The deadline for transitioning to the ICD-10 code sets is October 1, 2014, yet recent surveys have found that many medical groups have not conducted impact assessments, implemented needed technology or started testing.
What do orthopedic medical groups need to do to prepare for this critical change?
1. View this as an opportunity to improve performance, not just a burdensome requirement.
The ICD-10 code sets represent a major step forward in terms of improving data collection and improving healthcare in the U.S., which is the only major country that is still using the 30-year-old ICD-9 codes. ICD-10's more expansive system will also enable providers and payers to better track data to measure the quality and safety of care, process claims for reimbursement, and improve clinical, financial and administrative performance.
One of the consequences of the Affordable Care Act is that many health plans are looking to trim their provider network. They will be looking for medical practices that are meeting benchmarks for quality reports and timely claim submissions. A medical group that has failed to take advantage of the new coding system will be at a serious disadvantage.
While there will be significant implementation and training costs for the transition, in the long-term the new ICD-10 codes will enable medical groups to improve patient care and increase reimbursements.
The number of diagnosis codes will increase from 14,000 to 68,000 and the number of procedure codes from 4,000 to 87,000. This sounds overwhelming, however, approximately 25 percent of the IDC-10 CM codes are the same except for indicating the right or left side of the patient's body. Another 25 percent differ only in the way they distinguish among "initial encounter," "subsequent encounter" and "sequelae." Note that ICD-10 CM codes are used for all healthcare settings, ICD-10-PCS codes are to be used for inpatient hospital settings only.
2. Understand the unique challenges facing orthopedic practices.
Orthopedics is a complex specialty so it is not surprising that the orthopedic section of ICD-10 codes is expanding more than any other section. An additional factor is that orthopedic treatment for many Medicare patients often includes the use of durable medical equipment, in addition to physician services. DME is billed differently than physician services; therefore, orthopedic offices and staff will need to submit ICD-10 codes for both Medicare Part A and Part B claims.
The AAOS online Practice Management Center (www.aaos.org/pracman) has a page of resources on the transition to ICD-10 (membership required).
3. Make sure your EHR and practice management system will be ready.
A successful transition to the ICD-10 codes will require an advanced EHR and practice management system. Practice managers must confirm that their EHR and PM systems will be ICD-10 ready well in advance of the October 2014 deadline to allow for testing and training.
The EHR should be capable of quickly and efficiently "cross walking" or "cross mapping" from ICD-9 to ICD-10. This ability should include mapping in both directions, i.e. the ability to identify codes where either ICD-9 or 10 codes are the "target" or the "source."
The EHR should also be able to search by multiple code ranges and individual codes. For example, it should be able to search for codes with the first three characters = 'nnn' and the 7th character = 'n'. In addition, the system should be able to assist in coding by identifying items that can lead to specific codes (such as side of body, which visit it is).
Finally, an advanced EHR system should be updated frequently by the vendor and have the ability to "learn" over time so that coding takes less time for staff.
4. Allow sufficient time for staff training.
The American Association of Professional Coders (AAPC) recommends a five-step training program for experienced coders that will take 50-60 hours to complete. In addition to coding professionals, many other practice staff members will need various types of training in ICD-10 including physicians, nurses, billing administrators and IT support personnel.
The Center for Medicare and Medicaid Services (CMS) has 56-page workbook for small-medium medical practices that identifies specific training needs for medical groups. It is available at: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumPracticeHandbook.pdf
5. Plan for both internal and external testing.
In addition to training, medical groups need to complete both internal and external testing well before the October 2014 implementation date. The CMS recommends that small medical groups complete vendor code deployment and begin internal testing as soon as possible. The agency recommends that initial external testing begin no later than early 2014. Comprehensive external testing should be completed by the summer of 2014, according to CMS.
In the internal testing phase staff should be able to accomplish the flow of ICD-10 data and make sure that the EHR and PM systems are integrated and functioning with no major issues. Also, internal testing should establish that the organization is coding properly and ready to send claims to external vendors.
External testing requires sending claims to a clearinghouse or health plan. Several clearinghouses have announced they will offer test programs for customers. While it is important to know that your claims are being accepted by an outside entity, clearinghouses cannot tell you whether the ICD-10 code is correct or if the if the clinical documentation is adequate to support the ICD-10 code listed.
6. Identify resources to help with the transition.
As noted, both the AAOS and the AMA have extensive online resources for their members. In addition, a number of other organizations have timelines and workbooks available for download. These include:
• The AAPC: www.aapc.com/ICD-10/icd-10-codes.aspx
• American Medical Assn.: www.ama-assn.org/resources/doc/washington/icd10-checklist.pdf
• Workgroup for Electronic Data Interchange (WEDI): www.wedi.org/topics/icd-10
Your EHR and PM vendor may also have training and testing resources that are helpful in the transition.
Zubin Emsley is chief executive officer of ChartLogic, based in Salt Lake City. The company is a leading national provider of EHR systems. For information, see www.chartlogic.com