Doomsday predictions certainly abound – Heaven’s Gate, Y2K, the Mayan apocalypse – and they all came and went with a fizzle. ICD-10 has its own group of “end of the healthcare world as we know it” zealots who predict catastrophe for the transition of code sets. Certainly, the change is huge: our healthcare system will go from the ICD-9-CM system of approximately 14,000 codes to the 70,000+ ICD-10-CM codes, seemingly overnight. We tell our clients that the change is akin to going to sleep on September 30, 2014 speaking English and waking up the next day, needing to speak another language, fluently and exclusively. It boggles the mind!
All in all, we’re probably the lone voices in assuring that the transition to ICD-10 for most small providers won’t be as bad as everyone thinks, assuming that the technological requirements are met. The components are analysis and preparation; it’s their timing that is the key. The sheer volume of ICD-10 codes can be intimidating, but the reality is the codes are laid out much like the ICD-9 series. In addition, the new code set removes a great deal of ambiguity in code assignment because rather than having, for example, a table with fifth digits, the codes are laid out completely in their own rubrics.
It would be behoove every small provider to begin today by conducting a thorough analysis of its organization in order to plan the transition. Single specialty practices work with a much smaller subset of diagnoses than what is ICD-10, so the first step is to know what those are. Next, it’s important for the provider to learn about the coding changes affecting those conditions. ICD-10 revises and even adds certain guidelines that will affect coding and impact claims payment. This is the point at which most providers will determine the type of assistance that best fits their organization: hands-on training and coaching; web-based, ‘self-service’ modules; or some combination.
The largest part of the assessment process, and likely the most challenging, is evaluating whether provider documentation will facilitate or impede proper code assignment in ICD-10. Once the organization’s assessment reveals frequently used diagnoses, obtaining a baseline of current documentation’s ability to provide enough information for coding will help the organization create a preparation plan to meet the October 1, 2014 deadline.
It is widely believed that the ICD-10 transition pains are due to new codes; our perspective is that inadequate clinician documentation is the primary issue, and it’s not a new one. Coding in ICD-9 is just as affected by imprecise charting as ICD-10 will be. The widespread adoption of EMRs is alleviating some of the consternation of coders and practice managers, but the substantiation of coded diagnoses will continue to be a problem until clinicians address their poor documentation habits. CMS, through its RAC and other audits, has been forcing the issue of documentation for quite some time so in a sense, ICD-10 is just the next step along that continuum.
Education on the changes in code sets – for clinicians and staff – is important, but cannot occur too early. Using the language fluency scenario above, one wouldn’t master a language today that cannot be used for 17 months, but there is basic education regarding the coding format and most frequently diagnosed conditions that can occur over the next six months. The bulk of education, depending on the organization’s complexity, should begin in the early spring of 2014. Ideally, the clinicians and staff will have some advance knowledge of the changes and a reduced “fear factor” so they can apply the information in a training environment.
That brings us to the practice component. Various methods of practicing ICD-10 exits from the more manual, such as coding a percentage of materials in both code sets, to using software programs. A rational training curriculum is critical so the education and application process lead to a smooth transition. As it is, experts predict it can take six months to a year for productivity to return to per-implementation levels. This can wreak havoc in small organizations because of the associated decrease in revenue.
The last part of the transition is to secure lines of credit early. Again, depending on organization size and complexity, transition to ICD-10 could require adjustments in the number of patients seen, how quickly claims can be reviewed and filed, and even how denials and appeals are handled. Adequate cash flow will minimize one large stressor so the organization can focus on the transition itself and preserve the quality of patient care.
Further delays in ICD-10 implementation are not likely so developing a transition plan is the first order of business. Excellent resources abound from CMS, professional organizations and consulting firms. The keys are analysis and preparation, and there is sufficient time to do both and skate through this massive change.