The official start date for ICD-10 isn't until Oct. 1, 2013, but that doesn't mean surgery centers should delay the implementation process. Rhonda Buckholtz, CPC, CPMA, CPC-I, of AAPC, discusses seven steps surgery center leaders should take over the next six months to prepare for the transition.
1. Start anatomy and physiology training for coders. Code set training should not start until 6-9 months before ICD-10 implementation, Ms. Buckholtz says. If training starts earlier than that, coders are likely to forget the information and need additional training, which would cost the center 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 bone up on the subject using an up-to-date textbook. Whichever method you choose, 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 want to build loyalty before then.
2. Start training physicians on documentation. Physicians need to start working on ICD-10 documentation immediately, Ms. Buckholtz says. "ICD-10 has a much higher level of specificity, and some of the concepts found in ICD-10 weren't found in ICD-9."
She has conducted thousands of documentation readiness audits through AAPC and has found that about 35 percent of the time, the coder is unable to assign an ICD-10 code based on physician documentation. "Either you can't assign a code, or you can't assign one to the level of specificity that is going to be required," she says.
If physicians are hesitant to start documentation training, emphasize that if their claims do not get paid, they will be living on 65 percent of their previous revenue, she says. If you can afford to hire a consultant to perform an external audit, Ms. Buckholtz recommends this strategy. Otherwise, you can test physician documentation progress on a regular basis by asking coders to try assigning ICD-10 codes based on the information given.
3. Talk to your vendors about their transition plans. Call up your software vendors as soon as possible to talk about their ICD-10 transition plans, Ms. Buckholtz says. You should also take a look at your vendor contracts and determine whether government-mandated upgrades are considered free through your contract. Ms. Buckholtz says the price of upgrades simply depends on the company — some will offer the service for free, and some will charge a hefty fee.
Some vendors may even choose not to make the transition to ICD-10 — an issue you need to know about as soon as possible. "You don't want to be left hostage at the last minute, finding out your vendor is not going to make the transition," she says. You may also find the vendor offers the software upgrades for free, but you don't have the hardware to accommodate it. Find out your areas of need now so you can budget for any necessary purchases over the next few years.
4. Talk to commercial payors about their transition plans. Check with your commercial payors immediately to find out how they're making the transition to ICD-10. You need to know whether they are going to make changes to policies and payments so you can adjust your processes and reimbursement expectations to match. Ms. Buckholtz says you may also discover your payor offers free education on ICD-10. Call up your representative today to find out if you can take advantage of complimentary training or, at the very least, talk through the transition process.
5. Make a contingency plan for workers' comp — especially if you are orthopedic-driven. Workers' comp and auto insurance are not required to make the switch to ICD-10, which could pose problems for your surgery center if you rely heavily on them for orthopedic procedures. In most cases, the payors will probably make the switch, but you should contact your workers' comp and auto insurers anyway to find out. "Especially in orthopedic practices and centers, you need to find out whether your panels are making the decision and then make a decision on whether or not to stick with the payor," Ms. Buckholtz says.
6. Follow the "day in the life" of a diagnosis code. There are many ASC policies, procedures and software products that will be affected by the transition to ICD-10 — in fact, every piece of paper or program that contains diagnosis codes. To make sure you don't miss any areas that will be affected, go through the "day in the life" of a diagnosis code at your facility, from the first time the surgery center calls the patient to the last check-in after discharge.
"Go through and do the physical inventory to find out where the diagnosis code is tied into your center," Ms. Buckholtz says. Ask your staff members to help you in this process; chances are, your business office manager and receptionists will know where diagnosis codes live in your center and how they affect your operations.
7. Determine which policies and procedures will be affected by ICD-10. Some policies and procedures will be affected by the transition to ICD-10, especially those that require diagnosis codes on forms, Ms. Buckholtz says. For example, every time a surgery center provides a service for a Medicare beneficiary, the staff has to provide an advanced beneficiary notification. If your surgery center has made customized ABN forms for this process, you will need to adjust the code fields to fit with ICD-10.
