Two Steps to Simplify ICD-10 Transition at Your Medical Practice

January 2, 2012

There is a way to start getting ready for the ICD-10 transition that is not totally disruptive to your practice.

There is a lot of panic-inducing marketing going on out there like: “ICD-10 is going to clog up the process so badly that no one will be paid”; “ICD-10 will not be accepted by everyone, which means double submissions in order to be paid by someone who has a secondary policy; etc.

While much of that is probably true, there is a way to start getting ready for the transition that is not totally disruptive to your practice. Since the adoption of 5010 code sets starting January 1, 2012 should take care of most of your electronic submission issues with ICD-10, there are only two steps that should be addressed right now.

Step One

Many people are overreacting and believe they’ll need to learn and possibly memorize all the code sets. That’s really not an issue now as the codes are not finalized. So, what is the best thing to do? Coders and billers: Brush up on your anatomy and physiology. With the amount of detail required in coding for ICD-10, a coder needs to have a very good understanding of anatomy and physiology in order to understand all the nuances of ICD-10. That way, when reading a physician’s documentation, a coder can pull out the information needed in order to code to the highest level of specificity. If you can’t get the information you need from the documentation, it is another ‘opportunity’ to educate the physicians in proper documentation. Hopefully, that will lead to you not having to constantly interrupt them to get the information that is needed in the future.

As physicians really don’t document for coding but document for healthcare, the information that coders need is often different than what the physician would need for care. However, with the government wanting more precise reporting from the healthcare sector, physicians will need to be trained on the new information required for proper coding and reporting. Remember, with PQRI / PQRS, the government is willing to pay for better documentation and reporting.

An example of a diagnosis code that is going to trip up physicians is mal-union of fracture. The code in ICD-9 is 733.81. In ICD-10, there are 1,400 codes from which to choose. They want to know which bone - proximal or distal - and how it was originally broken, etc. I foresee that many insurance companies will not pay properly if the most specific code is not used. This is why an even more detailed knowledge of anatomy and physiology is extremely important.

Step Two

You need to look at your specific office processes. Look at those codes that are used the most often by your physicians. I would suggest picking the top 20 to 30 diagnoses. After finding the top diagnoses, you will need to create some type of cheat sheet for the doctor to use or a brand new “superbill” that includes all the permutations for those most used diagnoses. After starting the creation of the cheat sheets or superbills, work with the doctors to make sure that everyone understands the “why” of the cheat sheet and the importance of being very specific. I would then have a list of the most detailed and common diagnoses that you and your physician came up with ready to use. Then, when the finalized codes do come out, you can quickly get the proper ICD-10 codes ready to go on your superbills, EHR, etc.

You’ll need to be sure that all forms are updated. A good idea to accomplish that is to follow one ICD-9 code now and follow it through all of your office procedures. See all the places where it impacts your practice. Then you will have a ready to list of all the places you need to update come ICD-10 time.

As is the case with most things; the more you do in preparation, the less you will have to do when the “heat is on.” I only bring this up because as I am writing this, it is only 654 days until there is no more time to prepare.

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