ICD-10: Getting Ready When You’d Rather Ignore It

ICD-10 Is Coming This Year

Many physician practices have avoided getting ready for ICD-10 (International Classification of Diseases, 10th edition) for a variety of reasons:

• Some hope that the Centers for Medicare & Medicaid Services (CMS) will postpone implementation yet again and don’t want to waste time and money preparing for something that won’t happen.

• Small groups have limited staff and budget for training and think that learning ICD-10 closer to the due date will be more effective than learning it too early.

• One physician worried that if she paid to send someone on her staff to learn ICD-10, the staff member could demand a higher salary or find a new job.

• Some groups feel they’ve invested enough time and energy into reporting on quality measures in CMS’s Physician Quality Reporting System, installing an electronic health record (EHR), and meeting the requirements for meaningful use.

• Physicians and managers with an optimistic outlook hope that their practice management system or EHR will provide an easy, seamless translation between ICD-9 and ICD-10 diagnosis codes.

But the clock is ticking. Implementation of the new code set is less than a year away. CMS has repeatedly stated that despite reports that small practices and systems may not be ready, there will not be another delay in the implementation date. Failure to prepare for ICD-10 could mean a delay in claims processing or denials. And delays and denials translate into empty bank accounts.

Resistance is futile! Now that the calendar reads 2014, it’s time for practices of all sizes to prepare for ICD-10. What practical, concrete steps should a medical practice take?

One important point: There are 2 ICD-10 code sets. The first, ICD-10-CM (International Classification of Diseases, Clinical Modification), is diagnosis coding. All healthcare providers will use ICD-10 for diagnosis coding. The second is ICD-10-PCS (International Classification of Diseases, Procedure Coding System), which is used only by facilities to report inpatient procedures. Physician practices will continue to use CPT (Current Procedural Terminology) to report what service was performed.

Actions That Will Help You Be Ready

Remove Inactive Problems From Problem Lists in Your EHR

Physicians often tell me that they spend considerable clinical time “cleaning up” the problem list. There can be incorrect or resolved problems on a problem list if all ICD-9 codes that have ever been assigned are imported into the problem list (not a recommended practice when transitioning to an electronic record) or when preloading of the patient’s conditions was performed by someone without a strong clinical background. An accurate problem list will help the clinician to select accurate ICD-10 codes more quickly.

Review Your Use of Unspecified Codes

Every coder will tell you to code diagnoses to the highest degree of specificity. Using unspecified ICD-9 codes will make the transition to ICD-10 more difficult. However, some conditions are accurately described with an unspecified code in both ICD-9 and ICD-10. For example, acquired hypothyroidism in ICD-9 is code 244.9 and is the correct code. There are more specific codes for postsurgical, postablative, iodine, or other iatrogenic types of hypothyroidism. This translates exactly in ICD-10 to E03.9, hypothyroidism, unspecified. It is a code that may be used on a claim form and accurately describes the condition.

Other unspecified codes, however, will be problematic. The code 174.9 is the ICD-9 code for malignant neoplasm of the breast (female) unspecified. There are 8 more specific ICD-9 codes that identify the exact location of the malignancy in the female breast. In this case, using the more specific, known location of the malignancy would allow for accurate ICD-10 coding, while the nonspecific code does not. There are over 50 ICD-10 codes in category C50.- that are defined by laterality, sex of the patient, and more exact location.

How can you determine if your unspecified codes need to be more specific? Try to code them in ICD-10, using a search function and from the clinical documentation. Make a list of the additional clinical documentation that is needed and give that information to physicians. Develop a list of these and post them around the office.

Get a Demo From Your EHR or Practice Management System

Take a test drive in your EHR or practice management system. Compile a list of your 25 most frequently used diagnosis codes. In your test system, try to search for those codes in your EHR and assign them as a reason for the visit or an indication for a test.

Most systems will have a mapping or translation program. One-to-one mapping is mathematically impossible when moving from 14,000 codes to 69,000 codes. It is imperative that groups check the accuracy of the mapping program by looking at complete descriptions of the ICD-10 codes (not shortened versions) either in a book or using an online program distinct from your EHR system. The goal here is to test the accuracy of the mappings before relying on them for claims submission.

Important Steps to Make the Transition More Painless

Get a Commitment From Your Vendor About Updating

Both your practice management and EHR systems will need to be updated to the latest version. When will your vendor do that? (Let’s hope it isn’t the last week in September.) If you are not on the most up-to-date version of your software, update now. It is sometimes more difficult to leapfrog software versions.

Buy an ICD-10 Book

It’s true: The ICD-10 book states that it is a “draft version.” But the World Health Organization has frozen both the ICD-9 and ICD-10 code sets, except for urgent additions. The best way to start preparing is to buy the book.

Who should pay attention to the book? Let’s start with the coding and billing staff. Coders should review the general guidelines at the start of the book. As in ICD-9, there is a set of principles that coders will follow in selecting codes. The first pages describe conventions and punctuation and explain the symbols used in the book. Next, the coder should read the notes at the start of each chapter. These notes are important for selecting and sequencing.

Train Your Coding and Billing Staff

For a single-specialty practice, select specialty-specific training. For multispecialty practices, select a more comprehensive ICD-10 training program that covers general principles and all chapters in the ICD-10 book. There are 2- to 5-day courses available.

The time is past for “Why We Are Converting to ICD-10” courses and “Introduction to ICD-10.” Coders should attend a course at which either a book or access to an electronic version of ICD-10 is available. The agenda must include coding sample cases. When looking for a course, remember that physician practices do not need to learn procedural coding, or ICD-10-PCS. That is for facility reporting of inpatient procedures only.

Decide How and When to Educate Physicians

Most physicians won’t want ICD-10 training in early 2014. They may not want it in the summer of 2014, but they will certainly need it then! Keep vacation schedules in mind and consider if spring training (no, not traveling to see your favorite team) will be more effective with review in late summer and September. Physicians won’t want to learn about ICD-10 coding for diseases and systems that they don’t treat. Specialty-specific training makes the most sense for physicians and will keep them engaged.

Purchasing on-line access allows clinical staff to complete this training at their convenience. The training times vary according to the physician specialty. There are several hours to 8-hour specialty courses. A single system, such as the respiratory system, may be covered in a 2-hour program, while courses aimed at specific specialties that treat a wider variety of conditions will be longer.

Primary care, general surgery, orthopedics, and the emergency department are examples of specialties that will require more extensive and longer training. Identify the online resource, set an expectation about when each clinician will complete the course, and then schedule a group meeting to review the information and answer questions.

There are advantages to face-to-face group training in place of online learning. Although it is more difficult to schedule, the clinicians will benefit by hearing one another’s questions, being able to practice coding common codes, and solving problems as they occur.

No more delays. Medical practices need to budget and plan training for ICD-10 for staff and clinicians. Practices need to update their software and get a commitment from their vendors about future updates required for ICD-10. Take a test drive around mapping and translation programs. And buy an ICD-10 book today!

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