Planning for ICD-10 Conversion

January 31, 2012

Here's how your medical practice should build a plan for the looming transition from ICD-9 to ICD-10 in 2014.

For medical practices, the path to ICD-10 conversion can seem like climbing to the other side of a very high mountain. While CMS has plied practices with incentives to make the climb, there are also penalties (starting this year) for not meeting conversion milestones. Regardless of your practice objectives, this is a government-mandated program that is unavoidable. Done well, ICD-10 will be time-consuming and costly. Done wrong, ICD-10 could cost your practice much more than it gains in financial incentives for programs like meaningful use, PQRS, and e-prescribing.

However you feel about converting to ICD-10, the deadline is looming. It's time to start thinking about drawing up your plan of action. Here are some statistics to consider:

• American Association of Professional Coders (AAPC) expects ICD-10 will increase your documentation time by 15 percent.

• Medical Group Management Association estimates it will cost $27,000 to $29,000 per doctor to move to ICD-10.

• Recovery Audit Contractors (RACs) collected $934.9 million in FY 2011, a scary increase over the scant $92.3 million they collected in FY 2010. For their efforts, the RACs earned $97.3 million for FY 2011 - think they see ICD-10 as a gold mine? I do.

For the sake of this article, let's assume ICD-10 does arrive on schedule on October 1, 2013. Though I would love to digress - Do we really need four codes for flatulence? - I will instead offer several things you can do to begin your journey toward successful ICD-10 conversion.

1. Pace yourself and your practice.

ICD-10 preparation is a marathon and not a sprint, best digested in smaller bites. We recommend setting incremental goals/tasks (like those suggested below) along a 6-12 month timeline.

2. Take advantage of ICD-10 training programs.

If you have a certified professional coder in your office, have him go through ICD-10 training and certification. Practice management consultant Sue A. Irwin astutely blogged on Physicians Practice's Practice Notes that coders and billers will need to understand anatomy and physiology at a more detailed level.

3. Run a report of your 50 most-frequently used ICD-9 codes.

If this list encompasses less than 80 percent of your claims, expand the list until you hit 80 percent. Now, use a tool such as the AAPC's ICD-10 code translator to determine how many ICD-10 codes are needed to replace your ICD-9 codes. These codes should be your focus. You and your clinical, coding, and billing staff will use these codes as your roadmap; the charge to each of you will be to understand the granularity of the expanded code set.

• An alternative to running the top 50 report would be to use the ICD-9 codes on the back of your face sheet/encounter form. Such an endeavor may be too much to handle initially; for instance, our pediatrician's encounter form contains 273 ICD-9 codes.

• Start with a manageable number (10 codes to 15 codes per week) and expand your effort rather than get overwhelmed by the magnitude of the project.

• You may choose to offer a weekly or biweekly lunch-and-learn in which you educate your staff on anatomy and physiology nuances.

4. Put yourself in the shoes of an ICD code.

Walk through your office. Look at where ICD codes are used and where incremental detail/documentation will be needed.

• You will discover that the ICD transition impacts many more facets of your operations than the 5010 transition or the HIPAA Privacy implementation of 2003. From authorizations to billing, and your documentation to referrals, many processes will be impacted.

• You will want to assess the impact of the ICD transition in each area.

5. Develop a plan of action.

Each affected area should develop a game plan for adjusting work flows, revising forms, etc. It then is helpful to aggregate these plans and look at how each process flows. Make sure that the respective game plans dovetail each other.

6. Communicate/coordinate with EHR vendors.

Some EHR/practice management system vendors may think it's a bit early to discuss their ICD-10 transition plans; I disagree. Your efforts will be for naught if your vendor is not on the same page.

• Ask your vendor for help in understanding any ICD-10-related changes to workflows, and reconcile these changes to your staff's game plans.

• Get something from them in writing with regard to their transition timelines and their plans to educate and test.

• Several vendors use robust clinical databases such as Medcin or SnoMed that should help you with the more granular documentation ICD-10 will require of you.

The other side of the mountain is less than two years away. ICD-10 is the latest in a progression of unfunded mandates, but unlike most of its successors, ICD-10 cannot be bluffed or winged. Nor, I believe, can it be implemented overnight. The time you invest in the next two years to prepare yourself and your staff for the conversion will, looking back in 2014 and beyond, appear to be one of the smartest things you may have ever done.

Lucien W. Roberts, III, MHA, FACMPE, is vice president of Pulse Systems, Inc., and a former practice administrator. For the past 20 years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He can be reached at