We have been hearing about the transition to ICD 10 for many years now. The most recent report is that ICD 10 codes will be required on dates of service from Oct 1, 2015 and forward to all HIPAA entities. Technically work comp and auto insurance companies are not going to be required to update to ICD-10 codes, however some companies are doing so. The way it stands now, a medical practice may have to use both ICD 9 (our current codes) and ICD-10 depending on whether the payers are health insurance companies or work comp and auto insurance carriers.
Over 30 years ago ICD 9 was developed, and while there are updates made to ICD 9-it still lacks the ability to correctly communicate details for non-acute conditions. The hope with ICD 10 is to make coding more accurate. By improving the ability to measure health care services, there would be a better ability to refine grouping and reimbursement methods, improve the ability to conduct public health surveillance, and decrease the need to submit medical documentation with claims for payment.
What are some differences between ICD 9 and ICD 10? Currently we have approximately 14,000 ICD 9 CM codes, and so far ICD 10 CM has about 68,000 codes. The new coding system will be alphanumeric codes that are 3-7 digits long. Confusingly I’s and 1’s, O’s and 0’s, S’s and 5’s will be used in the new code set. Also, the many of the new codes will have laterality built into the code. This means coding for an arm fracture of the left arm will have a different code than the same fracture on the right arm. Pregnancy codes will have trimester built into the code, as well as an additional set of codes specifically for the week of pregnancy. Each specialty needs to research and see how their new codes will be used. It is highly recommended to have at least one person designated as the ICD 10 coding facilitator of the office. This person should ensure the office and staff are ready for the changes.
To determine what needs changing or upgrades, it is important to determine every place that a diagnosis code is located. The first place is your billing software. There are some software companies that are currently in business, but their products will not be able to make the ICD 10 transition. No one wants to believe that could be the case for the software in their own office, but you won’t know until you call and ask. This is the same scenario for your clearinghouse, or any other outside billing/coding vendor you may use. It is better to know now that you will have to get new software, then to find out on Oct 1, 2015 that you can’t bill out. Once you know your software will be ready for ICD 10 compliance, find out how the updates occur. Will someone need to run an update late on September 30, or will updates begin early and then there is an automatic switch over? Make sure all electronic software using codes will be able to handle the transition. If diagnosis codes are on any office paperwork, charge tickets, or insurance verification forms someone will need to update those forms with the new codes too.
Make sure each credentialed person in the office has the new ICD 10 certification-if the certifying body offers such a thing. Credentialed staff can include: medical practitioners, billers, coders, etc. As a certified coder through the AAPC, I can attest that AAPC does have a “re-credentialing requirement” for ICD 10. Each association is different-so have your ICD 10 facilitator check on this.
ICD 10 training should be conducted by every member of your staff. The best way is to set aside time for staff to train together. Offer incentives or a meal to entice staff to commit to the training. This new coding set is going to require more effort from everyone, so foster the team spirit now. It is important that all staff members are aware of the changes with ICD 10. Even your front desk receptionist should get some training. The receptionist may not code, but they are your first line of communication with the patients. Some of the new codes will require more information from the patient to get the correct code, and it may make some patients uncomfortable if asked specifics about their injury, or where they were when it occurred. If the patient airs the complaint to the receptionist, you want the front desk staff to be knowledgeable enough to explain that the doctor isn’t just nosey, but the new codes require this information. Furthermore, there may be times where additional contact is needed from the patient after the visit, to determine the correct code. If you have the front desk contact the patient to ask which arm got injured, or if anyone was around when they go hurt in their home, that front desk person needs to be armed with reasons to explain to the patient why this information is needed.
Resources need to be available for staff to use to locate ICD 10 codes. If your office uses electronic means for coding, purchase the ICD 10 module and have staff start familiarizing themselves with the new codes. Purchase at least one ICD 10 book, even if your office uses computer software for coding and have staff look up codes and familiarize themselves with the chapters most applicable to your specialty. If your coders use ICD 9 books currently-buy each of them ICD 10 books. Some health insurance websites have their policies available online with the new ICD 10 codes. Medicare has had their LCD’s and NCD’s available for quite some time with ICD 10. Look up the policies that apply to your practice and make sure staff knows the codes you will need to use. Many insurance companies, including Medicare are offering ICD 10 testing days. When your office feels they are ready for the transition, contact your clearinghouse and insurance payers to find out what is required to participate in the testing day. It’s better that you participate in a readiness test and figure out what isn’t working than to learn after ICD 10 is implemented and have to wait on reimbursement for your claims.
ICD 10 will be a big change for everyone working in the healthcare industry. There is talk of ICD 10 being postponed again, but it is quite unlikely. Even if an office hasn’t started the transition and training for ICD 10, it is still possible to be ready and compliant by October 1, 2015. Appoint and ICD 10 facilitator for your office. Make sure all credentialed staff will still be able to hold their credentials after ICD 10 is implemented. Ensure all your software and forms will be updated and correct for implementation. Lastly, train the whole office on ICD 10, in areas that their own work performance will be affected. CMS has a website dedicated to ICD 10 readiness. AAPC also has many resources to help professionals and office get ready for the change. As a business owner myself, I have been training and getting ready for ICD 10 for the last three years and I am very sympathetic to anyone needing to be prepared for this transition. It is work, but as those of us in healthcare know, healthcare is an always changing and growing industry.