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1. Start anatomy and physiology training for coders. Code set training should not start until 6-9 months before ICD-10 implementation, Ms. Buckholtz says. If training starts earlier than that, coders are likely to forget the information and need additional training, which would cost the center 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 bone up on the subject using an up-to-date textbook. Whichever method you choose, 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 want to build loyalty before then.
2. Start training physicians on documentation. Physicians need to start working on ICD-10 documentation immediately, Ms. Buckholtz says. "ICD-10 has a much higher level of specificity, and some of the concepts found in ICD-10 weren't found in ICD-9."
She has conducted thousands of documentation readiness audits through AAPC and has found that about 35 percent of the time, the coder is unable to assign an ICD-10 code based on physician documentation. "Either you can't assign a code, or you can't assign one to the level of specificity that is going to be required," she says.
If physicians are hesitant to start documentation training, emphasize that if their claims do not get paid, they will be living on 65 percent of their previous revenue, she says. If you can afford to hire a consultant to perform an external audit, Ms. Buckholtz recommends this strategy. Otherwise, you can test physician documentation progress on a regular basis by asking coders to try assigning ICD-10 codes based on the information given.
3. Talk to your vendors about their transition plans. Call up your software vendors as soon as possible to talk about their ICD-10 transition plans, Ms. Buckholtz says. You should also take a look at your vendor contracts and determine whether government-mandated upgrades are considered free through your contract. Ms. Buckholtz says the price of upgrades simply depends on the company — some will offer the service for free, and some will charge a hefty fee.
Some vendors may even choose not to make the transition to ICD-10 — an issue you need to know about as soon as possible. "You don't want to be left hostage at the last minute, finding out your vendor is not going to make the transition," she says. You may also find the vendor offers the software upgrades for free, but you don't have the hardware to accommodate it. Find out your areas of need now so you can budget for any necessary purchases over the next few years.
4. Talk to commercial payors about their transition plans. Check with your commercial payors immediately to find out how they're making the transition to ICD-10. You need to know whether they are going to make changes to policies and payments so you can adjust your processes and reimbursement expectations to match. Ms. Buckholtz says you may also discover your payor offers free education on ICD-10. Call up your representative today to find out if you can take advantage of complimentary training or, at the very least, talk through the transition process.
5. Make a contingency plan for workers' comp — especially if you are orthopedic-driven. Workers' comp and auto insurance are not required to make the switch to ICD-10, which could pose problems for your surgery center if you rely heavily on them for orthopedic procedures. In most cases, the payors will probably make the switch, but you should contact your workers' comp and auto insurers anyway to find out. "Especially in orthopedic practices and centers, you need to find out whether your panels are making the decision and then make a decision on whether or not to stick with the payor," Ms. Buckholtz says.
6. Follow the "day in the life" of a diagnosis code. There are many ASC policies, procedures and software products that will be affected by the transition to ICD-10 — in fact, every piece of paper or program that contains diagnosis codes. To make sure you don't miss any areas that will be affected, go through the "day in the life" of a diagnosis code at your facility, from the first time the surgery center calls the patient to the last check-in after discharge.
"Go through and do the physical inventory to find out where the diagnosis code is tied into your center," Ms. Buckholtz says. Ask your staff members to help you in this process; chances are, your business office manager and receptionists will know where diagnosis codes live in your center and how they affect your operations.
7. Determine which policies and procedures will be affected by ICD-10. Some policies and procedures will be affected by the transition to ICD-10, especially those that require diagnosis codes on forms, Ms. Buckholtz says. For example, every time a surgery center provides a service for a Medicare beneficiary, the staff has to provide an advanced beneficiary notification. If your surgery center has made customized ABN forms for this process, you will need to adjust the code fields to fit with ICD-10.
Related Articles on ICD-10:
How Are Payors Preparing for ICD-10?
With ICD-10 Coming, What is a Coder's Earning Potential?
CMS Releases Four ICD-10 Implementation Handbooks to Ease Transition