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Coding & Billing: Your Last-Minute ICD-10 Checklist
13 steps to take before the new coding system kicks in next month.
OSD Staff
Publish Date: September 3, 2015   |  Tags:   Financial Management
ICD-10 CODING CONFUSION ICD-10 is just around the corner are you ready?

With just a month to go until ICD-10 goes live, if you've been hoping for another delay, or lagging behind on your prep work, you should be worried — very worried. The new complex coding system is replacing ICD-9 and will be required on all medical claims starting Oct. 1. If you haven't made much progress (or have been crossing your fingers that it's all a bad dream), it's time to get serious. With the ICD-10 transition date just around the corner, here are 13 to-do items to help you survive.

Identify your champion(s) — or create one
If you haven't yet, appoint 1 person — with a backup, if available — as the ICD-10 champion of your facility. This person should be trained and have a good understanding of ICD-10. Your champion can help others troubleshoot problems as they arise and be the point person for all questions from staff and surgeons. By having a single person ready to tackle any and all things ICD-10, it helps minimize confusion and establish a clear line of inquiry and resolution.

Identify those likely to need assistance
Just as it's important to identify champions, it's also crucial to know who'll need extra help after the transition. Rank the physicians and any other employees involved with ICD-10 according to their knowledge and willingness to help others. To help you determine how well a physician will pick up on the new system, look to the quality of the doctor's current operative documentation. Ranking staff and physicians in this way helps you know ahead of time who'll need extra training and who those people can turn to for help.

Focus, focus & focus some more
ICD-10 will not affect every facility in the same way. While surgery as a whole will be greatly impacted by the switch, orthopedics will face more significant ICD-10 challenges than some other specialties. If you know that one of your specialties will be greatly impacted — or that your bread-and-butter procedures will require major coding changes — consider focused training in these areas to reduce the risk to your revenue cycle.

If you haven't started training, look to other options
If your coders aren't trained in ICD-10 by now, it's probably time to turn to outside resources. Outsourcing your coding can make sure your current cases are coded while your internal staff catches up. Start researching and contacting companies ASAP — more will become unavailable as we get closer to implementation.

Take advantage of online tools
Spend some time researching ICD-10 this month. There's a plethora of advice, services and tools available to assist you with ICD-10 readiness. A quick web search can reveal hundreds of free websites, books and articles focused on ICD-10. There's no excuse not to have a good understanding of best practices, coding guidance, metrics and other compliance support. There are also plenty of expert consultants available online, if you need more personalized help.

Form partnerships
Consider teaming up with another facility similar to yours, or one that is a little farther along in the process, to make implementation easier. Sharing information, challenges and advice is important right now, and these partnerships could prove advantageous after the October conversion deadline as well. For example, you can coordinate a training program for staff, or advise each other on how to tackle a common problem.

Don't forget lucky No. 7
One of the biggest differences between ICD-9 and ICD-10 is the 7th character. ICD-10's 7th character provides information on the physician encounter — whether it's an initial or follow-up treatment — not previously included in the old coding system. This is especially crucial for orthopedic surgeons.

Additionally, codes with fewer than 6 characters will need to use the placeholder "X" when that 7th character is required. Refresh staff and doctors on how to use the 7th character. You can find more details in "Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes" in the ICD-10 Tabular List of Codes, a handy 1,593-page PDF you can download at osmag.net/C5ouST.

Document the essentials
ICD-10 requires more specificity than ICD-9. Stress to staff and physicians the importance of capturing the following information about each case, where applicable:

  • detailed anatomical site information
  • time parameters
  • complications
  • laterality
  • any contributing factors

Make capturing info easy
Consider creating a template or checklist to help your doctors record the information above. You can add an "indications paragraph" in the operative notes section, where the surgeon can list all of the essential information about the procedure. Note that many EMR vendors allow you to customize your chart templates. This simple addition to your records can help you avoid major coding confusion.

Be clear about ICD-10-PCS
Ambulatory surgery centers likely will not have to worry about the procedure portion of ICD-10 (known as ICD-10-PCS) since most, if not all, centers use CPT codes to bill for procedures performed. However, double check that your payers' contracts do not require PCS codes and confirm this with each one before Oct. 1.

Think outside of your box
You know how ICD-10 is changing your facility, but what about your business partners? Do you know where they stand? Check in with anyone you work with outside of your facility to ensure they're ready for ICD-10. This includes groups like payers, third party billing companies and software vendors.

Give your forms a facelift
The codes are changing, so your documents will have to, too. ICD-10 requires more specificity, so check that documents like ABNs, history & physical forms, HIPAA disclosure/restriction forms and anesthesia records are in compliance with ICD-10. If this task seems overwhelming for your current staffing levels, consider a freelancer to help update all forms.

Get some help
We know that ICD-10 will likely slow down productivity. If you have any doubt whether your staff can sufficiently handle expected ICD-10 workloads, start looking for external help now. That can be hiring an extra hand to work in-house during the transition, adding a consultant to help out during the transition or moving some of your cases to third-party coders. Don't wait until it's too late to ask for a little help.

This too shall pass
ICD-10 is coming, whether you're prepared or not. If you start now by following the above advice, I can't guarantee that you'll make it to November without a few bumps and bruises — but at least you won't be run over.