5 Steps You Can Start Taking Today to Prepare for ICD-10

January 22nd, 2014
ICD-10, Preparation, Transition

So, you’ve heard: ICD-10 is coming—dun, dun, dun. Just kidding about that last part. While there are several preparatory tasks we really think you should get started on now (if you haven’t already), ICD-10—contrary to what some people believe—is nothing to be afraid of. But it is something to take seriously. So what can you do to prepare? Well, here are our top five next steps and when to take them:

1. Accept the facts (today)

Sure, you could go through all five stages of Kübler-Ross’s mourning process before finally landing on acceptance, but we suggest you make it a quick trip. Beginning on October 1, 2015, you will only receive reimbursement for claims you submit with ICD-10 diagnosis codes. The sooner you accept this fact, the better. Use this as motivation—you have a deadline. And I don’t know about you, but I sure work better with a firm end date.

2. Elect a lead—or a team (this week)

There’s someone in your office who excels at this sort of thing—and that may or may not be you. This person is a born project manager with a knack for research and a love of all things organizational. This is your ICD-10 implementation lead, so go buy him or her a coffee—or maybe a personal espresso machine.

Depending on the size of your office, you may need to elect an ICD-10 team, but at the very least, every practice needs one head ICD-10 honcho who is responsible for staying up to date on the latest and greatest in the world of diagnosis codes—and translating that information into comprehensible tidbits and action items for everyone else. Looking for a place to start? Assign your lead the first task of compiling a list of great ICD-10 resources like CMS, APTA, and AdvancedMD. (Bonus points if he or she puts WebPT at the top of that list.)

3. Create a plan (next week)

Now that you’ve got your lead and a host of really helpful resources, it’s time to start laying out a plan—that is, what you want to accomplish by when. Just like you do for your patients, we recommend using the SMART goal method—setting learning objectives that are specific, measurable, attainable, realistic, and timely. You can start by taking a look at your current diagnosis code processes and determining how these will need to change in the coming months to accommodate the new codes—an ICD-10 compliance audit, if you will.

And it’s not just about your internal processes. If you outsource your billing or use an electronic medical record for documentation, make sure that your vendors are ready to handle the new codes as well. If they aren’t prepared—or don’t seem confident in their ability to transition—you may need to start looking for new partners. (In case you’re wondering, WebPT will be ready to handle the new codes well before the October go-live date, and we’ve made it our mission to provide you with a wealth of free educational resources so you’ll be prepared, too.)

You could spend every waking moment between now and October 1, 2015, preparing, and you still might hit a snag or seven when it’s time to submit—not on your end, but on your payers’. That’s why experts recommend having at least six months’ worth of cash revenue available to ensure you can weather the potential storm of delayed reimbursements. If you can’t save this much in advance, Heidi Jannenga suggests “having a plan B, such as a line of credit or supplemental income to ensure your clinic’s viability during the transition.” She cautions not to “wait until after October 1 because you’ll have to vie for financing and pay higher interest rates.”

4. Start training (next month)

You’ve got your lead, and you’ve got your plan. Now, it’s time to begin training—and that means including everyone in your office, whether it seems immediately beneficial or not. As an industry (and as a nation), we’ve been using ICD-9 codes for the past 30 years, and it’s going to take a while to unlearn what we’ve learned, so start sooner rather than later—especially because there are five times as many ICD-10 codes as there are ICD-9 codes. Whereas ICD-9 codes are mostly numeric and have three to five digits, ICD-10 codes are alphanumeric and contain three to seven characters. While that may not sound like a big difference, it is.

As you begin training, pay attention to what your trainees need in order to be successful. Are they audio, visual, or hands-on learners? Knowing this will help you and your lead train effectively. Look back at your list of resources; there is a lot of great information out there in a variety of formats. And as the year wraps up, even more resources will begin to surface.

5. Test, test, test, and test some more (next year)

  1. AdvancedMD succinctly summed up this stage in three sentences:
  2. “Test that your office staff can competently work with the redesigned workflow [and new codes].
  3. “Test each redesigned process.
  4. “Test integration with partners.”

Beginning on the first of the New Year, your clinic should be almost (you still have your patients after all) singularly focused on ensuring that come October 1, 2015, you’ve got ICD-10 on lock. That is, you and your staff know the ins and outs of the new codes and how to properly use them, as do your partners (billing, documentation, etc.). So start testing and keep testing until you are 150% confident.

