Areas Of Focus To Navigate From ICD-9 To ICD-10

By Brian Diaz, Director of Marketing with Health Language, part of Wolters Kluwer Health

As the healthcare industry migrates from ICD-9 to ICD-10 many organizations find that with less than six months to go before the October 1, 2015 compliance deadline they’re applying new strategies, shifting focus and addressing critical areas that need urgent attention.

Switching to ICD-10 diagnostic and procedural codes was never going to be easy. What makes the conversion work complex is that ICD-10 code sets have greater detail, changes in terminology, and expanded concepts for injuries, diagnosis and other related procedures.

Added to this, prioritizing tasks, developing plans to mitigate potential financial risk, and finding the right skills to help with the ICD-10 transition are some of the many challenges facing healthcare organizations.

For many small healthcare practices the situation is dire. A survey released earlier this year and conducted by Porter Research highlights these difficulties. Among those participating in the survey, 57 percent were practice administrators or billing managers. Billers and coders made up 14 percent of respondents and another 13 percent of participants were practice executives involved with ICD-10 conversion work.

The results revealed that while 81 percent said they have some degree of confidence they’ll be ready for the transition, many other respondents have their doubts.  

In fact, 15% of respondents said they haven’t started preparing at all for ICD-10 implementation. When participants in this category were asked why their practice hasn’t started preparations for code conversion work, 23 percent said they do not have the time, staff or resources to begin preparing for ICD-10.    

If you’re finding that you need the skills to help you meet the deadline and the software tools to assess your systems and prioritize your goals then you should consider Health Language’s step-by-step program to address your ICD-10 concerns.  

With only a few months left before the deadline, your first critical step is to identify the potential impact of ICD-10 conversion on your revenue cycle. I’m sure you know that one of the greatest threats to reimbursement neutrality is the potential DRG shifts between ICD-9 and corresponding ICD-10 claims.

Your coders know by now that the sequencing rules for several diagnoses have changed. One example that drives home this point is Anemia with neoplastic disease. Anemia is sequenced first in ICD-9, but malignancy should be the principal diagnosis in ICD-10. This sequencing change may result in a different DRG weight, which can cause errors in documentation that in turn can have a financial impact on your healthcare business.

Interestingly, 59 percent of respondents in the Navicure study said their greatest concern is revenue and cash flow losses that may occur as a result of the potential impact of the ICD-10 transition.

To identify errors, our services designed around a claims analytics tools can spot potential financial impact with ICD-10, categorize your risks, and develop a comprehensive mitigation plan. Our analysis is based on either the MS-DRG and/or APR-DRG determination.

For those who have started their ICD-10 work, 14 percent said they do not believe they are on track with their ICD-10 projects and another 13 percent do not feel confident that they will be prepared by the October deadline.

To boost confidence in your ability to meet your ICD-10 project goals we have a team of  AHIMA-approved ICD-10 trainers and certified coders, medical professionals, PhDs, and medical informaticists. These skilled professionals, will help you with our ICD-10 systems remediation analysis, and offer you our ICD-10 reporting maps that remediate your ICD-9 based analytics and reports with maps that provide a one-to-one relationship between ICD-9 and ICD-10. Additionally, our test claims tools simulate ICD-10 claims to support end-to-end system testing.

Our ICD-10 remediation approach can help you leverage claims analytics to accomplish the following objectives:

• Understand where there are true increases and decreases based on today’s ICD-9 claims. For providers, this information can help spark conversations regarding contracts with your payers.
• Identify what specifically where you need to focus your dual coding and chart review activities before October 1, 2015 (which diagnosis codes and procedure codes will be particularly problematic).
• Obtain insights that will help you focus your clinical documentation improvement projects.

By now coders working on implementing ICD-10 understand the benefits of the increased level of detail expressed in the codes, but greater specificity requires more training on ICD-10 to fully understand the gist of reporting changes inherent in the new code sets.

To help align the tasks you need to accomplish with the skills to do the job, we can target areas for coder training (many coders will attend an ICD-10 training course). We will also help you justify coding education expenses and the need for additional coding staff. 

Now is the time to take the necessary steps to get your project back on track. We can help you target those areas that will mitigate the greatest risks, optimize the most from your investments and provide the skills needed to make your ICD-10 conversion work easier to manage.