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How Far Ahead Should Specialty Practices Begin Working in ICD-10?

By: Nextech | January 29th, 2015

How Far Ahead Should Specialty Practices Begin Working in ICD-10? Blog Feature

How_Far_Ahead_Should_Specialty_Practices_Begin_Working_in_ICD-10The ICD-10 transition should involve a multi-pronged strategy on how to fully adopt and implement ICD-10-CM in your specialty practice less than 9 months from now. The scope and breadth of that strategy depends on the size of medical practices; obviously larger practices have more time-intensive preparations to look forward to than small or medium-sized practices. One of the critical steps in ICD-10 preparation is starting to work in ICD-10 prior to the October 1, 2015 deadline.

ICD-10 application presents a vast array of benefits for specialty practices, such as a significant mitigation of production declines, inefficiencies, claims rejections, and overall reimbursement delays. Once the switch flips from ICD-9 to ICD-10 on Oct. 1, medical production is projected to decrease between 30% and 60% and may not completely recover to the pre-ICD-10 norm if the U.S. follows the Canadian trajectory of ICD-10 implementation.

Michelle Bamford, the regional coordinator of clinical information at Vancouver Island Health Authority, reported that coding in ICD-10 (after Vancouver’s ICD-10 implementation) doubled from approximately 12-15 minutes to 33 minutes, and the time to obtain claims approval rose from 69 days to 139 days. These figures don’t necessarily apply to U.S. specialty practices but they demonstrate what may happen if U.S. practices aren’t sufficiently ready for ICD-10 by the due date.

So, let’s circle back to our previous point: beginning to code in ICD-10 before October 1. Insurance companies will only accept ICD-9 codes when you file claims for reimbursement until Oct. 1. For this reason, physicians and medical coders would need to double or dual code in order to conduct claims testing. Double coding and dual coding have different meanings.

Double code: Defined as coding a medical record in ICD-9 and then completely recoding the same medical record in ICD-10.

Dual code: Defined as the simultaneous addition of matching codes from ICD-9 and ICD-10 to the medical record.

How soon you begin to dual (or double) code depends how your organizational readiness. But how do you know if your practice is ready? It boils down to three major points:

  • Updates for EMR/EHR applications – Evaluate your health information management (HIM) software for ICD-10 purposes. Get in communication with your software vendor about update release timelines so that you have an accurate idea of what to expect and can plan your IT upgrades and installations accordingly.
  • Human capital and training – Physicians, medical billers, coders, and other organizational staff who are intimately connected to the practice’s revenue stream need to get trained on ICD-10-CM – at least the basics before they work in ICD-10 and test claims. There are a multitude of training opportunities that offer online and classroom settings, such as:
  1. The World Health Organization (WHO) ICD-10 Training Tool
  2. American Association of Professional Coders ICD-10 (AAPC) Training Courses
  3. AHIMA Coding Basics ICD-10 Courses
  4. Allied School’s Online ICD-10 Courses 

Additionally, healthcare professionals and their personnel should tweak their clinical documentation (if necessary) so it fulfills the level of detail and specificity required for ICD-10-CM. The last thing any physician wants is to have clinical documentation returned to him or her repeatedly because it doesn’t have the precise data to find the right ICD-10 code. Vague documentation could slow the claims process considerably, so physicians should be thinking with ICD-10 and claims testing as they document patient care.

  • Clearinghouses and payers – Just as with software vendors, maintain proactive contact with your clearinghouse and payers to remain in the loop on when they begin processing claims with ICD-10-CM codes. You obviously cannot test with ICD-10 if your clearinghouse and payers don’t have the infrastructure established to do their part – no matter how ready you are internally.

Once they are onboard and you have all other ICD-10 preparations completed, your practice can start dual coding a subset of your most common medical cases. Having all parties involved will allow you to gain familiarity with the new codes, smooth out any kinks with clinical documentation, increase your ICD-10 coding speed, and handle claims rejections based on ICD-10 errors.

ICD-10 claims testing will provide you with much-needed expertise in order to prevent your revenue cycle from taking a heavy blow. The Centers for Medicaid and Medicare Services (CMS) advises physicians to start working in ICD-10 as soon as this month (January) according to their ICD-10 transition timelines.

Download the whitepaper and get ready for ICD-10!