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ICD-10. Are you ready?

October 21, 2013

It’s everywhere.  ICD-10.  Are you ready? Are you ready for the transition?  So apparently we have moved from “being aware” to the new “are you ready?”

And for many, the response may be well, of course.  Because of the “awareness” campaign, we contacted on EMR and Practice Management vendors and they have assured us that “they will handle everything”.

Now, most of us think we have an idea of what  “everything” should be….of course the EMR needs to code into ICD-10 and the claim forms, whether the 837i ( UB-04) or the  (837p)CMS 1500 should be able to handle ICD-10 for billing.  Isn’t that all there is?

And that is the million dollar question.  To which the answer is no.   A close look at the potential uses of ICD-9-CM currently in place may amaze you.   Lab requisitions all require diagnostic coding, and many use the exact code, as compared to a diagnostic statement.  If you still handle a paper encounter form (aka as fee slip, superbill, charge ticket etc.) many diagnostic codes are preprinted on these documents.  How about your pre-certification or referral processes?  And these are simply a few areas that may be impacted by a transition to ICD-10.

Know to that much of what ICD-10 is for data collection.  Falling back on the original London Bill of Mortality, where in the 1600’s diseases were classified for children under the age of 5 who were dying of all sorts of diseases.  ICD was created from that original premise.  ICD-10 simply takes us into the 21st century.

So what’s the next step?

The transition to ICD-10 requires a tremendous effort on the part of the whole organization.  You will want to start with a project plan addressing where you want to be on October 1st, 2014, the date that you will need to start submitting ICD-10 on your claim forms.

With any project plan comes a project team – and in this case, multiple teams.  You will want a high level team of strategic leaders, and the teams that will need to address education training and communication.  Within each department there should be a team that will work with other project teams.  And don’t forget senior management, you will want their full support throughout the process.

What’s next is the “gap analysis”.  Just where do all those departments use diagnostic coding?  And will it require a change by October 1, 2014?

Back to the Vendors, who will take care of everything?  Just when do they plan on making that happen?  Will you have new systems up and running well before the deadline?  Will you be able to practice and train prior to go live?  You will need to have contingency plans in place if that new upgrade doesn’t go as planned.

Once the gap analysis is complete, it’s time to build your business plan or the work plan….how will each one of those departments get to October 1 unscathed?  Creating the business plan will make sure that every department is heard, and accounted for within the plan.  You can then group similar tasks so that everyone has the benefit of the group process.

How long will this all take?  We anticipate that you should allow up to 3 months just for the gap analysis and then that business plan process will depend upon what you have uncovered and the extent of the plans for each department.

And remember, this is just leading up to the actual training.  Teaching physicians to document and coders to code will be time consuming.  Coders need to have a good back ground in A+P and medical terminology; it’s no longer selecting one code from a list.  Fortunately many of the ICD-9-CM coding conventions and guidelines still hold true.

But you can’t train too early or all will be forgotten, and you will want a period of learning and practice.  But onsite trainers are going to go for a premium so you need to reserve your trainer and the dates now.

To help out with this process, you can take the PMG ICD-10 Readiness Assessment….we can then see where you stand and what needs to get done.  Good luck as we launch into the future.

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