What are some differences between ICD 9 and ICD 10? Currently we have approximately 14,000 ICD 9 CM codes, and so far ICD 10 CM has about 68,000 codes. The new coding system will be alphanumeric codes that are 3-7 digits long. Confusingly I’s and 1’s, O’s and 0’s, S’s and 5’s will be used in the new code set. Also, the many of the new codes will have laterality built into the code. This means coding for an arm fracture of the left arm will have a different code than the same fracture on the right arm. Pregnancy codes will have trimester built into the code, as well as an additional set of codes specifically for the week of pregnancy. Each specialty needs to research and see how their new codes will be used. It is highly recommended to have at least one person designated as the ICD 10 coding facilitator of the office. This person should ensure the office and staff are ready for the changes.
To determine what needs changing or upgrades, it is important to determine every place that a diagnosis code is located. The first place is your billing software. There are some software companies that are currently in business, but their products will not be able to make the ICD 10 transition. No one wants to believe that could be the case for the software in their own office, but you won’t know until you call and ask. This is the same scenario for your clearinghouse, or any other outside billing/coding vendor you may use. It is better to know now that you will have to get new software, then to find out on Oct 1, 2015 that you can’t bill out. Once you know your software will be ready for ICD 10 compliance, find out how the updates occur. Will someone need to run an update late on September 30, or will updates begin early and then there is an automatic switch over? Make sure all electronic software using codes will be able to handle the transition. If diagnosis codes are on any office paperwork, charge tickets, or insurance verification forms someone will need to update those forms with the new codes too.
Make sure each credentialed person in the office has the new ICD 10 certification-if the certifying body offers such a thing. Credentialed staff can include: medical practitioners, billers, coders, etc. As a certified coder through the AAPC, I can attest that AAPC does have a “re-credentialing requirement” for ICD 10. Each association is different-so have your ICD 10 facilitator check on this.
ICD 10 training should be conducted by every member of your staff. The best way is to set aside time for staff to train together. Offer incentives or a meal to entice staff to commit to the training. This new coding set is going to require more effort from everyone, so foster the team spirit now. It is important that all staff members are aware of the changes with ICD 10. Even your front desk receptionist should get some training. The receptionist may not code, but they are your first line of communication with the patients. Some of the new codes will require more information from the patient to get the correct code, and it may make some patients uncomfortable if asked specifics about their injury, or where they were when it occurred. If the patient airs the complaint to the receptionist, you want the front desk staff to be knowledgeable enough to explain that the doctor isn’t just nosey, but the new codes require this information. Furthermore, there may be times where additional contact is needed from the patient after the visit, to determine the correct code. If you have the front desk contact the patient to ask which arm got injured, or if anyone was around when they go hurt in their home, that front desk person needs to be armed with reasons to explain to the patient why this information is needed.
Resources need to be available for staff to use to locate ICD 10 codes. If your office uses electronic means for coding, purchase the ICD 10 module and have staff start familiarizing themselves with the new codes. Purchase at least one ICD 10 book, even if your office uses computer software for coding and have staff look up codes and familiarize themselves with the chapters most applicable to your specialty. If your coders use ICD 9 books currently-buy each of them ICD 10 books. Some health insurance websites have their policies available online with the new ICD 10 codes. Medicare has had their LCD’s and NCD’s available for quite some time with ICD 10. Look up the policies that apply to your practice and make sure staff knows the codes you will need to use. Many insurance companies, including Medicare are offering ICD 10 testing days. When your office feels they are ready for the transition, contact your clearinghouse and insurance payers to find out what is required to participate in the testing day. It’s better that you participate in a readiness test and figure out what isn’t working than to learn after ICD 10 is implemented and have to wait on reimbursement for your claims.
ICD 10 will be a big change for everyone working in the healthcare industry. There is talk of ICD 10 being postponed again, but it is quite unlikely. Even if an office hasn’t started the transition and training for ICD 10, it is still possible to be ready and compliant by October 1, 2015. Appoint and ICD 10 facilitator for your office. Make sure all credentialed staff will still be able to hold their credentials after ICD 10 is implemented. Ensure all your software and forms will be updated and correct for implementation. Lastly, train the whole office on ICD 10, in areas that their own work performance will be affected. CMS has a website dedicated to ICD 10 readiness. AAPC also has many resources to help professionals and office get ready for the change. As a business owner myself, I have been training and getting ready for ICD 10 for the last three years and I am very sympathetic to anyone needing to be prepared for this transition. It is work, but as those of us in healthcare know, healthcare is an always changing and growing industry.
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