Why Approach ICD-10 with a Sense of Urgency

January 18, 2014
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approach 1cd-10 with urgency HISAs the October 1, 2014 deadline approaches, the necessity for immediacy in preparation for the transition from ICD-9 to ICD

approach 1cd-10 with urgency HISAs the October 1, 2014 deadline approaches, the necessity for immediacy in preparation for the transition from ICD-9 to ICD-10 is crucial. The ICD-10 coding impacts every step along the patient treatment process from the initial encounter with the examining physician to the billing department submitting requisitions for reimbursement of services.  

However, the billing department will face the greatest challenge in claim submissions if the coding is not properly structured.  Orthopedics, in particular, will be hard-pressed to receive correct reimbursement with incorrect coding. Over 60% of the ICD-10 pertains specifically to Orthopedics and Musculoskeletal (MSK).

ICD-10 consists of two separate parts: ICD-10-CM for diagnosis and description of the patient’s symptoms, and ICD-10-PCS for inpatient hospital procedures.

The ICD-10 addresses and provides additional information about the patient as well as the causes, location and other data about the patient’s diagnosis.  The coding includes elements that more aptly reflect and are more consistent with contemporary terminologies and classifications.  The result is a more concise interpretation of the patient’s condition.  In addition, the new coding eliminates the need for extra paperwork frequently required with the ICD-9 coding.  With the inclusion of the extra data in the ICD-10 coding, time, confusion and unnecessary utilization of resources can be reduced or eliminated.

For facilities that desire detailed specifics about the transition, there is a General Equivalency Mappings (GEMs) database available. Created by CDC and CMS, it is designed to help users better understand, analyze and manage the deciphering from the old code to the new.  The GEMs database is well-worth becoming familiar with as the differences between the old code and the new are significant. Physicians, clinicians and office personnel involved with billing procedures are highly encouraged to familiarize themselves with GEMs as soon as possible prior to the October 1, 2014 deadline.

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There is a substantial number of changes as a result of the new coding including:

  • Application updates
  • Software updates
  • New technologies
  • Training
  • Education
  • Workflow
  • Processes
  • Forms
  • Documentation
  • Staffing challenges

With such an extended array of changes forthcoming, it behooves everyone in your office or facility to become familiar with ICD-10 as soon as possible.  Preparation should also begin to recognize and prioritize the current inventory of items that will need to be addressed:

  • Documentation of current applications that utilize ICD-9 coding
  • Documentation of internal forms that utilize ICD-9 coding
  • Documentation and prioritizing of staff members requiring ICD-10 training or education
  • Determining what reference methods your practice currently has or expects to have for implementation
  • Communication with vendors, hospitals, partners, contracted payers and external forms sources about their plans for transition
  • Who pays for staff training and education
  • Selecting a primary member or team to receive the initial training and education and become the ICD-10 experts for your practice

With all the aforementioned important aspects the transition encompasses, rapid deployment of your practice’s plans for preparation and compliance is highly recommended.  The last thing your practice needs is delays in reimbursement or loss of revenue because of a simple error in coding or insufficient training or education.  Communication with all entities that you conduct business with or share information with has never been more important.  The upcoming changes are the most important and extensive for patient care to be introduced in the past 20+ years.  Make sure that your facility or practice is prepared to transfer smoothly into the next phase of patient care.

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