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The Transition to ICD-10 is a Year Away. Will Your Practice be Ready?

The transition to ICD-10 is a year away. Is your practice ready?(November 22, 2013):  On October 1, 2014, the health care industry transitioned from ICD-9 to ICD-10 codes for diagnoses and hospital inpatient procedures. This means everyone covered by HIPAA must use ICD-10 codes for health care services provided after October 1, 2014.  ICD-10 allows more than 14,400 different codes and permits the tracking of many new diagnoses. The codes can be expanded to over 16,000 codes by using optional sub-classifications. The following is a list of topics a physician practice needs to address now to prepare your .

I.  When the Transition to ICD-10 Implementation Occurs, Will You be Able to Submit Claims?

If you use an electronic system for any of your payers, you need to contact the software vendor (if necessary) and ensure that your system can integrate ICD-10’s expanded codes. If your billing system has not been upgraded to Version 5010 for the current version of HIPAA claims standard you will not be able to submit claims. It is imperative that you verify whether your software system has been upgraded.  This step should be accomplished NOW.

II.  Will You be Able to Complete Medical Records?

If you utilize electronic health records (EHR), you need to verify that it is properly capturing ICD-10 codes. Look at how you enter ICD-9 codes (e.g., do you type them in or select from a drop down menu) and talk to your software vendor about your system’s ability to accurately implement ICD-10’s expanded code sets.

III.  Coding Your Claims Under ICD-10:

If you currently code by look up in ICD-9 books, we recommend that you purchase ICD-10 code books in early 2014. As you code services under ICD-9, try and code the same records using ICD-10’s expanded codes. Get familiar with the new ICD-10 codes you will likely be using on a daily basis.  Also, you may want to explore ICD-10 training options and determine if formal training is necessary.

IV.  Where Do You Use ICD-9 Codes? Have You Reviewed all of Your Forms?

Keep a log of everywhere you see and use an ICD-9 code as you do your job. If the code is on paper, you will need new forms (e.g., patient encounter form, superbill). If you see the code on your computer, check with your EHR or practice management system vendor to see when your system will be ready for ICD-10 codes.

V.  Are There Ways to Make Coding More Efficient?

For example, develop a list of your most commonly used ICD-9 codes and become familiar with the ICD-10 codes you will use in the future for the same case. Also, think about ways to make sure the new coding does not delay payments. Look at your most common non-visit services—do any sometimes trigger reviews or denials related to medical necessity? It is important to understand how to code these services correctly before the mandatory date of ICD-10 implementation arrives.

VI.  Final Remarks:

There’s no doubt about it, physician practices transitioning over to ICD-10 are likely to experience significant coding and billing delays when the change occurs.  In all likelihood, this will adversely impact your cash flow.  Are you prepared for these delays?  Ultimately, the best way to transition to ICD-10 is to prepare for this monumental change now, not a year from now.  Should you have questions, please feel free to call me.

Healthcare LawyerMichael Troy is a Partner at Liles Parker, Attorneys & Counselors at Law.  Michael represents health care providers around the country in audits by ZPICs and other CMS contractors.  For a free consultation, please give us a call at: 1 (800) 475-1906.


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