We've still got a few years before the greatly expanded ICD-10 code sets replace the ICD-9 code sets, but you've got a lot of work to do between now and then to be sure you're prepared for what some are calling the most significant overhaul of the medical coding system since the advent of computers. And when you consider the size and impact of the project, the implementation date of Oct. 1, 2013, really isn't that far away. Here are 5 steps you can take to begin the transition to ICD-10.

1. Educate your staff and surgeons. Begin increasing awareness now by introducing information about the ICD-10-CM diagnosis and procedure code changes to your business office staff and physicians. Some details to stress:

• Casting a wider net. In the long run, you'll capture more procedures and conditions than you do now. ICD-10 contains about 155,000 more codes than ICD-9 and almost twice the categories of ICD-9. It accommodates a host of new diagnoses and procedures, and is key to supporting an electronic healthcare system because it will provide more coding detail.
• Why the change? ICD-9 was developed about 30 years ago and is widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses. It contains about 17,000 codes and is expected to start running out of available codes next year. Once implemented, ICD-10 will provide more accurate coding for complex conditions and procedures. Former Health and Human Services Secretary Mike Leavitt said "the greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay-for-performance, bio-surveillance and other critical activities."
• For ASCs and hospitals. There will be 2 types of new ICD-10 codes — the ICD-10-CM (Clinical Modification) for diagnosis codes used by physicians and outpatient providers such as surgery centers, and the ICD-10-PCS (Procedure Coding System) used by hospitals. ICD-10 uses alphanumeric categories instead of numeric only. The codes used by the surgery centers are longer — 3 to 7 characters — than ICD-9-CM diagnosis codes.

2. Reassess your software purchasing. If you're planning to buy a billing, accounting or electronic medical records system within the next 18 to 24 months, ask the vendor about how it will handle the necessary upgrades to its software to support the new electronic code sets in Version 5010 (electronic transactions) and the ICD-10 requirements. If you're planning a purchase in the next 3 to 4 years, choose a vendor whose software has been successfully updated and time your purchase closer to the deadline for ICD-10 implementation in October 2013.

Also review your facility's billing, accounting and EDI (electronic data interchange) clearinghouse software contracts to determine how your vendors will handle upgrades due to "regulatory requirements." Vendors may pass such costs on to you. Reading your contracts and talking to your vendors is the only way to verify this. You can then use this information to budget for these costs and analyze the cost benefit of a new system purchase. Keep in mind that HIPAA has standardized the electronic transactions that providers, health plans, clearinghouses and vendors must use for claims, remittances, eligibility, claims status requests and responses. The current version, X12 Version 4010/4010A1, will be upgraded to the new Version 5010 by Jan. 1, 2012.

3. Examine your payor contracts. Do any of your contracts use ICD-9 codes in the language for payment of certain procedures? For example, some carveouts use ICD-9 codes to identify which procedures are covered. Re-negotiate affected contracts using appropriate ICD-10-CM codes.

4. Strengthen your business office. Correct any process weaknesses that hinder your facility's ability to adopt new codes or billing changes. Have there been problems surrounding new CPT codes or understanding the new payment schedule from CMS? Did your facility have any problems with the NPI (National Provider Identifier) implementation in 2006?

If so, do you know why there were problems and where the breakdown occurred? Was it on the facility side or from your software vendors and payors? Understanding these root causes now can help you plan and take steps to prevent denied or slowed claims processing and avoid reduced revenues in the future.

5. Measure the impact of the change. From registration and scheduling to materials management, do a department-by-department inventory of all the areas where your facility currently uses ICD-9 codes. Getting a sense now of how large of an impact the new codes will have on your systems and forms will help you to get a realistic picture of how to plan for changes, what needs to be done, who can help and a better idea of additional expenses.