Warren Averett conducts practice management roundtable discussions in multiple locations across Alabama and Florida.  As we began 2014 discussions, it became evident that many practices are not aggressively preparing for the ICD‐10 transition. We understand the immense burden on medical practices, both administratively and clinically, but the transition to ICD‐10 on October 1st of 2014 is the biggest factor to impact healthcare revenue in decades.

Many physicians and managers thought ICD‐10 would be delayed again, which has encouraged a lack of participation.  Physicians will be impacted at the office level and the hospital level; therefore it is important to understand the key factors in this transition in order to be successful.  This is not only a coding initiative; it is technology‐driven, communication‐driven and documentation‐driven.  Each practice should identify the positions and systems that will be affected by the transition to ICD‐10, and prepare a team to outline the areas to begin preparation, communication and planning.

Below are steps to consider:

  • Obtain crosswalks for the top 50 ICD‐9 codes you currently report. You can acquire these, by specialty, at AAPC.com or through your specialty’s association.
  • Contact your practice management vendor, EMR vendor and clearinghouse for update schedules, readiness notification and testing dates for carriers.  Alabama BCBS tested claims March 3‐7, 2014.  For Georgia and Florida dates, contact the clearinghouse and carrier.
  • Will your EMR vendor update your diagnosis codes or will you be expected to do it? Will you have to update your templates?  If so, how many are there?
  • If you are using a paper superbill, discuss options available once you review the impact of the crosswalk.
  • Review each physician’s documentation for descriptive support of the diagnosis code.  Could you code the diagnosis with ICD‐10 codes based on the details provided?  If documentation is an issue, consult a coding specialist to counsel the physician on enhanced documentation.
  • Consider applications or computed automated coding as a tool for assisting physicians with coding at the service level.

ICD‐10 will encompass 5 times the number of codes available in ICD‐9.  After the October 1 date of service, ICD‐9 will not be accepted.  Claim forms are already updated to allow up to 12 diagnoses opposed to 4 diagnoses. ICD‐10 is highly specific so it will be difficult for staff to code to this level unless the documentation is specific.

As a certified coder, I believe medical documentation has deteriorated with the implementation of electronic medical records.  Engage a physician on your team to improve documentation efforts and reinforce the importance of demonstration and medical necessity in the documentation to support the services that were performed.