Interested in seeing a few other suggested timelines? Here’s one from AdvancedMD and one for small- to medium-sized practices from CMS. Now, it’s important to note that both timelines suggest that ICD-10 preparation should have begun months ago, but not to fret. There’s still plenty you can accomplish in the time you have left. You’ll just have to step on the gas, pick up the pace, give it some gusto—you get the idea.

Have you started preparing? If so, what steps have you found most useful? Tell us your thoughts in the comments below.


ICD-9 vs. ICD-10: An Example

January 17th, 2014
ICD-10, ICD-10 Example, ICD-9

We’ve talked plenty about ICD-9 and ICD-10, including the differences and improvements. The best way to truly see how much better and more precise ICD-10 diagnosis codes are than ICD-9 is through some examples.

ICD-9-CM ICD-10-CM
Description Mechanical complication of other vascular device, implant, and graft Mechanical complication of other vascular grafts
Number of codes 1 code (996.1) 49 codes, including:
T82.311A — Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.312A — Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.329A — Displacement of unspecified vascular grafts, initial encounter
T82.330A — Leakage of aortic (bifurcation) graft (replacement), initial encounter
T82.331A — Leakage of carotid arterial graft (bypass), initial encounter
T82.332A — Leakage of femoral arterial graft (bypass), initial encounter
T82.524A — Displacement of infusion catheter, initial encounter
T82.525A — Displacement of umbrella device, initial encounter
Description Pressure ulcer Pressure ulcer
Number of codes 9 location codes (707.00 — 707.09); show broad location, but not stage 150 codes that show more specific location and stage, including:
L89.131 — Pressure ulcer of right lower back, stage 1
L89.132 — Pressure ulcer of right lower back, stage 2
L89.133 — Pressure ulcer of right lower back, stage 3
L89.134 — Pressure ulcer of right lower back, stage 4
L89.139 — Pressure ulcer of right lower back, unspecified stage
Page 3L89.141 — Pressure ulcer of left lower back, stage 1
L89.142 — Pressure ulcer of left lower back, stage 2
L89.143 — Pressure ulcer of left lower back, stage 3
L89.144 — Pressure ulcer of left lower back, stage 4
L89.149 — Pressure ulcer of left lower back, unspecified stage
L89.151 — Pressure ulcer of sacral region, stage 1
L89.152 — Pressure ulcer of sacral region, stage 2
Description Angioplasty Angioplasty
Number of codes 1 code (39.50) 854 codes: Specifying body part, approach, and device, including:
047K04Z — Dilation of right femoral artery with drug-eluting intraluminal device, open approach
047K0DZ — Dilation of right femoral artery with intraluminal device, open approach
047K0ZZ — Dilation of right femoral artery, open approach
047K34Z — Dilation of right femoral artery with drug-eluting intraluminal device, percutaneous approach
047K3DZ — Dilation of right femoral artery with intraluminal device, percutaneous approach
047K4ZZ — Dilation of Right Femoral Artery, Percutaneous Endoscopic Approach

ICD-10 offers a lot more codes and much more specificity, right? That’ll certainly help documentation accuracy.


There’s a New CMS-1500 Claim Form Coming to a Practice Near You

January 9th, 2014
CMS-1500, ICD-10

The Centers for Medicare and Medicaid (CMS) recently revised the CMS-1500 form in preparation for the new ICD-10 diagnosis codes. On the new form (version 2/12), providers will be able to include up to 12 possible codes (this is an increase from four possible codes on version 8/05) and note whether they’re using ICD-9 or ICD-10. As a reminder, in order to receive reimbursement, providers must continue to use ICD-9 codes through September 30, 2015, and switch to ICD-10 beginning October 1, 2015.

Medicare will begin accepting the new form on January 6, 2014, and will stop accepting the old form on March 31, 2014. Note: Medicare will only accept CMS-1500 claim forms from providers who are exempt from electronic submission. CMS recommends that providers who use service vendors check with those vendors to determine when they’ll switch to the new form.

For more ICD-10 information, visit CMS’s website and check out this blog post.


ICD-10 and Improved Interoperability in Healthcare

December 16th, 2013
ICD-10, Interoperability

By now, almost everyone in the healthcare industry has heard about ICD-10, the diagnosis coding system that will go into effect October 1, 2015. There’s a lot of information out there regarding this so-called upgrade from ICD-9—some positive, some not-so-positive. According to major healthcare organizations like the Centers for Medicare & Medicaid Services (CMS) and the World Health Organization (WHO), one of the main advantages of making the jump to ICD-10 is that it will significantly improve interoperability. The healthcare industry as a whole, however, is not completely sold on the switch. Some argue that it will not solve interoperability issues, while others suggest that interoperability isn’t even the objective of ICD-10.

