The official date for the ICD-10 transition is October 1, 2014; with certainty CMS has stated there will be no additional delays! That leaves 22 months to be production ready with ICD-10 implemented fully within your organization. Some may think this is far away, when in fact it is not and will arrive very quickly. Do not underestimate the size and scope of ICD – 10 implementation and educational needs.
This is the first article of a six month series focusing on the provider community as they transition to ICD-10 CM. Many organizations and providers find themselves constantly time pressed on a daily basis, leaving resources stretched thin with fleeting if any time to focus outside of the daily workload. If you wait until the last minute to tackle your ICD-10 implementation you will certainly suffer a financial impact. Now is the time to build your plan for training, education and ICD-10 implementation. If the switch was implemented today, how would you fare. How much of your operation is ready for it? Are you sure? Your certainty could make or break your paycheck.
The sheer volume of code changes is massive, moving from 13,000 ICD -9 codes to over 64,000 ICD-10 codes – either plan now or run damage control later.
As leaders, educators and providers, we must be cognizant that learning occurs at different rates and ways for different resources. Those with different skills often require educational methods. Prior to my career in health-care, I taught English as a second language. In order to be integrated into an American classroom, a student needed to be taught the language. Think of ICD-10 CM as a new language and get the sense of the learning principles that will need to be applied to achieve implementation. Not everyone learns the same thing, in the same way or at the same pace. To achieve a successful ICD-10 implementation with minimal disruption consideration must be given to learning’s basic principles.
Identify the learning styles
While we learn in many ways; some are visual and need to see, for others it’s hearing, still others must experience it with their own hands. For most students, one of these methods stands out. You will need to be aware of these styles and balance their use across those being trained.
A basic explanation of learning styles is this: Some students remember best materials they’ve seen; some remember things they’ve heard, while others remember things they’ve experienced. As you plan your ICD-10 CM training and education, don’t lose sight of these basic education principles. By understanding and considering the learning style of each employee, you will be able to select the right type of training for each person.
Here are some tips for the ICD-10 Transition and what to do now.
Identify all staff involved in the ICD-10 transition. Establish a process and frequency to communicate the agenda and the continuing progress. Think about how best to distribute the information within your team. Emails, in-person meetings, power-points, and webinars may all be effective, with some working better for different employees.
2) Work Flow.
You must fully asses and understand all points of your workflow impacted by ICD-10CM. Create a list of all elements relying on ICD-9 and plot what is needed for the transition in each area and process. Define who will be responsible for each; know which systems are under internal control and which ones will rely on an external vendor. Treat each system independently and monitor progress and pitfalls. For those under external control, work with vendors; determine their readiness and the status of their implementation. And most important, when will they be ready to test their solutions within your process. Consider changes to existing processes including clinical documentation that should be addressed now.
3) Practice Management Systems.
Talk with your practice management system vendor about their transition plan. Confirm completion and full adherence to 5010 standards. Any system not 5010 compliant will not correctly process ICD-10 codes. Clarify when you can test the system with ICD-10 codes. How will your system handle both code sets as the transition occurs? Will the old ICD-9 codes be phased out when the ICD-10 ones are implemented? If you deal with auto or work comp cases, discuss with your vendor if your system will be able to handle both code sets as ICD-10 is not currently mandated for auto and work comp payers. Stay tuned to follow state by state decisions affecting the implementation of ICD-10CM for workers compensation and no fault carriers.
4) Roles and Responsibilities.
Assign and clearly define roles and responsibilities. Be certain that all team members and employees are clear with their responsibilities and their timeline. Identify one physician who will be the ICD 10- CM champion and go to person, responsible for ensuring the overall implementation stays on track to meet the deadline.
5) Training Needs.
Asses the training needs within your practice. Training should be divided into three main groups; clinical staff, billers/coders and executive team. Each group will most likely have a different training agenda, with different implementation time requirements. Determine if training will occur as part of the normal work hours, or if additional dedicated time will be allocated. There are a wide variety of training options and materials available through professional associations, onsite training, online courses, and webinars. Determine the delivery methods that will be used and schedule accordingly. Here are some options:
- In person live-session or workshop that is interactive
- Computer based distance learning non interactive
- Web based live sessions with chat sessions
Work should begin 10 months prior to the compliance date learning the individual ICD-10 CM codes. To achieve this, learning the format, rules, guidelines, sequencing and nuances of the new code set is the task ahead for this year. Each provider will need to review their documentation to insure elements needed to properly code an ICD-10 CM encounter is documented. Remember, specificity is the driving force in ICD-10.
Budget should be allocated for training, implementation and process changes. How much money will you need to allocate for training? This will be determined by the training methods you chose to use. Remember to allocate costs for physical items, like forms, templates software upgrades, coding books. Secure a line of credit to reduce the impact of any cash flows issues, remember that while you may be ready, some of your systems may not. Payers may have problems beyond your control. Prepare in advance for the possibility to avoid any potential impact. Secure a line of credit to reduce the impact of any cash flow issues!
7) Charge Capture Tools.
Regardless of if you are paper based or using an electronic solution, the sheer volume of new codes, will result in significant changes to your charge capture process. Imagine a super bill going from one page to five, six or even nine. How would you handle this? Will your charge capture tool even survive? If you are using an EMR software product, what will the diagnosis list look like? Will you be scrolling though pages of lists to find the correct one you need? Will you be able to customize a list? What will happen if you need to use both ICD-9 and ICD-10?
How will your physician communicate the code to use for an encounter? What method will be used to indicate that more than one code is needed? ICD-10 CM uses notes throughout the book. The rules around this feature will have to be learned. These are all practical aspects requiring examination and accepted solutions long before the implementation date arrives. Now is the time to give serious thought and discussion to the impacts to all of your processes. For many internal resources will not have the needed skillset to achieve this and outside resources should be engaged as consultants.
Early preparation and clear communication will be the key to a successful ICD-10 implementation. The process must begin now. Begin by downloading and reviewing the coding guidelines from the CMS website. Download the ICD-10 CM code-set online, or purchase a hardcopy book. No need to buy a 2013 ICD-9 book since a code freeze is in place until ICD-10 is implemented. Understanding the volume of code changes and what your individual practice will be dealing with is key element of a successful transition.
Once you have identified who will be the ICD-10 physician champion in your group or organization, take your top 20 ICD-9 diagnosis codes and convert them to ICD-10. Pay careful attention to the number of resulting codes, the differences in specificity, and the additional documentation requirements. From this you can begin to assess the work involved and plan the training, education and implementation.
Next article preview: With 21 months remaining, we will review the structure and organization of ICD 10 CM and its new unique features.
Dena K. Mallin, CPC is an AHIMA ICD-10 CM approved trainer. She can be reached at firstname.lastname@example.org or 267.519.6102.