Preparing your practice for ICD-10

So you’ve decided to get your practice ready to use ICD-10-CM coding. Where do you begin? Our experts recommend the following steps:

   
Put someone in charge:

“Appoint one person, be it the officer manager, the coder, or the biller, to drive the process and oversee all the details,” says Maxine Lewis, presidentof Medical Coding and Reimbursement.   

Develop a timeline:

“I think it’s important to put goals in front of yourself to achieve this planning,” she says. 

Identify your codes and assess coder knowledge:

One of the most important elements in preparing will be identifying the codes your practice uses the most, so that you can begin learning what they will be in ICD-10-CM, Lewis says. The easiest way to do this is to review your superbills. Also, you must make sure your coding staff has knowledge in the areas of basic anatomy, physiology, and medical terminology. This will be necessary for them to better understand the provider’s documentation.

Analyze your contracts with third-party payers:

“Chances are, you have a lot of services that are carved out, or services that are automatically provided because of a certain diagnosis. So you have to find those in your contracts and make sure you’re using ICD-10-CM for the services you are performing, because if you don’t know what the new code is, you won’t get paid,” Lewis says.

Improve Documentation Now:

Better documentation is absolutely critical for ICD-10-CM coding. Start evaluating provider documentation today, says Renee Stantz, CPC, billing and coding consultant for VEI Consulting Services.  Learn where deficiencies lie and where education is needed to fulfill the ICD-10-CM code requirements. Although some have said that electronic health record (EHR) systems will handle this, many are skeptical. Through regular reviews, most auditors and consultants will tell you that that physicians and NPPs are currently not documenting the necessary information for ICD-10-CM coding. 

For providers, an assessment will entail reviewing current documentation to evaluate if the required ICD-10-CM detail is included.  The assessment should also incorporate mapping of ICD-9-CM to ICD-10-CM codes for the practice’s frequently-billed codes, and identifying any deficiencies that exist. This exercise will clearly pinpoint specific information that is lacking for accurate coding in the ICD-10-CM world, and allow for parallel provider training and payer testing.  Keep in mind that temporary workflow change-and additional staff-might be needed to conduct this assessment.

Begin Staff Training:

The Centers for Medicare and Medicaid Services (CMS) has estimated that ICD-10-CM training for clinical staff and providers will require 8 to 16 hours, 24 to 40 hours for coders, and 4 to 8 hours for IT staff members. Some form of in-office and classroom training will be necessary for your entire staff, and fostering good communications between providers and coders is essential, Stantz says. All staff involved with dagnosis coding will need to know their training goals and clinical staff will need to understand how their documentation will impact the ability to code.   

Claims Testing:

Talk with your software vendor, clearinghouse, billing service, and payers to make sure they are prepared for ICD-10-CM claim testing, Stantz says. Ask your vendor if your practice management and EHR systems will need to be upgraded in order to handle the new diagnostic codes. If so, find out when that upgrade will be finished. Ask your clearinghouse, billing service and each payer if their software can accomodate the new codes and when you can start testing.

Schedule tests and review results:

Schedule times to send test transactions, and review results when testing is complete, Stantz says. Some payers are already equipped to accept test claims, so don’t wait to test. If a payer is not ready to test, find out when testing can start. Work out a process in advance to address any glitches. Do not allow your revenue to be delayed because you didn’t test the right way.