The actual impact of the change remains to be seen, but at this point in the game, one thing is clear: the task of improving interoperability rests predominantly with the people directly affected by the transition, including clinicians, billers, and administrators. Curious about the connection between ICD-10 and interoperability? Read on to learn more about the switch and how it could alter the healthcare landscape.

Interoperability in a Nutshell

So, what exactly is interoperability? At the most basic level, interoperability is about information exchange. It occurs when diverse systems and organizations work together for an overarching purpose. In a healthcare context, this means successful, seamless data transmission across all healthcare platforms—a goal that requires both effective communication and adequate technology.

The Role of ICD-10

How would ICD-10 aid in the quest for complete interoperability? Well, for one, ICD-10 code sets are super specific, which means the data they produce will be really specific, too. This system also allows for simplified coding of information, making it easier to share than the more complex code sets of yore. Still, for true interoperability to occur, all of the different systems must be able to “talk” to one another—something that currently isn’t happening on a consistent basis across the healthcare spectrum. Electronic patient record systems are growing increasingly prevalent, but—as Forbes contributor David Shaywitz points out in this article—there are a lot of different electronic medical record systems out there, and they’re not all totally compatible with one another. And in this day and age, it would be nearly impossible to achieve constant interconnectivity and communication across all healthcare providers without across-the-board implementation of secure, portable, cloud-based EMR systems.

It’s Up to You

Positive change won’t happen on its own; to achieve interoperability in the healthcare field, all hands must be on deck. Of course, as with any major transition, there are a lot of naysayers out there—and some of them have valid objections.

In a Healthcare IT News post titled “Will ICD-10 Solve Interoperability Problems?,” author John Lynn makes a fairly strong case against the new coding system improving interoperability, writing, “All we have to do is look at the current ICD-9 diagnosing patterns…often a doctor gets stuck searching for the right ICD-9 code. Right or wrong, they end up picking a code that may not be exactly the right code for what they’ve seen. Maybe they choose NOS (Not Otherwise Specified) instead of the specific diagnosis that would be more appropriate. Add in the complexity of diagnosis requirements for getting the most out of your insurance billing and I don’t think anyone would disagree with the assertion that ICD-9 code entry is far from accurate.” In this article, Lynn also questions how healthcare professionals will possibly be able to master a complex set of ICD-10 codes when they are not even correctly coding in ICD-9.

In the article “Chasing the Tail of Interoperability,” author Gary Palgon urges his readers to recognize that interoperability requires more than just “connectivity”—it requires communication. “Organizations seldom encounter ongoing challenges with connectivity, yet the language—or semantics—used across different disciplines changes frequently,” he writes. Thus, all healthcare professionals must take responsibility for their own data by making sure everyone is on the same page and speaking the same language—at least from a technological standpoint.

Sure, there are a lot of challenges associated with implementing ICD-10, and challenges always breed concerns. But at the end of the day, there’s no sense in complaining about the change. It is going to happen; you can’t control that. What you can control, however, is your attitude and your clinic’s preparedness. Start getting ready now. That way, when the change happens, you’ll not only be less stressed, but you’ll also know that you’re actively helping the US healthcare industry progress toward the ideal of total interoperability.


Sample the ICD-10-CM Codes

December 12th, 2013
Codes, ICD-10

The CDC has released a series of downloads for the 2014 update of the ICD-10-CM (diagnosis codes). Each download features an addenda file that details the latest content changes for the 2014 release, and this year they’ve made PDF and XML file formats available. Click here to access the list of downloads.

A couple of things to note:

  1. Some downloads are in a compressed zip format, which is a file type where many files are compressed together into one download. If you right-click the file and select “extract,” you can uncompress all the downloads and choose where all the individual files will save to your computer.
  2. Although this ICD-10-CM release is available for viewing, the codes in ICD-10-CM are not currently valid for use yet, because the mandatory implementation date isn’t until October 1, 2015.

The National Center for Health Statistics (NCHS), under authorization from the World Health Organization, anticipates further updates to ICD-10-CM prior to implementation. Thus, anything you download now is bound to change in some form before October 2015.


