It seems providers everywhere are asking the same question: How should we prepare for the ICD-10 implementation deadline? A good place to start is to identify every way you currently use ICD-9 codes, since all of those codes will need to be updated for ICD-10. Once you understand which areas of your practice ICD-10 will impact, you can focus on identifying the ICD-10 codes that will be most important for you and train your staff accordingly.
Here are some steps that can help you identify your relevant ICD-10 codes and guide your training efforts:
- Discover which ICD-9 codes your practice uses most often today. These are the ones that account for the majority of your claims and have a big impact on your revenue.
- Next, determine which ICD-9 codes are used for the claims that account for your highest revenue. Since these claims are responsible for your largest payments, it will be important to understand how the codes translate for ICD-10 so you continue to capture your revenue.
- Use a crosswalk tool, like the Centers for Medicare & Medicaid Services’ GEMs, to identify the applicable ICD-10 codes for your commonly used ICD-9 codes. ICD-10 codes provide greater specificity for diagnoses, so there could be several ICD-10 codes that correlate to one ICD-9 code. Focus your staff training around this list of possible ICD-10 codes.
- Conduct a chart assessment of claims that use your common ICD-9 codes. How much documentation did your clinical staff provide? Is it enough to assign an appropriate ICD-10 code? Coders will not be able to assign the right ICD-10 code unless the doctor or nurse provides sufficient detail when recording the patient’s condition. And, if the coder picks the wrong code due to a lack of documentation, your practice may not be adequately reimbursed. If your clinical staff is not providing enough detail now, you need to work with them to start doing so.
- Get coders and clinical staff together to discuss the information needed on the patient chart. Some EHR systems are adding fields and questions to their forms to prompt the clinical staff to provide these extra details for ICD-10, such as laterality or week of gestation. Other practices may find it helpful to develop a cheat sheet of common diagnoses and the level of detail coders need so providers can easily reference it in the exam room.
- Ask clinical staff to start documenting to this level of specificity now so it is second nature by the time ICD-10 is implemented. Many practices are evaluating dual coding for a percentage of their claims so these can be evaluated as a training exercise. Even if your practice management system does not support dual coding, you can dual code selected claims on paper and review periodically. Then when ICD-10 is required, you'll feel more confident about using the appropriate code(s).
It’s wise to do all this research and training now and check off a major step in your implementation plan. You will improve your coding productivity for the Oct. 1, 2014, deadline, and your office will be far better able to handle any payment issues.
The reality is that your claims denials will likely increase as payers change their reimbursement policies to incorporate ICD-10 codes next year, but you can reduce the risk by ensuring that your staff understands how clinical documentation and accurate coding will impact your reimbursement. Educating your clinical and billing staff well in advance of the ICD-10 deadline will enable you to address problem areas upfront and minimize payment delays.
Jackie Griffin is the director of client services at Gateway EDI – A TriZetto Company. She also serves as the company’s ICD-10 expert, leading efforts to educate customers and the industry about ICD-10 planning, issues and concerns.
This article is based on original reporting at ICD10Watch.