How to Prepare for ICD-10 – Info from a Top Medical Billing Company

How to Prepare for ICD-10 – Info from a Top Medical Billing Company


According to the Workgroup for Electronic Data Interchange (WEDI), transitioning to ICD-10 is not going to be easy for all healthcare providers. The survey group found that only half of the organizations and practices were prepared for the transition date of October 1, 2014. Also, 40 percent of providers reported that they didn’t completely understand how the change from ICD-9 to ICD-10 would impact their business changes, impact assessment, or external testing.

Obstacles to ICD-10

There are many obstacles when preparing for the implementation of ICD-10, such as staffing, vendor readiness, competing priorities, budget, and impact on information systems. When asked how ICD-10 codes will be produced, a quarter of the providers in a recent survey reported that they expected to choose the code themselves. Also, more than 50 percent said they would use mapping (crosswalking), as well as direct coding. Due to the complexity of the new code set, this is somewhat concerning.

The Centers for Medicare and Medicaid Services (CMS) issued specific stopgap data files, which are supposed to help providers get accustomed to the new code set. This will allow the organization to map from ICD-9 to ICD-10 and vice versa. The General Equivalence Mapping (GEM) guidelines can be used to assist providers with the transition, as they are set up to allow forward and backward mapping. The data sets now can be downloaded and imported to a relational database that will assist with the mapping.

Providers who try to find a new code are faced with many combinations and scenarios, particularly where the old code does not match the new one and where the provider can choose from one or more new codes that vary related to severity of the condition, description, laterality, and cause. This gives multiple choices for the codes and scenarios. The options for the provider are:

  • Pick one code from Menu A, and one or more codes from Menus B or C, or
  • Pick one code from Menu A, and one or more codes from Menus B and C, or
  • Pick one code from Menu A, and depending on which one you chose, also select some of the codes in Menu B, but not from Menu C.

Source it Out

For providers who do not wish to deal with direct coding and mapping, the option is to outsource the medical billing. This allows providers to focus on healthcare instead of clerical and billing issues. Billing companies are well-prepared for conversion to ICD-10, as they invest in hardware and software for the purpose of accurate claim submission. This will prevent the disruption in reimbursement and providers will be better prepared for the difficult transition from 9 to 10.

CMS Recommendations

  • Establish a team – The healthcare organization needs to appoint a team, which includes a project coordinator that will lead the ICD-10 transition.
  • Develop a plan – There needs to be a timeline and plan to identify the various tasks, milestones, and resources required.
  • Assess the overall impact – Management should assess how ICD-10 will affect the organization. This is done by reviewing codes, medical records, encounter forms, billing systems, practice management systems, and deciding which ICD-10 codes to use.
  • Secure a budget – This will allow the organization to upgrade software, purchase hardware, revise forms, train staff, and make necessary workflow changes.
  • Electronic health record templates – The practice needs to review how ICD-10 will affect certain HER templates and clinical documentation requirements.
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