Welcome back to Part II of our continuation on the top five ways to make the most of the ICD-10 implementation delay – October 1, 2015. In Part I, we covered:
- The preparation costs and how to plan a budget
- The necessity of EMR/EHR upgrades, the key EHR features that will assist you in the transition, and how to stay in tight collaboration with your EHR software vendor.
Now we will examine three additional ways to take advantage of the ICD-10 delay, such as honing your clinical documentation, training on ICD-10-CM codes, and testing insurance claims.
3. Hone your clinical documentation to match ICD-10 requirements
ICD-9-CM is different from ICD-10-CM in many respects, so physicians need to adapt their clinical documentation accordingly. For example, ICD-9-CM is 34 years old and includes outdated and obsolete medical terms along with codes that contain imprecise, ambiguous, and incomplete information. ICD-9-CM can’t accommodate for the emerging medical technologies and services administered to patients in the 21st century. Therefore, updated medical terminology and a greater level of detail and specificity set apart ICD-10-CM from ICD-9-CM. Here’s an example:
Mechanical complication of other vascular device, implant and graft
1 code (996.1)
Mechanical complication of other vascular grafts
49 codes, including:
T82.311A – Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.312A – Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.329A – Displacement of unspecified vascular grafts, initial encounter
T82.330A – Leakage of aortic (bifurcation) graft (replacement), initial encounter
T82.331A – Leakage of carotid arterial graft (bypass), initial encounter
T82.332A – Leakage of femoral arterial graft (bypass), initial encounter
T82.524A – Displacement of infusion catheter, initial encounter
T82.525A – Displacement of umbrella device, initial encounter
As you and your personnel train for ICD-10 and start to become familiarized with the new codes, you may need to make slight changes to your clinical documentation in order to adjust to the higher specificity required. Consider utilizing clinical documentation templates tailored to the demands of ICD-10 to get some practice. Clinical documentation that doesn’t meet the ICD-10-CM criteria will delay the claims process because finding the correct ICD-10-CM codes will take longer.
4. Develop an Effective Training Strategy
My advice: sit down with your practice office manager and create a detailed training plan for you, your associate physicians, medical coders, and all other employees who will use ICD-10-CM as part of their jobs. Training for ICD-10-CM may be easier than you think if you compare a traditional comprehensive dictionary to ICD-10-CM. It’s unnecessary to learn every word and its meanings in a traditional dictionary. Individuals only look up certain words instead of studying the entire dictionary!
The same principle applies to ICD-10-CM. You don’t need to memorize all 68,000 ICD-10-CM codes. Instead, isolate a list of the most common and applicable ICD-10 codes to your medical specialty and become thoroughly familiarized with them. This action will narrow down the scope of your training tremendously and make it much easier for you.
With that in mind, there are a multitude of online resources that provide indoctrination for various medical specialties, such as:
- Allied Schools ICD-10-CM and ICD-10-PCS Coding Training
- The Medical Management Institute Online Training
- The American Association of Professional Coders (AAPC) Training for Coders, Physicians, and Managers
- The American Health Information Management Association (AHIMA) Training
Courses in a traditional classroom also exist for those healthcare professionals who prefer this educational platform. The benefit of online educational classes is the flexibility they offer to physicians, medical coders, etc. in terms of time management. Some healthcare professionals can’t take time off from work or their family responsibilities to attend classes on a rigid schedule, but they can progress with their training at their own pace and whenever they have a free moment. On the other hand, classroom training allows healthcare professionals to ask questions and receive counsel, assistance, and hands-on experience with ICD-10. The same can’t always be said of the online courses.
Discuss with your staff before deciding the best and most efficient training course for your specialty-specific practice.
5. Conduct ICD-10 Claims Testing
After you adjust your clinical documentation (if necessary) and train on ICD-10-CM, you should do ICD-10-CM claims testing. As a side note: healthcare providers will only use ICD-10-PCS to report inpatient procedures in hospitals. Physicians will continue to utilize Current Procedural Terminology (CPT) codes, rather than ICD-10-PCS, to report medical procedures and services.
Physician practices should maintain strong communication with their payers and clearinghouses regarding claims testing. These payment processing facilities have to invest a large amount of resources to allow physicians to test claims on top of regular day-to-day claims processing. Larger insurance companies and clearinghouses will be more likely to develop ICD-10 claims testing as a side business function than smaller ones. Therefore, find out if your insurance carriers will offers it because not every insurance carrier or clearinghouse will provide testing opportunities.
ICD-10-CM claims testing will give you valuable practice filing claims based on ICD-10 codes and requirements. Snags, errors, and problems are bound to arise when you start testing. You will have a chance to iron out the kinks and resolve any issues before the deadline. This strategy facilitates a much smoother transition after the deadline. It makes sense to handle these problems beforehand so you won’t have to face the revenue hit and stress that comes from delayed or denied claims after October 1, 2015.