The next major transition to the new International Classification of Diseases (ICD)-10 coding system is coming, leaving organizations asking the dreaded question, “Are we ready?” Time is just about up, especially for healthcare organizations that may find themselves behind schedule.
With the Senate scheduled to vote on a permanent fix of the reimbursement formula for Medicare physicians in a couple of weeks, Oct. 1, 2015 looks to be the deadline the industry is racing towards. Many healthcare providers have delayed critical impact assessment and testing tasks that should have been conducted nine months prior to the October deadline, but do not fear, the following information will help you understand ICD-10 and provide tips for your final preparations.
What is ICD-10?
ICD-10 is the 10th updated edition of the ICD codes and will replace the United States’ current ICD-9 system. ICD-10 has two parts:
Why make a change to ICD-10?
The 30-year-old set of ICD-9 codes uses outdated terminology, lacks specificity, and is running out of room as hundreds of new diagnosis codes are submitted annually. Also, the United States is the only country that is still using ICD-9, and the switch to ICD-10 will enable more accurate comparisons of healthcare data with other countries. ICD-10’s more expansive system will also help the U.S. healthcare system better track data to measure the quality and safety of care, process claims for reimbursement, and improve clinical, financial, and administrative performance.
How many codes are in ICD-10?
ICD-10 has 141,000 codes—more than 8 times the 17,000 codes in ICD-9. The additional codes will enable practices to be more specific on claims forms in reporting the care provided to patients.
Where can I find the ICD-10 code sets?
The ICD-10 code sets are available now, but they are in draft form, as codes will continue to be added prior to the transition deadline. The code sets are available free of charge on the Centers for Medicare & Medicaid Services website.
Many healthcare organizations recognize that their coders are faced with the colossal task of scaling-up their coding structure from about 16,000 to approximately 150,000 ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS) codes. With this feat, they’ll have to test and retest across their hospital’s internal departments and also with outside organizations. Additionally, hospitals typically have between 100 and 200 software systems that must be reviewed, but this number can change. It is recommended to revisit your ICD-10 plan to find out whether the strategy you developed more than a year ago is still relevant to your healthcare organization’s business operations today.
If you feel unprepared, you’re not alone. With competing priorities and limited resources, many providers feel they are not close to being ready for the transition. You can gain focus by identifying your organization’s most critical codes, for example, the top 10 most frequently used and the highest revenue generators. Creating a comprehensive action plan that ensures the essentials are in place is a critical next step. After identifying what needs to be done, rally your entire team in understanding that codes are most important and in making the necessary workflow and system changes to ensure readiness for October 1st.
With external factors such as payer readiness, no provider can truly anticipate what will happen in October, regardless of one’s ICD-10 readiness efforts. Providers can create a financial safety net by talking to their bank or filling out paperwork for a line of credit. In the best-case scenario, the extra cash on hand won’t be necessary; however, it can provide peace of mind during an unpredictable time.
As you determine how to best use your remaining time, remember accuracy is key. Accurate and comprehensive clinical documentation and coding are the foundation for every clinical and financial step changed by ICD-10. Work with your physician, coding, and revenue cycle teams to make sure they have all the information they need to attain accuracy and understand that speed may have to wait. The more accurate your physicians’ clinical documentation is, the less detrimental longer-term problems there will be.