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3 Key Things to Know About ICD-10

If you work in the healthcare field, you’ve known for a while that ICD-10 is coming.
Don’t look now, but it’s here!

Much of the developed world has already adopted the 10th version of the International Classification of Diseases Clinical Modification coding system, and after a series of delays, the U.S.implemented the revised code sets on Oct. 1, 2015. For years ICD-9 has been plagued by a lack of specifics, such as the fact that similar injuries on opposite limbs have the same code. ICD-10 will offer a greater degree of specific information in areas such as right versus left, initial or subsequent encounters and other relevant clinical information by expanding the number of digits in the coding from three to five in ICD-9 to five to seven in ICD-10. Adding two digits increases the number of alphanumeric code combinations medical professionals can use to categorize and diagnose medical conditions, providing a more detailed account of a patient’s history and present condition.

That’s the good news. The bad news is that a more detailed coding system will require medical practices to record and track more patient data and information. As part of the effort to provide more information, ICD-10 will have approximately 68,000 available codes, with flexibility for adding new ones, compared to ICD-9’s 13,000.

If you run a medical practice, you and your staff have probably already spent months preparing for the ICD-10 transition. Here are a few key things to remember about ICD-10, and how it will affect your office.

Anticipate delays in payment
Insurance providers will be forced to cope with many of the same transition difficulties as your office. They’re training their staff and updating their systems. As such, expect processing delays for reimbursement payments, which could linger for several months.

“A lot of the problems associated with revenue cycle management will rest with payers needing to process claims,” says Michael F. Barron, MHSA, vice president of health care operations at The Shealy Group. “There is concern throughout the medical industry that players are going to have some difficulty adapting to the seven-digit coding system, which could affect timeliness of reimbursement.”

In anticipation of possible payment delays, it’s a good idea to arrange for access to alternative sources of operating funds for the remainder of 2015.

“Expenses and payroll don’t stop just because there are delays in reimbursement, so you need to plan for that contingency, whether it means seeking a line of credit, or ensuring that you have significant savings to cover yourself and your practice for 30 to 90 days,” Barron says. “If your payers don’t have any issues with timely payments, you don’t need to tap into any of those funding resources, but it’s wise to have the contingency plan in place.”

Scale back scheduling
As a first point of patient contact, primary care physicians (PCPs) see just about every head-to-toe malady and illness in their practices. As a result, they must use a wider range of ICD codes when treating patients. Unfortunately, that means PCPs stand to face the biggest adjustment during the ICD-10 implementation.

“If you’re a dermatologist, you see a less broad variety of symptoms and conditions, which means fewer possible codes,” Barron says. “Primary care physicians see symptoms across the board and will have to account for all of them in their coding.”

To aid in the adjustment period, Barron recommends primary care practices scale back their scheduling for the first few weeks of October.

“Don’t schedule patients wall-to-wall for the first part of October,” he says. “If you’re normally scheduling 70 patients a day, consider bumping it down to 35 for the short term. It will help your practice cope with the adjustment while still allowing claims to be submitted in an efficient manner.”

Work with your vendors
Whether you run a paperless office or rely on traditional paper-based records, you need to work closely with your practice management system vendors to ensure the transition is as smooth as possible. This collaboration will be especially important in the weeks and months immediately following the transition, when practices will be operating under both the ICD-9 and ICD-10 code sets.

“On Sept. 30, ICD-9 theoretically ended, and the next day, ICD-10 began,” Barron says. “The switch of code sets is immediate, but the claims system doesn’t work that fast. You’ll still have active medical claims from September and before, even once the calendar shifts to October and ICD-10 starts. So you’ll still have to work in both worlds until the pre-Oct. 1 accounts receivables are paid down to zero.”

The overlap makes a smooth changeover to ICD-10 even more complicated, and practices should work closely with their electronic health records or practice management system vendors. Your vendor will have its own workflow plan in place for the transition, so make sure that you and your staff understands your vendor’s plan for working in both code sets.

“Understand the electronic system in place if you work with an EHR, and make sure you have updated documentation and workflow in a paper environment – updated super bills and encounter forms,” Barron says. “This is a monumental implementation, and every bit of preparation is going to help you and your practice succeed in this transition.”

For more information on ICD-10 and how it affects your practice, contact Mike at mbarron@shealygroup.com.

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