PMI Addresses the Transition to ICD-10

ICD-10 Implementation Delayed Until Oct. 1, 2014

On August 24, 2012, the Centers for Medicare and Medicaid Services (CMS) announced that the implementation date for ICD-10 would be delayed one year. This moved forward the ICD-10 code set implementation date to October 1, 2014. These code sets, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes. ICD-10-CM is a far superior system to ICD-9-CM. Developed by the World Health Organization in 1993, ICD-10 has already been adopted nearly worldwide. Actual unique codes increase from around 14,000 to about 68,000. This allows for a considerably higher degree of specificity and facilitates huge gains in communication, tracking and outcome studies.

After years of speculation and planning the United States is scheduled to transition from ICD-9-CM to ICD-10-CM. As with any project of this magnitude, the scheduled implementation date has experienced some delays, as the professional staff at PMI predicted, but the conversion process continues to move forward. What is clear is that the actual work to successfully transition to the new system should already be well underway before the full implementation date.

Implementation of ICD-10 will accommodate new procedures and diagnoses unaccounted for in the ICD-9 code set and allow for greater specificity of diagnosis-related groups and preventive services. This transition will lead to improved accuracy in reimbursement for medical services, fraud detection, and historical claims and diagnoses analysis for the health care system. Many researchers have published articles on the far-reaching positive effects of ICD-10 on quality issues, including use of specific reasons for patient non-compliance and detailed procedure information by degree of difficulty, among other benefits.

Version 5010 and the NCPDP D.0 and 3.0 Standards

You should already have completed the transition from the 4010A1 Transaction Code Set to the new 5010 Transaction Code Set. All health care entities were required to have Version 5010 in place by January 2012. Business partners such as billing services, clearinghouses, or practice management software vendors should also be compliant with Version 5010. If not, you should obtain written documentation from business partners regarding the status of compliance with Version 5010 and the National Council for Prescription Drug Programs (NCPDP) D.0 and 3.0 standards.

Testing transactions now using Version 5010 standards helps ensure health care organizations will be able to:

• Send and receive compliant transactions effectively
• Address any potential issues in advance
• Avoid problems with submitting claims for reimbursement after the compliance deadline

Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT, and finance staff to coordinate on ICD-10 and Version 5010 transition efforts. If you haven't completed the 5010 Upgrade, your practice is risking denied Medicare claims and enforcement penalties effective as of June 30, 2012.

ICD-10-CM Implementation

While the final date of implementation was delayed by one year, it is clear is that preparations should not stop! Everyone in the office needs to familiarize themselves with the new coding system now. CMS has published a lot of good information on their web site to help health care professionals orient to ICD-10. Review the following links from the CMS ICD-10 Web site to get you started:

ICD-10 Basics for Medical Practices

ICD-10 Transition Basics and Frequently Asked Questions

Small Providers Implementation Timeline

Clearly, the transition to ICD-10 implementation is a staged process. CMS advises providers to develop an implementation strategy that includes assessment of impact on your office, a detailed timeline and budget.

6 Stages of ICD-10 Implementation

1. Planning
2. Communication and Awareness
3. Assessment
4. Operational Implementation
5. Testing
6. Transition

For more information, review this informative guide prepared by CMS: Guide to ICD-10 Implementation for Small and Medium Practices

Staff Training

When it comes to the staged ICD-10 implementation, many offices have just begun to scratch the surface. Training is an integral piece of the transition pie. The staged implementation has many components and will work best when phased in over time. The process is already well underway and your ICD-10 plan should be moving forward now.

PMI began its ICD-10 training series last year, focused on promoting awareness with classes that painted the ICD-10 picture with a broad brush, explaining the system in real-world terms that everyone could get comfortable with. The feedback was excellent as relieved participants told us that the conversion didn't appear as difficult as they thought it was going to be.

