07 Aug Is your Medical Practice ready for ICD-10?
The Workgroup for Electronic Data Interchange (WEDI) on the preparations for transitioning to ICD-10 being conducted by healthcare providers show that around fifty percent of those surveyed either have not become preparing for conversion to ICD-10 use or that they do not know when they will start the process.
The Centers for Medicare and Medicaid Services has set the date for ICD-10 use for October 1, 2014. Approximately 40 percent of practices surveyed had no idea when they would complete their business changes, impact assessment, or start external testing.
The main obstacles to preparing for implementation of ICD-10 appeared to be split between budget, staffing, competing priorities, information systems, and vendor readiness. When quizzed concerning how they will produce ICD-10 codes, one fourth of the practice billing managers reported that they expect the physician to choose the code directly, while around half said they would employ crosswalking (a system called mapping) and direct coding. Incidentally, fewer than 15 percent expected to crosswalk from ICD-9 to ICD-10.
General Equivalence Mapping (GEM)
Considering the complexity of the new code set, this brings about many concerns. The CMS has issued stopgap data files to aid physicians with transitioning to the ICD-10 and to assist with mapping from ICD-9 to ICD-10 and vice versa. The General Equivalence Mapping (GEM) guidelines will help providers start to crosswalk from one coding set to the other.
The GEMs allow for both forward and backward mapping. The data sets are easily downloaded and imported to a relational database. With these data sets, physicians attempting to locate a new code can encounter many combinations and scenarios, as with the old code not matching the new code.
However, the provider can choose from one or more alternative new code options that will vary by severity of condition, code description, cause, and laterality. Also, there are multiple code choices and scenarios associated with these varying codes. The new code set has a logical organization and nomenclature, but this does not guarantee that it will decrease the time needed to do the crosswalking during the transition process.
Tips to Transitioning from ICD-9 to ICD-10
- Identify the work processes and current systems that use ICD-9 codes – These include clinical documentation, practice management systems, encounter forms and superbills, contracts, public health and quality reporting protocols, and electronic health record systems.
- Consult with the practice management system vendor – Discuss accommodations for the new codes. Ask if the contract has upgrades as part of the vendor agreement. Physicians who are in the process of developing a management system can purchase one that is ICD-10 ready.
- Have implementation plans in place – Discuss this process with billing services, payers, and clearinghouses to be sure their systems are ready for the new coding guidelines.
- Evaluate personnel training needs – Assess billing and office staff education needs and identify those who will be responsible for coding and use of the new ICD-10 data set.
- Include time and costs related to ICD-10 implementation in the budget – This includes expenses for software updates, system changes, resource materials, and staff training.
- Conduct test transactions – Using new ICD-10 codes with payers and the clearinghouse, do trial runs of billing to assure the system is ready for transition.