Are Practices More Ready for ICD-10 Than They Realize?

Recent survey results from the Workgroup for Electronic Data Interchange (WEDI) seem dire for physician practices, but the numbers may not tell the whole story.

The WEDI survey, released amid fanfare as the industry hurtles towards the Oct. 1 deadline for the ICD-10 transition, revealed that less than half of physician practices surveyed (350 in total) said they would be ready for the switch. Moreover, only approximately 20 percent of physician practices said they have started or completed external testing, 15 percent have conducted impact assessments, and 40 percent said they'd test only with clearinghouses.

The stats regarding physician practices were in stark contrast to the data from WEDI on the rest of the industry - including hospitals and health systems, payers, and vendors - which painted a picture of near readiness. Physician practices could be facing a rough transition come Oct. 1 if they are as ill-prepared as they say. However, Jim Daley, Director of IT at BlueCross BlueShield of South Carolina and Co-Chair of WEDI, isn't convinced they are this far behind.

"Many of them may in fact be ready, even though they responded [negatively]. They may figure out a lot of the work is done for them, such as vendor software upgrades or other things that will help them along their preparation," Daley said. The first thing physician practices should do between now and Oct. 1, he added, is ensure their software is updated to handle ICD-10. "Many may be surprised [the upgrade] is out there and they're just not aware of it."

Lack of understanding

For many physician practices, Daley said they probably don't understand what's needed to switch over to ICD-10. He said that many still think they have to know the countless numbers of codes that come with ICD-10, which total approximately 68,000. The truth is they probably don't have to use a significant percentage of those codes, such as those for hospital inpatient procedures.

"General physician offices will continue to use CPT codes, but make sure the diagnosis is appropriate for the procedure they are doing. In many cases, that's a small number of codes," Daley said. "Depending on the office, they may use a few dozen codes. Some may go beyond that, but it's not going to be 68,000."

Along with ensuring systems are updated, Daley advises practices to talk with key training partners. This should include medical societies, physician user groups, clearinghouses, and payers. He noted that many partners, especially payers, will already be ready to go and can be of assistance to practices. Another one of his tips is to use the plethora of resources from WEDI and CMS, which give specific details on the transition.

In a sense, Daley said that physicians haven't had as much to do for the ICD-10 switchover as other parties. "The big payers, they've spent tens of millions [of dollars], some have spent even more than that. The big hospital systems, same thing. Physicians don't have anywhere near that complex mix of systems and processes … especially a small office. They need to understand what the codes are, understand that the software is upgraded. Some of that can be learned in a fairly short order," he said.

In contrast to those millions of dollars being spent by payers and health systems, Daley said that some studies have pegged the switchover at under $10,000 per physician practice. Other studies, such as this one from AHIMA, have it well below that figure, while some, such as this one from the AMA, have it above.

No more delays

One thing physician practices shouldn't do, Daley said, is bank on another delay. He said that it's too late; Medicare can't undo its systems. Bills in Congress intended on delaying the transition once more will not go anywhere, he predicted.

The recent changes from CMS, which allowed for more flexibility when coding in ICD-10, also have been misunderstood. "I've seen people say CMS softened the requirements, that's not really the case," he said. "It still has to be a valid code, it still has to be in ICD-10, and it must make sense, related to that condition or procedure that has been performed."

Daley notes that the provision for coding laxity only applies to the post-payment process, not getting claims paid. The announcement also doesn't apply to commercial payers. "It's not as big of a relief as some were interpreting," he said.

Despite this, Daley said the readiness concerns are likely being overstated. He used an example of one physician's experience switching to ICD-10 overnight, who gave testimony on the transition during a Congressional hearing in February.

"This physician's office had a pilot version of the vendor software and decided to go from using ICD-9 codes on a Friday to using ICD-10 codes the next Monday. They had no special training and they didn't spend a dime on upgrades. They just decided to start doing it on a Monday and everything went business as usual. It can be done extremely reasonably," Daley said.