ICD-10 Lessons from Those Who Went Before: Australia and Canada

December 10th, 2013
ICD-10, Transition

On October 1, 2015, ICD-10 will become mandatory in the United States. But we aren’t the first to make the transition—not by a long shot. In 1998, Australia adopted ICD-10, and in 2001, Canada did as well. So although the US appears to be a little behind the times, it might be for the best. After all, there are plenty of things we can learn from those that went before. Just ask Carl Natale of ICD-10 Watch. He wrote a few articles on the topic, and here, we’ll summarize his main points:

Australia

According to Natale—who cited source Debbie Abbott, the ICD-10 Implementation Officer for Queensland Health—Australians love ICD-10. However, although Australia runs on a similar healthcare system (citizens can choose to buy their own insurance or participate in government run programs), there are several distinct differences. The first is that Australians started out only using ICD-10 for inpatient coding, and the second is that their hospitals operate on a single diagnosis-related group (DRG), which is conducive to ICD-10. Despite these differences, there are still several key learnings we can take away from our friends Down Under. After all, their coders were back to their previous productivity rates within three month of implementation. Here’s why:

  • Assessment began early—consultants helped identify the processes clinicians were using with ICD-9 to determine “who needed to know what” and when.
  • Training began early—18 months before implementation.
  • Testing began early—early enough to identify the areas where more education was necessary and where workflows needed alteration.

Are you seeing a pattern here? I am: start early. Assess, train, and test—early. The more we can understand upfront, the better prepared we’ll be to make the transition. But that doesn’t mean we can iron out all the kinks ahead of time. And according to the Australians, “it’s expensive,” which is all the more reason to consider a few more tips from another country that went before.

Canada

Whereas the Australians had an easy transition, the Canadians did not. But they did do a great job of learning from their mistakes and passing along that wisdom. Natale referenced Gillian Price, Project Director Canada at QuadraMed, in an article where he cited several lessons the US can—and should—learn from our neighbors to the North. Here are four:

  1. Take control of your own learning: CMS has some great resources, but don’t leave it up to them to hand-feed you the information you need. Do your research. Teach yourself and share your knowledge.
  2. Get everyone involved: It’s not just your coders who should understand the differences; everyone in your office should know the ins and outs of ICD-10 and how the transition is going to impact your entire practice.
  3. Plan for the unexpected: Save. Save. Save. Make sure that you have enough funds available—experts recommend at least six months’ worth—to keep your clinic afloat in the face of potential loss of revenue.
  4. Collaborate: According to Natale, “Price is very proud of Canada’s very collaborative culture. She says it was a key part of learning from mistakes and making ICD-10 transitions smoother.” So let’s work together—and make the best of it.

There you have it: a handful of helpful takeaways from Australia and Canada that we can use to make the US transition that much easier. Want more details? Here are Natale’s full articles about Australia and Canada.


Resistance is Pointless: Here’s Why You Should Embrace ICD-10

December 6th, 2013
ICD-10, Transition

The thought of transitioning to ICD-10 and its 68,000 diagnosis codes might have you shaking in your boots. So, you might also be doing anything in your power to deny the inevitable—possibly to the point of eschewing any of the noted benefits of ICD-10. But before you pooh-pooh 10 and say 9 is just fine, hear me—and CMS—out. Look at all these drawbacks of ICD-9:

  • It is 34 years old. (People still smoked in medical facilities 34 years ago. Not a good sign.)
  • It doesn’t provide the necessary detail for patients’ medical conditions or the procedures and services performed today.
  • It uses antiquated and obsolete terminology. (Let’s leave the old-hat for the moths.)
  • It uses outdated codes that produce incorrect and limited data. (Oh dear, like auditors need any more excuses.)
  • It is inconsistent with current medical practice because it cannot accurately describe 21st century diagnoses and inpatient procedures of care.

So, ICD-9 is nowhere near fine. Now that we’ve acknowledged the severe flaws of our oldie-but-not-goodie system, let’s consider—thanks to a list from CMS—what ICD-10 will bring to the table:

  • Greater specificity of clinical information, which will result in:

    • Improved ability to measure services and conduct public health surveillance
    • Increased insight for refining grouping and reimbursement methodologies
    • Decreased need to include supporting documentation with claims
  • Updated classification of diseases and medical terminology
  • Codes that allow for comparison of mortality and morbidity data
  • Better data for:

    • Measuring patient care
    • Conducting research
    • Designing payment systems
    • Processing claims
    • Making clinical decisions
    • Tracking public health
    • Identifying fraud and abuse

And with that, I’d say ICD-10 is by and large better than ICD-9. Sure, it’ll be quite the transition, but an important and necessary one. Thus, rather than shake in your boots, it’s time to tighten your laces and start running—confidently—with the changes. To help facilitate that, check out this timeline. It starts now and so should you.