ICD-10 Is Almost Here – Are You Ready for the Journey?
 Print this Article | Send to Colleague
Pat Stricker, RN, MEd, Senior Vice President, TCS Healthcare Technologies
The day we have been waiting for (or dreading) is almost here. Unless there has been some drastic change since the time I wrote this article and the time you are reading it, we will be transitioning to ICD-10 codes in less than two weeks! (If there was another delay announced, just bookmark this for future reference, because the ICD-10 journey will happen someday. If not, buckle up and let’s get ready to go!)
This article is not meant to be a discussion on how to get ready for ICD-10; it’s too late for that. It is also not a tutorial on the format, structure, and use of the codes; I assume you have already been trained on these points (or at least I hope you have). For those of you who want more in-depth information on this type of information, I recommend reviewing the very informative ICD-10 Training Guide developed by the World Health Organization.
The intent of this article is to share some light-hearted facts and thoughts about ICD-10, provide you with some hints and tips on how to get to the finish line, and make you feel good about where you are in the process. I’d like us to take a few deep breaths and relax before the "big day." If you are all set for the October 1 date, that’s terrific! If you are almost ready, keep going – the finish line is near! If you aren’t ready at all... all I can say is "good luck"!
Believe it or not, the statistical study of disease began in the 1600s. In 1891, the International Statistical Institute commissioned the development of a classification of causes of death. Over the years, countries began to add data on diseases, morbidity, and injuries. At the 6th International Conference in 1948, this data had evolved into the Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Today, we would describe it as the International Classification of Diseases-6 (ICD-6). The 7th version was released in 1955, the 8th in 1965, and ICD-9 in 1975 (36 years ago). Work on ICD-10 began in 1983 and the diagnosis codes were endorsed for use in 1990, with the full release in 1994. Since that time, 138 countries have implemented ICD-10 for mortality and 99 countries are using it for morbidity. The codes have also been translated into 43 different languages.
Many of you may not realize what a long process the ICD-10 transition has been for the U.S. Plans for implementation began in 1995, but the HIPAA regulations enacted in 1996 put a regulatory hold on the process. The U.S. did implement ICD-10 for mortality coding only (death certificates) in January 1999, but the decision to standardize the use ICD-10 codes for diagnostic, reimbursement, and resource allocation continued to be delayed by regulatory issues and public comment periods.
In 2003, the Department of Health and Human Services (HHS) was given the responsibility to implement ICD-10. Six years later, in 2009, they announced ICD-10 as the new national coding standard and set an implementation date of October 1, 2013. That decision process and announcement only took 14 years (1995-2009)! Although the implementation process was scheduled for another four years, that was later pushed back to 2014 and then finally to 2015. So, it has taken us 20 years to transition to ICD-10! You can see why people want to see it actually happen. And just in time – ICD-11 is just around the corner! It is scheduled for release in 2018, but let’s not think about that just yet. We need to get ICD-10 up and running first, and then it should be easy to transition to ICD-11, right?
We need to keep in mind why we are moving to ICD-10. It’s not just to keep up with the other countries that transitioned years ago; we need to make this change to improve our health care system. ICD-9 codes are 36 years old and use outdated and obsolete terminology that is inconsistent with current medical practice. The ICD-10 codes use updated terminology and specificity to describe diagnoses and procedures now being used in the 21st century versus those used in the 1970s. Other benefits of using ICD-10 codes include:
- Specificity of diagnosis provides more meaningful data about conditions, their interventions and treatments, complications, and reasons for non-compliance, resulting in better evaluation and analysis of medical processes and outcomes.
- Improved data and ability to measure health care services and outcomes, which will provide
better quality of care.
- Improved management of populations due to better data analysis, which will lead to quicker, more informed decisions.
- Improved claims processing, payment methodologies, processes, and resource allocations.
- Support for new, innovative payment models that improve
quality of care and help us move towards value-based purchasing and payment reform.
- Enhanced fraud detection efforts.
- Improved coordination of a patient’s care across providers over time.
- Fewer burdens on clinicians to provide detailed supporting documentation.
- Better comparison of mortality and morbidity data.
- Advanced public health research initiatives and surveillance, analysis of public health trends, and detection of disease outbreaks.
- Better tracking of injuries, accidents, adverse events, and complications from medical devices.
- Improved interoperability and data sharing by assuring that EHRs and programs for value-based purchasing and meaningful-use incentives use the same terminology.
