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Upcoming ICD 10 Implementation and Checklist

If you haven’t started working on it, there is no time to waste! Your revenue will be at great risk!

The compliance date for implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) is October 1, 2013 for all covered entities. ICD-10-CM/PCS will enhance accurate payment for services rendered and facilitate evaluation of medical processes and outcomes.

Although there is no silver bullet for ICD-10 implementation, there may be a silver lining. Many organizations leveraged their Y2K investments to upgrade and replace outdated systems, which in turn helped them drive business innovation and operational efficiencies. Perhaps, not unlike Y2K, ICD-10 will also result in a positive return on the investment. However, one point is certain: If you haven’t started working on it, there is no time to waste! If your organization is not completely ready by the compliance deadline, your revenue will be at great risk!

October 2013 sounds far off, but it will be upon us sooner than we think. Many have compared ICD-10 to Y2K. But Y2K was easy by comparison. It dealt mostly with remediating IT systems. ICD-10 is more complex. It requires staff along the care continuum to learn and use a new order and magnitude of diagnostic and procedure codes:

* from the scheduler who needs to ensure an authorization is in place for a given procedure;

* to the physician documenting at a higher level of granularity;

* to the HIM professional assigning codes that reflect the physician’s notes;

* to the biller creating a claim for the medical encounter.

Unquestionably, ICD-10 introduces an added layer of complexity to the multitude of challenges already at hand.

The new classification system provides significant improvements through greater detailed information and the ability to expand in order to capture additional advancements in clinical medicine. ICD-10-CM/PCS consists of two parts:

* ICD-10-CM: The diagnosis classification system developed by the Centers for Disease Control and Prevention for use in all U.S. health care treatment settings. Diagnosis coding under this system uses 3-7 alpha and numeric digits and full code titles, but the format is very much the same as ICD-9-CM; and

* ICD-10-PCS: The procedure classification system developed by the Centers for Medicare & Medicaid Services (CMS) for use in the U.S. for inpatient hospital settings ONLY. The new procedure coding system uses 7 alpha or numeric digits while the ICD-9-CM coding system uses 3 or 4 numeric digits.

The current system, International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), does not provide the necessary detail for patients’ medical conditions or the procedures and services performed on hospitalized patients. ICD-9-CM is 30 years old, has outdated and obsolete terminology, uses outdated codes that produce inaccurate and limited data, and is inconsistent with current medical practice.

Although the implementation date for ICD-10-CM and ICD-10-PCS may still be two years away, it is not too early to begin planning for the transition, and even putting some of those plans in motion. A well-planned, well-managed implementation process will increase the chances of a smooth, successful transition. Experience in other countries has shown that early preparation is the key to success. The best way to manage the challenges inherent in making a transition of this magnitude is to tackle them in a phased approach.

Some of the preparation activities necessary for implementation provide benefits to the organization even before ICD-10 is implemented, such as medical record documentation improvement strategies and efforts to expand coding staff knowledge and skills. Also, an early start allows for resource allocation, such as costs for systems changes and education as well as staff time devoted to implementation processes, to be spread over several years. Thus, many of the costs can be absorbed by existing annual budgets rather than requiring a large budgetary investment at one time.

Healthcare Compliance Pros has created a comprehensive checklist for all of its clients to assist you in your transition to ICD 10. If you would like a free electronic copy of that checklist, please send your request to [email protected]

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