ICD-10 is on Hold, but Your Preparations Shouldn’t Be

August 26th, 2014
ICD-10, Transition

When news of the ICD-10 implementation delay broke this past spring, the reaction among healthcare providers was similar to what you might expect from a class of college students receiving news of a term paper extension: a collective sigh of relief interspersed with a few high-fives and cheers.

If you’re among the crowd of healthcare professionals who are thanking their lucky stars for the one-year pushback, keep in mind that the new deadline won’t make the transition any less challenging or resource-intensive—it merely delays the inevitable. And just like the first time around, procrastination won’t get you anywhere. Because at some point—just as those college students are going to have to buckle down and crank out their essays—you’re going to have to start submitting claims with ICD-10 diagnosis codes. And once the go-live date of October 1, 2015, is upon us, you’ll have a pass-fail situation on your hands as carriers will deny all claims lacking ICD-10 codes.

So, what should you be doing in the meantime? That question is currently on the minds of many medical professionals. According to this Government HealthIT article—which summarizes a study by the American Health Information Management Association and eHealth Initiative—the preparatory items of highest concern within the healthcare community are documentation improvements, workforce training, and partner testing.

The first two tasks are closely related; after all, to improve the quality and efficiency of your practice’s documentation processes, you’ve got to not only educate your staff about what is expected of them, but also allow them the opportunity to practice creating documentation that meets your standards. The data speak to that relationship with 61% of survey participants saying they’re training more staff in preparation for the switch and 68% conducting additional training and practice exercises to help combat the expected productivity loss. Furthermore, about one-third of respondents said they plan to hire more coders.

When it comes to testing, the results are a little more split. About 40% of participants in the above-cited study plan to begin end-to-end testing by the end of 2014 with an additional 25% saying they’ll start in 2015. On the other hand, 41% indicated that they don’t know how to test, and 45% admitted they’re unsure of how ready their business partners are. (If you’re not up to speed on the ins and outs of ICD-10 testing, check out this blog post on external testing and this one on internal testing.)

Of special concern to physical therapists is coordination with top referral sources. As certified coder and medical coding auditor David Zetter says in this HealthLeaders Media article, “The person in your office who is taking that phone call or referral needs to understand what information they need from that referral partner to make sure that diagnosis code is as accurate as possible and includes all the information.”

Another thing to consider? How your practice—or, more specifically, your EMR—will handle dual coding. Medicare allows providers to submit claims up to a year after the actual date of service, which creates a bit of a pickle. As the HealthLeaders Media article explains, “…a claim submitted for service before October 1, 2015, will require an ICD-9 code even though you may submit it in January 2016—but that claim will require the new ICD-10 code as well.”

October 1, 2015, might seem like a long way off, but with so many things to check off of your to-do list before ICD-Day, you’re certainly better off being proactive. That way, by the time the transition rolls around, you won’t be holding your breath and hoping for an extension.

Was your practice ready for the original ICD-10 transition date? How have your preparatory plans changed in the wake of the delay? Share your thoughts in the comment section below.


CMS Sets ICD-10 Transition Date, Releases Testing Information

August 5th, 2014
ICD-10, Testing Week, Transition

It’s official: October 1, 2015, is the new ICD-10 transition deadline. While that gives providers ample time to prepare for the switch, it’s imperative that those affected by the change stay on top of their prep work to ensure a timely and seamless transition when that day finally arrives.

To that end, CMS recently revealed its testing plan for the months leading up to the ICD-10 implementation date. According to this MLN Matters article, CMS is taking “a comprehensive four-pronged approach to preparedness and testing” in an effort to ensure everyone in the healthcare community has enough practice with submitting the new codes before it becomes a requirement. The four pieces of the testing plan are:

  • Internal testing of CMS’s claims processing systems
  • Release of downloadable beta testing tools
  • Acknowledgement testing
  • End-to-end testing

As you may recall, CMS successfully conducted acknowledgement testing this past March. To build on that round of testing, CMS has invited all providers, suppliers, billing companies, and clearinghouses to submit acknowledgement test claims any time before October 1, 2015. Additionally, CMS has scheduled special acknowledgement testing weeks in November 2014 and March and June 2015. During these testing periods, participants will have access to real-time desk support. You do not need to sign up to participate in these testing activities. If you’re interested, simply contact your Medicare Administrative Contractor (MAC) for more information.

