ICD-10

Where to begin? Practical steps for Starting ICD-10

The first in our series on the new coding system identifies the 8 steps every practice should take to prepare for October 2014.

Patricia Kennedy, COMT, CPC, COE, Duncanville, Texas

As most medical personnel know, ICD-10 will be implemented on October 1, 2014. It is the most noteworthy coding change to happen in more than 30 years and the ophthalmic support staff, especially the technicians, will have a significant role in the success of the implementation.

This article, the first in a series on ICD-10, outlines 8 specific steps the ophthalmic professional can take to fulfill the important role of leading the staff in a smooth and successful transition.

1. Appoint a technician who is ambitious and detail oriented to take the lead for the clinical staff. If the practice is large, consider appointing one technician per location or per sub-specialty such as retina, glaucoma, etc. That technician (or technicians) will then become the point person for teaching the remaining staff as well as fielding questions as the process unfolds.

2. Equip each technician with reference material to study. While the ICD-10 manual published by the American Medical Association (AMA) should be available, it can be daunting at first. That’s because ICD-10 code sets have “fundamental changes in structure and concepts that make them very different from ICD-9,” according to the AMA. For example, codes will contain 3-7 characters, vs. 3-5 for ICD-9.

The number of available diagnostic codes will increase from 13,000 under ICD-9 to about 68,000. These expanded codes will provide much more detail in the areas of etiology, anatomic site and severity. As you can imagine, the size of the AMA manual, which covers all medical specialties, can be intimidating.

An alternative: Consider purchasing the 2014 ICD-10 for Ophthalmology book published by the American Academy of Ophthalmology (AAO). The introduction of this book provides succinct descriptions of the differences and similarities between ICD-9 and ICD-10. It also defines the terms critical to conquering the ICD-10 system.

3. Have the technician attend ICD-10 seminars or classes. Encourage the technician to become a member of larger groups where ICD-10 is discussed and explained, such as the American Society of Ophthalmic Administrators (ASOA), American Academy of Ophthalmic Executives (AAOE) or American Academy of Professional Coders (AAPC). These live presentations allow the technician to get coding questions answered immediately. In addition, your technician will be able to develop a valuable network of colleagues.

4. Carve out time for the technician(s) in the schedule to learn the ICD-10 system. If your technician feels challenged by the new coding system, imagine how much more intimidated he/she will feel if they have to learn ICD-10 on top of a full work load. Identify a regular block of free time in the technician’s schedule that can be set aside for training.

In addition, you should help facilitate the technician’s understanding of the new codes. For example, if the technician is new to billing, consider pairing him or her with an experienced person in the billing department to assist in understanding the billing vocabulary.

5. Obtain a report of the ICD-9 codes used in your practice from the practice management system. With this report, the technician should determine the most common ICD-9 diagnosis codes and identify the associated sections of diagnostic codes from ICD-10. The technician should note the similarities and differences. Create a crosswalk comparison list or grid, which illustrates the differences in the two systems, to use as a teaching tool.

6. Commit to reviewing a small number of charts per week. Determine the ICD-9 codes used for a given visit and then the ICD-10 codes that will be required in the fall. This will allow for real-time and practical application of the new diagnosis code system. Again, the technician can convert these comparisons into teaching tools.

7. Schedule regular meetings to review the progress. In these meetings, include all personnel involved with the implementation, including:

• The administrator.

• Billing department.

• All charge entry staff.

• Physicians.

8. Technician comfort comes first. That is to say, once the technician is comfortable with navigating and understanding the ICD-10 manual, then it’s time to begin planning educational meetings with the rest of the ophthalmic personnel.

It is vital that the steps be planned and executed in a methodical fashion. October 1, 2014 will be here before we know it. This is not a subject that can be left until September 2014 and immediately implemented.

This process of transitioning to ICD-10 must start now, if it has not already. It will require study, practice, leadership and teamwork to prevent long term and significant adverse impact to the ophthalmic practice. OP