To-do list for the ICD-10 changeover on Oct. 1, 2013

The gossip I am hearing is making it sound like way too many hospitals are flat-out not prepared for the changeover. The added cost of the transition will hit some who are cash-strapped hard. Nonetheless, I maintain that clinicians need the extra flexibility in the expanded codes so as to represent the particular aspects of individual patient medical conditions. I did some research for my dissertation on mapping ICD-9 to ICD-10 codes for palpitations and arrhythmias, and it looked reasonably straightforward. But I wonder about diseases like autism, which the DSM-V will handle rather differently.

I found this list of to-do issues from Rhonda Buckholtz on http://www.beckersasc.com:

Start anatomy and physiology training for coders: coders should be focusing on anatomy and physiology training to make sure they can code to the level of specificity required by ICD-10. Once the ICD-10 implementation date rolls around, coders will be in short supply and you want to build loyalty before then.

Start training physicians on documentation. “ICD-10 has a much higher level of specificity, and some of the concepts found in ICD-10 weren’t found in ICD-9.”…about 35 percent of the time, the coder is unable to assign an ICD-10 code based on physician documentation.” 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.

Talk to your vendors about their transition plans. 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.

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.

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.

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.