Medical Billing Blog

Painless Preparation For ICD-10

Posted by Barry Shatzman on Wed, Apr, 17, 2013 @ 12:04 PM

Not Time To Prepare For ICD10A recent survey conducted by the Workgroup for Electronic Data Interchange (WEDI) regarding the preparations for transitioning to ICD-10 being conducted by healthcare providers shows that nearly half of the survey group either have not started preparing for ICD-10 or do not know when they expect to start their testing. 

With the implementation date less than 18 months away, it appears the majority of providers, vendors, and payers also postponed their transition efforts when CMS pushed the transition date back to October 1, 2014.  In fact, nearly 40% of the providers surveyed had no idea when they would complete their impact assessment, business changes, or begin external testing, in spite of the looming start date. 

There’s a hole in the bucket.

Top obstacles to preparing for implementation were split evenly between staffing, budget, competing priorities, vendor readiness and the impact on information systems.  Asked how they will produce ICD-10 codes, a quarter of the providers surveyed said they expect to choose the code directly; more than half will employ both crosswalking (also called “mapping”) and direct coding; and less than one-sixth expect to just crosswalk from ICD-9 to ICD-10.

This is somewhat concerning, given the complexity of the new code set compared to the old.  In fact, CMS has issued special stopgap data files to assist providers with getting accustomed to the new code set, and to help them map from ICD-9 to -10, and vice versa.  After looking carefully through these “General Equivalence Mapping” (GEM) guidelines, we at MBR anticipate that providers will gain a healthy respect for the complexity of the new code set once they begin to crosswalk from one set to the other. 

Do you want fries with that?

Why do we say providers will develop “a healthy respect?”  Well, for one thing, the GEMs are set up to allow forward and backward mapping (i.e. from ICD-9 to -10 and from ICD-10 to -9)  The data sets can be downloaded and imported to a relational database to help in the process.  (Think, MS Access.)  The ICD-9 GEM includes all of the codes in the ICD-9 code set, and crosswalks to one or more *or to no code* in ICD-10.  The ICD-10 GEM does the same thing, but backwards.  It is also possible that providers, when trying to find their new code, will be faced with multiple combinations and scenarios, where the old code either does not match exactly to any new code, but where the provider may choose from one or more alternative new codes that vary in description, severity of condition, cause, and laterality.  There may also be multiple choices of codes and different scenarios associated with different codes, such that the provider will find him or herself essentially choosing from a menu:

Pick one code from Menu A, and one or more codes from Menu B or Menu C, or

Pick one code from Menu A, and one or more codes from Menu B and Menu C, or

Pick one code from Menu A, and depending on which code you picked, pick from some of the codes in Menu B, but not from some of the codes in Menu C.

Of course, the new code set does have a natural, logical organization and nomenclature, but that does not necessarily mean it will cut down on the time it takes to do the crosswalking in the early term.

If the idea of mapping, direct coding and dealing with the uncertainty associated with making sure you’ve considered all the possible scenarios in ICD-10 does not appeal to you, providers do have one simple solution to the problem of how to prepare for ICD-10:  Source it out.

But wait, there’s more…

Billing services like Medical Billing Resources have been working on ICD-10 preparedness for a couple of years already, and are ahead of the game in preparing our clients for it as well.  At MBR, we do this because it’s our primary business.  In fact, our staff includes multiple Certified ICD-10 Trainers, who are training our clients and other outside provider groups on proper ICD-10 billing and coding.  Honestly the cheapest and easiest way to comply with ICD-10 is by using the skills and infrastructure available through a certified ICD-10 trained billing service.  Why invest in new hardware and software and still have to train your staff on ICD-10?  Is it wise to direct that time and capital in that direction when you can hire a service that already has certified ICD-10 coders, instead? 

According to the conductors of the survey, the bottom line is that there will be significant disruption in reimbursements starting on October 1, 2014, unless more providers move quickly toward implementing ICD-10 beforehand.  Give Medical Billing Resources a call and save yourself thousands of dollars and a lot of frustration, and we will make your transition not just painless but fruitful.