Healthcare professionals and ambulatory surgery centers nationwide will be slowly transitioning to the ICD-10 code set in attempts to meet the Oct. 1, 2014, deadline for implementation.
Here are seven practical tips from industry professionals to make the next 20 months optimally productive and the overall switch as non-disruptive as possible.
1. Start anatomy and physiology training for coders. Code set training should not start until 6-9 months before ICD-10 implementation, said Rhonda Buckholtz, CPC, CPMA, CPC-I, of AAPC. Any earlier and coders are likely to forget the information and need additional training, which would cost your ASC more money. Instead, coders should be focusing on anatomy and physiology training to make sure they can code to the level of specificity required by ICD-10.
Coders can take external courses in anatomy and physiology or independently study using an up-to-date textbook. No matter the method, make sure to pay for training to retain coders. Once the ICD-10 implementation date rolls around, coders will be in short supply and you will want to build loyalty before then.
2. Go through a "day in the life" of an ICD-9 code. Raemerie Jimenez, director of education for AAPC, recommends that information technology personnel and coders work together to analyze a "day in the life" of an ICD-9 code. She said many practices and facilities will underestimate the number of systems and programs that will be affected by ICD-10. The "day in the life" will help them clarify what needs to transition to the new system. "If you just did a day in the life of an ICD-9 code and walked through every system that's affected, you'd see the systems that need to keep working correctly with the new codes," she said.
ASCs may underestimate the impact of ICD-10, she said, because they buy electronic systems piece-by-piece instead of all at once. "They don't get everything, so when they need another function, they look for a different program and apply all these band-aids to help the programs communicate with one another," she said.
3. Help specialty coders expand their knowledge base. Specialty coders, or coders who concentrate on a particular specialty such as GI, may face new challenges in the transition to ICD-10. "It will be a challenge because you won't just have to learn the GI portion of ICD-10, you'll have to learn the whole thing in order to assign the co-morbidities," said Rosalind Richmond, CCS, senior consultant for Open Minds. "A lot of facilities assign work based on specialty to get the work out faster, so you have a lot of specialized coders." She says these coders may need to re-train in other areas as they prepare for ICD-10 implementation.
4. Perform a gap analysis on in-house coding staff. If an ASC has not outsourced its coding to a third-party vendor, the ASC leaders will have to perform a "gap analysis" to determine where coder weaknesses lie prior to training, said Lolita Jones, RHIA, CSS, independent coding and billing consultant. "Usually that will focus on biomedicine skills," she said. "For instance, how strong are they in medical terminology, anatomy and physiology and even pharmacology?" ASCs can find free gap assessments on AHIMA's website and other sites, she said. The gap assessment will help the ASC administrator understand where coders need to concentrate their training and how long training will take.
5. Budget for all possible costs. Some costs of the coding transition are obvious, such as software and hardware upgrades, but practices should plan additional funds to cover any unexpected indirect costs that may arise. Direct costs may come with coder training and clinical education, testing, consulting services, data conversion and form redesign and printing. However, some unforeseen monetary losses could result from a drop in productivity after the initial implementation, increased accounts receivable cycles and temporary staffing to assist with billing backlogs.
6. Be aware of workers' compensation. Workers' compensation is exempt from ICD-10, meaning they will continue on ICD-9. If your surgery center treats a large volume of workers' compensation patients, be prepared to work in ICD-9 and ICD-10 at the same time or dual code. For some surgery centers, the complexity of this transition or the retirement of current coders might mean outsourcing these functions will be easier and more cost-effective.
"If you are thinking about outsourcing, do it today and lock in a long term contract," said Kevin McDonald, senior vice president of surgery sales at SourceMedical Solutions. "There are a lot of unknowns. We are concerned that costs will go up, and if you can get a billing services group to enter into a long term agreement with you, you could come out very well."
7. Determine whether new codes can be used to renegotiate contracts. Coders should thoroughly review the ICD-10-CM codebook to see whether new codes can be used to renegotiate contracts, Ms. Jones said. "The ASC may now be in a position to collect information on patient lifestyle that has an impact on surgery and how they're treated," she said.
For example, obesity is coded more thoroughly in ICD-10-CM, with many different codes used to capture the causes and types of obesity. She said this information could be coded and reported on a claim, and ASCs should build that into their contract information.
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