CMS also plans to facilitate end-to-end testing in January, April, and July of 2015. Approximately 2,550 volunteers representing a variety of regions and provider types will be selected to participate in these testing events, which involve submission of test claims with ICD-10 codes to Medicare as well as the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims. According to the above-cited MLN Matters article, CMS will soon release information on the volunteer registration process.

For more information on these testing initiatives, as well as links to various testing resources and tools, please refer to the MLN Matters article.


How to Conduct External Testing for ICD-10

May 28th, 2014
ICD-10, Preparation, Transition

In a previous blog post, we explained how and why you should test the ICD-10 code set inside your practice. Now, let’s talk about external testing—that is, verifying that all of your outgoing and incoming data transmission processes are completely ICD-10 ready. That way, by the time the transition date—which is set for October 1, 2015, according to recent hints from CMS—rolls around, there will be no question of whether you’ll get paid.

In this article, ICD10Watch editor Carl Natale explains the importance of proper external testing. In his words, such testing should allow you to:

  1. “Verify that [your] practice can submit, receive, and process data containing ICD-10 codes.
  2. “Understand the impact that clearinghouse and payer policies will have on the transactions.
  3. “Identify and address specific problems.”

If you find the task of architecting—and executing—a comprehensive external testing plan to be more than a little overwhelming, relax. As Jennifer Bresnick writes in this EHR Intelligence article, you should employ a “multi-phase approach to testing to cover different testing objectives in a reasonable time frame…” Essentially, treat ICD-10 testing as you would a fine dining experience; you wouldn’t scarf down your appetizer, entrée, and dessert all at once, and you don’t want to dive into all portions of your testing at once.

Instead, break it down into stages, and be sure to set specific, measurable, attainable, relevant, and timely (SMART) testing goals. Then, present your goals and target deadlines to your staff as well as your business partners and vendors. As you’re formulating your plan, be sure to research where your partners are in their own ICD-10 preparations. That way, you’ll know where you might need to build a little bit of cushion into your schedule so you don’t get derailed by surprise setbacks.

Natale pulled the following key action items from the external testing plan CMS provides here:

  • Pinpoint and prioritize the parties with whom you need to test
  • Make arrangements to submit test claims to your clearinghouse, billing service, and/or payers
  • Analyze the results of your test submissions
  • Adjust your clinic’s processes accordingly

Furthermore, according to this article, CMS and the Workgroup for Electronic Data Interchange (WEDI) recommend that you perform testing with claims representing all of the code categories your practice uses, especially those that may be susceptible to “common errors, such as mistaking a zero for [the letter] O” so that you will see what happens if your claims don’t go through. And regarding test claims that contain real patient data—a.k.a. protected health information—take heed of these cautionary words from the American Medical Association (AMA): “Be sure to follow all appropriate security and privacy measures to protect the data, such as sending the transactions using a secure connection.”

If your practice only works with a certain clearinghouse or billing service, you’ll have a simplified external testing experience because you really only need to ensure they can receive the codes. However, you should also confirm that such parties are conducting their own testing initiatives with payers and other clearinghouses. Otherwise, it could affect your cash flow.

While many experts recommend that you dedicate six to nine months to your external testing endeavors, we say the more testing you can do, the better. So as we count down the weeks and months to transition time, keep a pulse on your partners’ testing preparations so you can get started as soon as you’re ready.

Does your clinic have a plan for external ICD-10 testing? What testing questions do you have? Share your thoughts in the comment section.


CMS Says ICD-10 Benefits Outweigh Prep Work

April 2nd, 2014
ICD-10, Transition

According to the Centers for Medicare and Medicaid Services (CMS), the work providers will have to do in preparation for the ICD-10 transition is temporary. The benefits for providers and patients alike, on the other hand, are forever—or at least until ICD-11. “From proper observation and documentation to improved clinical documentation, progress notes, operative reports, and histories, the benefits of ICD-10 begin with enhanced clinical documentation enabling [providers] to better capture patient visit details and lead to better care coordination and health outcomes,” CMS writes. So, although you might feel more than a bit overwhelmed as we get closer to the October 1, 2014, transition deadline (27 weeks and counting), there is a light at the end of the tunnel. Come 2015, you’ll be an ICD-10 expert, and instead of worrying about transition plans and preparedness strategies, you’ll be able to kick back and enjoy the fruits of your labor (as described on this CMS page and in this SuccessEHS article):

Clinical Benefits

  • Make more informed clinical decisions as a result of more thorough documentation, collection, and evaluation.
  • Achieve new insights and identify new trends thanks to greater specificity, laterality, and detail of patient diagnoses. (This also improves our nation’s ability to report, track, and evaluate public health.)
  • Take advantage of more opportunities for research, trials, and studies because injury classifications will be more accurate. (Plus, because most of the world already uses ICD-10, we will be able to conduct comparative research with other countries.)

Operational Benefits

  • Access more information to better match patients with providers and have more productive and more frequent communication with other healthcare professionals.
  • Use specific patient condition information to make better decisions regarding capital investments and resource allocation to address practice needs.

Professional Benefits

  • Introduce new procedures and diagnoses because the code set is more flexible.
  • Support credentialing and certification through clearer objective data.
  • Improve quality and efficiency reporting by using more specific measures.

Financial Benefits

  • Increase the likelihood of reimbursement through more thorough documentation of patient complexity and level of care. (Plus, the specificity of ICD-10 codes should provide payers with enough information to eliminate the need to request copies of medical records.)
  • Reduce your audit risk exposure because the diagnosis codes are more specific.
  • Facilitate peer-to-peer comparison and benchmarking by using more objective data.

Do you see the light at the end of the ICD-10 transition tunnel? If so, what benefits are you most looking forward to? Tell us in the comment section below.


Breaking News: ICD-10 Implementation Delayed Until October 1, 2015

April 1st, 2014
ICD-10, ICD-9, Transition

Note: This is not an April Fools’ joke.

On March 31, the US Senate voted 64-35 to approve a House-drafted bill that includes a provision to push the ICD-10 deadline back a year—all without a single mention of ICD-10 during a nearly three-hour Senate floor debate. The main purpose of the bill—HR 4302—was to enact a one-year “fix” of the Sustainable Growth Rate (SGR) formula, thus preventing a 24% cut in Medicare’s physician reimbursement rate. This legislation represents the 17th temporary Medicare fix since the passage of the Balanced Budget Act was in 1997. According to an APTA press release, “the final bill replaces the cut with a .5% provider payment update through the end of the year and no update from January 1 to April 1 in 2015.” In addition to the SGR patch and the ICD-10 delay, the bill includes one-year extensions for the therapy cap exceptions process and the Geographic Pricing Cost Index (GPCI). The bill now awaits President Obama’s signature, which, according to social media buzz, should occur today.

As this article explains, no one is quite sure how an ICD-10 delay made its way into the SGR fix bill. Although the legislation was the product of a bipartisan effort, there were senators from both sides who vocally opposed its passage, citing the importance of paying for the quality—not the quantity—of healthcare services. However, in the midst of all this passionate debate, not a single Senator mentioned ICD-10—much to the chagrin of the associations that so vehemently opposed the implementation delay, including the College of Healthcare Information Management Executives (CHIME), the American Health Information Management Association (AHIMA), the Medical Group Management Association (MGMA), the American Medical Association (AMA), the Health Information and Management Systems Society (HIMSS), and the Centers for Medicare and Medicaid Services (CMS).

So, why the silence on ICD-10? One theory is that lawmakers were simply unaware of the ICD-10 provision and its potential implications. As this Government Health IT article suggests, “Perhaps if the Senate had voted down the bill, regrouped, come back with another stab at permanent SGR repeal, someone would have noticed Section 212 saying that HHS cannot mandate ICD-10 as the standard code set before Oct. 1, 2015.” But now that the delay is happening, the healthcare industry must face the financial consequences. CMS estimates that the total cost of delaying implementation will fall somewhere between $1 billion and $6.6 billion, and Resultant founder and healthcare consultant Joe Lavelle projects that waiting another year could cost each of his clients anywhere from $500,000 to $3 million, according to the Government Health IT article.

With no indication that President Obama will exercise his veto rights, this bill should become law today. We’ll update this post as the story unfolds.


Survey Says: Providers Lack ICD-10 Readiness

February 24th, 2014
ICD-10, Preparation, Transition

If you’re feeling less-than-ready for the impending transition to ICD-10—set to blast off in T-minus eight months and counting—you’re definitely not alone. In fact, a recent survey by the New York-based healthcare advisory firm KPMG found that nearly three-quarters (73%) of respondents—including health plans, hospital and health system-affiliated providers, large physician groups, and nurses—predicted that ICD-10 would have a moderate to severe impact on their bottom lines. Furthermore, 67% of survey participants admitted that they had yet to conduct end-to-end ICD-10 testing with outside vendors, payers, and software systems.

In this article about the survey, Wayne Cafran, advisory principal in KPMG’s Healthcare & Life Sciences practice, estimates that the organizations in question could suffer financial losses of anywhere from $1 million to $15 million. “Healthcare organizations are in for a rude awakening when they finally realize what [impact] the new standards will have on their bottom lines,” Cafran said.

Following the rules of probability, there’s a solid chance your practice falls into one or both of the groups cited in this study. Which begs the question: If so many players in the healthcare arena aren’t adequately prepared for the switch, how can it go forward? That’s the (literally) million-dollar question many medical providers and organizations are posing as they scramble to adjust their processes to accommodate an entirely new—and much more complex—diagnosis coding system.

In fact, the American Medical Association (AMA) has been very active in building a case for another extension to the ICD-10 deadline. As part of that effort, the group asked physicians to complete a ten-question survey about software readiness. The crux of their argument is that many vendors won’t have their ICD-10 upgrades in place until well into 2014, which doesn’t leave much time for providers to adjust to any changes and work out the kinks. According to the article cited above, the AMA has twice been successful in similar lobbying efforts. But don’t get too excited; as this article explains, the chances of another pushback are slim to none. The fact of the matter is that ICD-10 is coming—whether you like it or not.

So, instead of wasting your time wishing for an extension that’ll probably never happen, you’re better off investing your time and energy into crafting a plan to get your ICD-10 preparations back on track. Need help? Check out the resource page on ICD10forPT.com to download an ICD-10 checklist and a step-by-step guide on preparing your practice for the transition.


Should Your Practice Hire an ICD-10 Coder?

February 17th, 2014
Codes, ICD-10, Preparation, Transition

The switch to ICD-10 will trigger a monumental shift in the way medical practitioners code patient diagnoses. In addition to an entirely new coding structure—ICD-10 codes contain up to seven characters, whereas ICD-9 codes max out at five—ICD-10 incorporates much more advanced anatomical terminology. Furthermore, in addition to coding for patients’ conditions, you often will need to submit supplemental codes to describe how and where certain injuries occurred as well as their degree of severity.

The result is increased specificity in coding, but all that slick, souped-up data comes at a cost—time. And as a rehab therapist, you don’t have a lot of that to spare. So rather than trying to manage the transition—and master a code set with five times more codes than the library you’re used to—all by yourself, you might want to consider calling in some backup in the form of an ICD-10 coder.

Medical coders are trained to review clinical documents and patient records and assign numeric codes for each diagnosis and procedure. So basically, when you have a coder, he or she will take your patient notes and translate them into the correct codes. Those codes help paint a clear picture of a patient’s condition and treatment, thus justifying reimbursement from payers.

Unlike large-scale medical organizations (such as hospitals), most small practices do not have dedicated coders, and with ICD-9—which features only about 13,000 codes to ICD-10’s 68,000—that might work just fine. But beginning October 1, 2015, if your practice fails to record and submit the proper ICD-10 codes, you won’t get paid. That’s a lot of pressure to deal with on your own—and that’s where a pro coder can help. Now, your gut reaction is probably, “There’s no way I can afford to hire a dedicated coder.” But considering the potential revenue loss your practice could suffer if you do not code correctly, the investment might be well worth it.

As this report explains, “The medical coders’ role in assuring that all information is accurate and complete is crucial to the economic well-being of the hospital since their entries determine the amount of reimbursement for patients covered by Medicaid, Medicare and other insurance programs. Coder efficiency in timely processing of coded bills maintains the flow of income into the institution.”

To code effectively, such professionals must demonstrate mastery in specific code sets and the ability to translate specific documentation into codes. For that reason, coders competent in ICD-10 are already in high demand among large institutions that currently retain on-staff medical coders. But as I mentioned above, ICD-10 could prompt smaller clinics to invest in trained coders as well—which in turn would drive up the demand even more. So, if hiring a coder to optimize your clinic’s ICD-10 coding and ensure reimbursements sounds like an attractive option to you, you’ll want to start looking for one sooner rather than later. Remember, you don’t necessarily have to add a full-time, in-house coder to your payroll; if you’d rather outsource to a third-party company (which is typically a much less expensive option), there are plenty of good ones out there. Check out the list at the bottom of this article for some suggestions.

And if bringing a coder on board simply isn’t in the cards—or the budget—for your practice, I would highly recommend sending your clinic’s current coding hat-wearer to an ICD-10 training course or two.

How is your practice planning to handle the switch to ICD-10? Would you consider hiring a medical coder? Share your thoughts in the comment section below.


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-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.