To help organizations prepare for the implementation, CMS developed fact sheets to dispel some of the myths and misperceptions surrounding ICD-10. Review the following examples for more detail and a list of even more resources: Five Facts about ICD-10, Five More Facts about ICD-10, and Myths and Facts about ICD-10-CM/PCS.
- ICD-10 codes will be used for diagnosis and inpatient procedures, not for outpatient and office procedures.
-ICD-10-CM will replace ICD-9 diagnosis codes in all health care settings for diagnosis reporting with dates of service or discharge that occur on or after October 1, 2015.
-ICD-10-PCS will replace ICD-9 codes for hospital inpatient procedures.
-CPT and HCPC codes are not changing.
-CPT: for physicians, outpatient facilities, and hospital outpatient departments
-HCPC: for other products, supplies, and services not included in the CPT codes.
- Non-covered entities like Workers’ Compensation and auto insurance companies are not required to use ICD-10. However, they should consider doing so, since the ICD-9-CM codes will not be updated after October 1, 2015.
- State Medicaid Programs are not required to update their systems to use ICD-10-CM/PCS codes. However, HIPAA requires the development of one official list of national medical code set, so CMS will work with State Medicaid Programs to implement the ICD-10 codes.
- CMS does not require the use of ICD-10-CM External Cause of Morbidity codes; however, State or payer-based programs may require them.
- ICD-10 codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, non-specific codes should be used when documentation doesn’t support the higher level of specificity. CMS will not deny claims for the first year due to lack of specificity. However, this is a practice period, so start to use them as quickly as you can.
- You won’t need to use the 68,000 codes, just as you don’t use the 14,000 codes today. Don’t be overwhelmed by the increased number of codes; they don’t make the system more difficult to use. You will still continue to use a very small subset of codes.
- You will look up ICD-10 codes using a process similar to what you use today to find ICD-9 codes. An alphabetic index, electronic tools, and ICD-10-CM and PCS code books are available to help you find the codes. Over time, you will find ICD-10 codes are actually easier to use and allow you to find more appropriate codes – ones that are much more specific and clinically accurate.
- If you cannot submit ICD-10 claims electronically, Medicare offers several options:
-Free billing software can be downloaded from Medicare Administrative Contractors.
-Part B claims submission functionality is available on about half of the MAC’s provider Internet portals.
-Submission of paper claims, if you meet the provisions of a waiver.
OK, we’ve spent enough time on "intellectual" content; let’s take a break and have some fun. Since there are now 68,000 codes instead of a mere 14,000 codes, and we have seven digits to use to give us much more specific descriptions of diagnoses, that has resulted in some rather weird and silly diagnoses:
- Z63.1 Problems in relationship with in-laws
- R46.1 Bizarre personal appearance (Really?)
- V91.07XDF Burn due to water-skis on fire, subsequent encounter (On fire in the water?)
- 92146 Injured at the swimming pool of a prison (Where is that prison?)
- Y93D1 Stabbed while knitting or crocheting (Wow, what a dangerous hobby!)
- V80.730A Animal-rider injured in collision with trolley (How often does that happen?)
- Y92.024 Injured in the driveway of a mobile home
- Y34 Unspecified event, undetermined intent (Well, that certainly clarifies things...)
- W61.12XA Struck by a macaw
- W5922XA Struck by a turtle (Wow! How fast was he going?)
- W61.62XD Struck by a duck, subsequent encounter (Didn’t he learn the first time?)
- V97.33XD Sucked into jet engine, subsequent encounter (Sucked into a jet engine twice?)
NOTE: "Subsequent encounter" means this is the second encounter with a health care provider as a result of the original event, not that it happened the second time.
Yes, these are legitimate ICD-10 codes. Even though our chances of being struck by a turtle or a macaw in a metropolitan city in the U.S. are slim, we have to remember that it might be more common in other parts of the world. Even though they sound weird, can you see how this type of specific information will allow us to categorize and analyze injuries in a more meaningful way? Based on specific diagnoses, we will also be able to better analyze the types of interventions and treatments that provide the best outcomes. And if we can do that with these types of "silly"
diagnoses, imagine the kind of data we will be able to analyze using realistic clinical diagnoses. If you want to have fun practicing the use of the new ICD-10 codes, check out this interesting training tool that uses humorous case studies. And, just for fun, here are some videos of The Top 5 Zaniest ICD-10 Codes. While these are fun and light-hearted, it is now time to get serious again and focus on what needs to be done in the last few weeks leading up to October 1.
