10 Key Points about the ICD-10 Transition for Medical Practices

Starting Oct. 1, 2014, all healthcare entities covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are required to use ICD-10 codes for services. Implementing ICD-10 will benefit physician practices, patients, and the broader healthcare system. As you prepare for the transition, here is a list of 10 key points your medical practice needs to know and tips for implementing ICD-10.

1. CMS made it clear there will be no further implementation delays. Oct. 1, 2014 is the compliance deadline.

2. ICD-10-CM will be used by all providers in all healthcare settings while ICD-10-PCS, for procedures, will be used only for hospital claims for inpatient hospital procedures. ICD-10-PCS will not be used on physician claims, even those for inpatient visits. CPT and HCPCS codes will continue to be used for physician and ambulatory services including physician visits to inpatients.

3. ICD-10-CM, used for diagnoses, offers a number of benefits for physician practices, including:

• Updated medical terminology and classification of diseases more consistent with current clinical practice;

• Improved efficiencies and lowered administrative costs including fewer rejected and improper reimbursement claims as well as decreased demand for submission of medical record documentation; and

• Better justification of medical necessity of services provided.

4. Development and execution of an ICD-10-CM educational strategy is critical to a successful transition.

• Different roles will require different levels of training.

• Physician practice coders will only need to learn ICD-10-CM, not ICD-10-PCS.

• Training for coders working in a medical specialty area can focus on the subset of codes used most by the practice.

• Physician practices should expect that each coder will require three days to four days of ICD-10-CM training, depending on their level of ICD-9-CM knowledge.

• Intensive coder training should occur starting in January 2014 through March 2014, six months to nine months prior to Oct. 1, 2014 compliance date.

5. The quality of medical record documentation should be assessed to identify opportunities for improvement.

• Consider how documentation might be improved to support multiple initiatives, not just ICD-10.

• Keep in mind that not every area of expanded detail in ICD-10-CM will lead to a need for a documentation improvement strategy, as some of the detail may already be documented.

6. Clinical documentation improvement is not driven by the ICD-10 transition.

• High-quality medical record documentation is increasingly in demand to support multiple healthcare initiatives aimed at improving care and reducing costs.

• The inclusion of expanded detail and specificity in ICD-10-CM was in response to demands for more detailed healthcare data and the quality of the data depends on the quality of the clinical documentation.

• Better clinical documentation promotes better patient care and more accurate capture of acuity and severity for:

     • More accurate clinical picture of the quality of care provided

     • Quality measures

     • Reimbursement

     • Severity-level profiles

     • Risk adjustment profiles

     • Provider performance profiles

     • Justification of medical necessity

     • Avoidance of misinterpretation by third parties (auditors, payers, attorneys, etc.)

7. Although ICD-10-CM has a greater number of codes than ICD-9-CM, it is not more complex to use. In fact, ICD-10-CM’s increased specificity and clinical accuracy make the process of identifying the correct code easier.

8. Use of electronic tools, such as computer-assisted coding technology and EHR templates and prompts, can facilitate the coding and documentation processes by increasing productivity and accuracy, improving clinical documentation at the point of care, and reducing costs and claim rejections.

9. Although ICD-10-CM contains expanded detail, "unspecified" codes are still available for use when sufficient clinical information is not known or available to report a more specific code.

10. Although the effect of the ICD-10 transition is significant, practices that prepare thoroughly, ensure proper education for their staff, and conduct sufficient testing prior to ICD-10 implementation will experience a smoother transition, decreased transition costs, fewer claims rejections and denials, higher coding accuracy and productivity, and earlier realization of benefits than less-prepared providers.

Sue Bowman, MJ, RHIA, CCS, FAHIMA is senior director for coding policy and compliance with the American Health Information Management Association (AHIMA). AHIMA represents more than 67,000 HIM professionals, and is dedicated to helping physicians transition to ICD-10. E-mail her here.