Steps to ICD-10 Preparedness

Mike Patel
Mike Patel

Guest post by Mike Patel, CEO, Meditab Software.

As most healthcare professionals know, an important step in the improvement of healthcare quality and cost will take place in October 2014, just under a year from now.  This important step is the transition from ICD-9 to ICD-10 – with this new code set, the largest financial system change will take place since the Prospective Payment System (PPS) in 1983.

This change has to take place for several reasons including that with a maximum of 13,000 codes, ICD-9 is not specific enough for detailed diagnoses and the current codes do not reflect new services and technology in CMS payment systems. With more than 171,000 codes, ICD-10 will provide much more detailed clinical pictures and data, improving accuracy in all aspects of patient care. New data available through ICD-10 will help determine public health needs and identify trends, as well as helping to spot bioterrorism and epidemics.

The transition will not only impact healthcare organizations, but also physicians, for whom it will be particularly beneficial. Physicians will be able to determine the severity of illnesses more clearly, and, therefore, quantify the level of care more accurately. The codes will also create an electronic trail of documentation, which can help physicians receive proper payment and ensure their reputation remains in good standing.

With the importance and significance of this transition, it is crucial that ample preparations are made. However, there are many organizations that have not yet embarked on the road to preparedness and many concerns exist throughout the industry. For example, according to a survey conducted by the MGMA-ACPME of 1,200 office-based practices surveyed, approximately 70 percent of respondents were very concerned about expected loss of clinician productivity and the same percentage was very concerned about changes to clinical documentation. 71 percent surveyed responded that, in order to accommodate ICD-10, their EHR systems either were upgraded or still need to be upgraded, will need to be replaced, or they are unsure which. Only 0.6 percent had tested their EHRs for ICD-10 compliance.

Undoubtedly, some healthcare providers will ask – is training really necessary? It absolutely is. To maintain their certifications, all medical coders must take a minimum number of ICD-10-specific CEUs before the compliance date. Each certifying organization determines the number of CEUs required. A follow-up question will most likely be – how much training does my staff need? It’s best to begin by conducting a gap analysis to determine the team’s knowledge of medical terminology, pharmacology, pathophysiology, anatomy and physiology. It is also important to review samples from different types of medical records to see whether the current level of documentation contains enough detail for ICD-10 coding. These initial steps will help determine a baseline for training needs.

While the training mostly focuses on the coding and billing staff, physicians have a learning curve too, as they will be required to provide more detailed documentation in visit notes to correlate with the new codes. Physicians with specialty-specific tools will be in the best position to make sure ICD-10 doesn’t have a negative impact on their revenue stream.

Below are some takeaway tips that all practices and physicians should keep in mind.

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Mike Patel graduated from pharmacy school at the age of 20 and upon graduation, grew a pharmacy business to more than $16,000,000 utilizing technology and maximizing workflow. During the course of his pharmacy work he realized he wanted to help physicians improve their efficiency and so started the development of IMS in 1998.  His vision was to design software for the healthcare arena to improve patient care and maximize efficiency.      

One comment on “Steps to ICD-10 Preparedness”

Good article…. Resources support will be getting tighter and tighter by the week. Start early and avoid the sleepless nights.

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