can with ICD-10.”