ICD-10: The Transition Is Coming…


While the ICD-10 transition has been pushed back to October 31, 2014, preparing for it should not be put off. Those affected by this transition should use this delay to their advantage in preparing for the impact to their practice both in how they treat their patients and in how their day-to-day operations are run and sustained financially.

Let’s review what ICD-10 is and where the United States fairs in relationship to the world. ICD-10 is an update and expansion of diagnosis codes used in the medical environment. It is expected that the coding system will go from approximately 14,000 codes to 70,000 codes in the outpatient setting and 3,400 codes to 72,000 codes for inpatient when ICD-10 goes in to effect[1]. Currently ICD-10 is used throughout the world for diagnosing and treatment. The United States is one of the last countries still utilizing the ICD-9 coding system. As a matter of fact, the Beta draft of ICD-11 was made available online in May 2012 for initial consultation and commenting.

ICD-10 will happen, and preparing now will help mitigate disruptions in treatment, documentation practices, claims submission and ultimately payer reimbursement. Are you prepared to go without steady income for up to 6 months once the transition occurs? According to The American Health Information Management Association, providers may experience up to 6 months of delays in reimbursement [2]. Delay of payment should be expected, and physicians should prepare now to put enough money in reserves to cover their expenses during this transition. Remember, the payers will be on the same learning curve and will be processing claims according to the new guidelines much slower than the current system allows.

Being prepared financially is only one aspect to consider. Documentation and coding will be at the heart of how fast claims are submitted and paid. Physicians should expect a significant increase in claim denials through this transition. Providers can mitigate the impact of this when they begin the process of analyzing their current level of documentation and start to adopt all of the required elements of ICD-10 now. More specificity is required, and the criteria for coding is more detailed. There are codes for where and how illnesses and injuries occurred. The codes will tell the complete story, and the documentation must support the codes. If it doesn’t the result is simple, you won’t get paid!

Staff education and training cannot be emphasized enough prior to this transition. It will be crucial for front desk staff to know what information is critical to collect prior to and at the first patient visit. There will also be new information gathering for all existing patients as their documentation and coding will also move to ICD-10. Billing and coding staff will bear the brunt of most of the training during this process. The required elements and sheer increase in codes will surely require ongoing training. When physicians decide that training their own staff is too much to oversee and pay for they will undoubtably seek the advice of experts and outside agencies, but at a much higher rate than they would pay today.

Business processes will need a complete overhaul to ensure the proper and full receipt of patient information necessary for physician documentation, coding and claims submission. Intake, insurance verification, financial and prior authorization forms should reflect the necessary elements. Patients will also need to be educated about the transition and told to expect increased claim denials. They should also be informed of the process you use to handle these rejections and the circumstances under which you will hold the patient responsible for the balance.

Finally, IT systems will be affected by way of software changes and updates. Have you really researched your current or potential EMR software and inquired into their preparation for the transition? Most physicians are being sold on EMR systems claiming to do the coding for them. Beware of this type of talk. No system can analyze what is done in person and cannot replace personnel. Doing so may put you at risk for audits and scrutiny. An entire article could be devoted to this subject, but for now just be objective and analyze sales tactics that sound too good to be true.

All areas of your practice will be affected by the ICD-10 transition, and physicians should take advantage of all the time they have to prepare, ensuring that the impact is not catastrophic to their practices.

[2] http://www.who.int/classifications/icd/revision/en/