In the time left, you need to focus carefully on making sure you are as prepared as you can possibly be. There
are a myriad of tips and tools out there to help those who still aren’t quite ready, but the following two resources are "must reads." The ICD-10 RoadMap Tool Kit and the ICD-10 Checklist for Implementation Readiness provide ideas and suggestions for the last few weeks of implementation and for the actual "go-live" period. Other helpful websites include:
- Provide last-minute review trainings and practice time for staff so they can maximize their knowledge and productivity.
- Review training documents and practice, practice, practice! The more familiar and "at ease" you are with the ICD-10 codes, the easier the transition will go.
- Convert the top 10-15 diagnoses to ICD-10 codes.
- Ensure documentation procedures are specific and accurate in order to clearly identify all seven characters required for correct ICD-10 coding.
- Strengthen accurate clinical documentation that ensures
coding accuracy and supports efficient billing, steady cash flow, and
optimized reimbursement.
- Test and retest all types of billing and dual coding; focus on the most common claims.
- Develop written procedures for all processes and contingencies for all potential problems. Examples include: how to handle orders written before October 1 with ICD-9 codes, downtime procedures, process for entering manual claims, etc.
- Proactively deal with the potential for reduced productivity so operations and revenue are not impacted: increase staff hours and resources in all affected areas, hire additional staff, increase hours for part-time staff, customer service, etc.
These are suggestions for "go-live" and the first two weeks after transition:
- Ensure management staff and "ICD-10 experts" are available to staff at "go-live."
- Ensure management, clinical, and IT support and responsiveness.
- Create a "war room" that is staffed with resources from all areas and with all staff levels so issues can be monitored, identified, and resolved quickly.
-Quickly identify and triage issues; carefully analyze problems; quickly and correctly resolve each issue; communicate resolution to all involved.
- Carefully monitor all processes, financial metrics, and staff performance.
- Develop a strong, comprehensive, daily communication plan.
-Clearly define all roles and responsibilities.
-Ensure leader involvement, support, and understanding.
-Increase morale and exude a positive attitude.
-Provide reminders through screen savers, group huddles, and daily memos/emails.
-Provide updates, issues/resolutions, tips, instructions, and positive encouragement.
-Communicate, communicate, communicate!
- Conduct short, daily review/communication meetings (15 min): provide updates, discuss issues/resolutions; provide re-education and tips; answer questions; provide positive encouragement.
- Provide a coding hotline and a helpline for customer service.
- Consider providing staff with a "Survival Bag" to keep spirits up that contains humorous, inspirational quotes, free lunch, coffee or gas cards, and some Tylenol (just in case).
The impending transition to ICD-10 has caused an unusual amount of angst for the health care industry. Given the overall changes and highly sophisticated health care procedures available today, should
implementing a new set of diagnostic codes generate this kind of turmoil? Sure, they have caused an enormous amount of extra work to prepare for the change; they will cause a slowdown in productivity; and they will cause financial issues with payments, revenue, and cash flow.
But it’s not all "doom and gloom"! Aren’t we always in the middle of some type of major change in health care? We’ve made it through other major changes in the past, such as Medicare, Medicaid, ICD-9, managed care, DRGs, and the Affordable Care Act. And other countries have implemented ICD-10 codes years ago without a major catastrophe. So why can’t we? We have spent 20 years thinking and planning for it, so I’m sure we can do it. Sure, there will be issues and some may be major, but once the transition is made, we will probably look back and say "that wasn’t so bad."
Remember how difficult it was when computers, and then cell phones, started to invade our quiet, organized lives? Most of us resisted and vowed we would not be tied to our phones, texts, email, and the Internet. Now, can you even imagine not having them? They run our lives. Change is inevitable, and we will get through this transition.
If you have prepared well, it’s time to take a deep breath, relax, and get ready for "smooth sailing." If you haven’t prepared as much as you should have, hold on and get ready for a bumpy ride. We will all eventually get to the same place, but our ride and experience may be different. Bon voyage!
Pat Stricker, RN, MEd, is senior vice president of Clinical Services at TCS Healthcare Technologies. She can be reached at pstricker@tcshealthcare.com.
   
|
