Nurse practitioners and other health care providers likely have ICD-10 on their minds. After all, the implementation date is 10/1/2015.
Take a look online and you’ll find no shortage of articles on ICD-10. It makes sense as the potential impact to our practices will be significant. Unfortunately, there is also data showing that most of us are not ready for it either.
There seems to be no question that ICD-10 is almost on our doorsteps. So let’s talk about what you can do right now to get ready.
Learn the Codes
Get your hands on the codes! One major difference between ICD-9 and ICD-10 is the shear number of codes (over 14K to over 68K). They require us to be more specific in our diagnosis and coding. For example, in ICD-9, diabetes has 69 codes. In ICD-10 there are 239 codes. It’s not all that bad though, migraines go from 40 codes to 44 codes.
Hint: Find the ICD-9 codes that you use constantly (we all use just a small fraction of codes) and then look for the corresponding ICD-10 codes. Be sure and look at the requirements for each code to match them to your appropriate patients.
The code structure tells you a bit more about what ICD-10 is looking for. This example is from a presentation given to NPBO™ members several months ago.
There are plenty of books available on ICD-10 in your favorite bookstore. You can also download the 2016 Code Table and Index at CMS.
And in case you were wondering, the CPT codes (procedure and visit codes) are essentially staying the same with minor updates.
Educate yourself and your staff
Staff Training is key. Everyone in your office that comes into contact with ICD codes will need to learn about ICD-10. This includes all providers and clinical staff as well as your coding/billing staff. For providers, we will need to get up-to-speed on documentation that is required for ICD-10. Requirements may include (depending on the problem you are documenting):
- Onset of care/problem: new, follow up, acute, chronic, persistent, recurrent
- Anatomical site specificity, anterior, posterior, superior, inferior
- Laterality – left, right, unilateral, bilateral
- Disease severity – mild, moderate, severe
- Etiology and manifestation – external factors (i.e., smoker), internal factors
- Complications of the problem
Update Forms and Processes
Any form that has an ICD-9 code on it needs to be updated. This includes superbills, order sheets and the like. If for some reason you are still doing paper billing, you’ll need to update your form CMS 1500 to allow for ICD-10 codes. And don’t forget any invoices you may have prepared for your patients… they too should have ICD-10 codes.
Every resource recommends you talk with your vendors and your health plans to confirm they are ready. Do you outsource your billing? Is the staff trained and ready to go? Have they checked and tested their systems? What about the clearinghouse? All of the health plans that I am credentialed with have sent out documentation confirming their readiness… so check to see if yours are ready as well.
Test, test, test
Test your systems and processes. In most cases, you can send in claims to see if they are going through with the new codes. You’ll want to check with your health plans, clearing houses and vendors to get details on how they want you to test.
Why Do This?
Change is never easy for any of us, and certainly not for such a massive change that we will be seeing in medical coding and billing. It’s unsettling that I keep reading that payments will be delayed due to denied bills and that practices should be ready for an initial reduced cash flow. Thus being as ready as you can for this change will help you weather the possible coming storm.
I’ve prepared a copy of this article in PDF, along with additional resources that may help educate you and your team as you work toward ICD-10 readiness.
Do you feel your practice is ready? What tips can you share with other healthcare providers? Let us know in the comments?