PMI is leading the way with targeted training created especially for medical office professionals. PMI workshops are currently being taught in classrooms across the country. PMI courses have been developed in accordance with CMS staged implementation and are designed to reinforce and build on the participant's existing body of knowledge, providing better overall comprehension and retention. These classes will prepare your office from the front to the back, moving you closer toward successful implementation. ICD-10-CM planning in the private practice setting can be divided into two camps, coders/third party billers, and managers.

ICD-10 Transition for Coders and Third Party Billers

For most physician office staff, training should be underway this year. PMI has already begun teaching its first phase of ICD-10 to office managers, coders and billing staff across the country both in classrooms and via webinars. All PMI Certified professionals should participate in ICD-10 continuing education in order to demonstrate proficiency. ICD-10 training is being integrated into many of the programs that PMI offers to certified professionals to maintain their credentials. Actual use of ICD-10-CM codes by coders will not begin until October 2014. PMI currently estimates that a Certified Medical Coder / Certified Medical Insurance Specialist should participate in some training - between 24 and 40 hours of ICD-10 instruction - to augment their existing skill set. All reimbursement staff should have already begun to orient themselves to the characteristics and differences between the two coding systems and more intensive training should begin within the next year, prior to implementation. This is to ensure optimal retention of the information prior to being put into daily use.

PMI ICD-10 classes include terminology instruction for coders focused on:

Determining what is and is not relevant in a medical record relative to the coding scenario

Transitioning to ICD-10
This class will explain the steps you can take now to improve your understanding of ICD-10. While the new codes won't be released for two years, every coder must get familiar now with changes coming with the new coding system. For example: ICD-10 includes 50 different codes for "complications of foreign body accidentally left in body following a procedure" compared to one code in ICD-9. ICD-10 codes will be much more descriptive, requiring a good understanding of both anatomy and medical terminology. Learn key points that every coder must know about this new system. Walk away from this program with valuable tips for a smooth transition to ICD-10.

Diagnostic Coding for Physician Services
Curb error rates now and put an end to denials that are decreasing your reimbursement. This class includes exercises that will sharpen coding accuracy, decrease reliance on EMRs, and protect the practice from RAC audits. ICD-9-CM revisions are becoming even more specific, requiring more detailed documentation in preparation for ICD-10. With more incremental changes to diagnostic coding already underway, coders must keep up or get left behind.

ICD-10 Coding Workshop
This class is appropriate for anyone in the practice. Experienced coders will get the technical details they need to begin learning the ICD-10 system. Clinical and non-clinical staff seeking a better understanding of the overall conversion are also encouraged to attend. Get important information on proper documentation procedures along with coding examples that will improve your ICD-10 coding comprehension and get you on the right track for the next phase of implementation.

Coding ICD-10: The Next Level
The Coding ICD-10: The Next Level class is designed to take coders with basic knowledge of ICD-10 to the next level. Armed with an improved foundation in documentation, medical terminology and anatomy and physiology, participants will be able to put their new knowledge into action in this class. Find out how many diagnostic codes can be used and what to look for when Superbills go away. Compare and contrast the terminology in ICD-9 with the codes for ICD-10. Hands-on work will reinforce knowledge base.

Specialty-Specific ICD-10 Training

PMI's TOTAL ACCESS program already has a growing library of 90-minute, specialty-specific ICD-10 training webinars, developed and presented by coding expert, Nancy Maguire. New sessions are conducted monthly as live webinars and archived on PMI's Web site for training on-demand.

ICD-10 Transition for Managers

The transition for managers is different than coders. Planning and system upgrades should already be underway. Study timelines and resources on the CMS Web site and stay tuned to PMI for operations-related training updates.

Nancy Maguire has developed a guide to help offices get comfortable with ICD-10. Using humor and her unique motivational touch, Nancy speaks to readers in their language, guiding them down the implementation path.

Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT
Nancy is a nationally-renowned procedural and diagnostic coding instructor, boot camp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations.