ICD-10

Despite the delay, practices still must Focus on ICD-10 training

Strategies for getting ready for the new code set.

Julia Lee, Marlton, NJ

To say the most recent ICD-10 delay (now scheduled for implementation October 2015) has resulted in a mixed response is an understatement. For those practices that have already started along the compliance journey, the delay is frustrating as it has the potential to stall momentum and make the work-to-date less impactful. On the flip side, practices that got a late start see the delay as a reprieve or perhaps as an opportunity to pursue other, more pressing projects.

For Ophthalmic Partners of Pennsylvania—a multi-specialty group of 11 ophthalmologists with service locations in the metro-Philadelphia area and southern New Jersey—the delay means the practice has more time to pursue a multifaceted approach to implementation that began several years ago. Providers are not looking on the delay as a setback or as an excuse to reprioritize, but as an opportunity to ensure the organization’s ultimate ICD-10 transition is a smooth one.

Regardless of where a practice is on the road to ICD-10, some key activities can support a strong and efficient conversion. This article details a few such strategies on which Ophthalmic Partners of Pennsylvania continues to rely.

Develop a conversion strategy

Given the size and scope of ICD-10, practices should not approach the transition without a plan. We developed a conversion strategy when we were still using paper records and revisited our approach as we migrated to an EHR system. The most recent delay prompted another review of the strategy to realign efforts given the new deadline. On the whole, the project plan covers a variety of topics including project leadership, upgrade schedules, code mapping strategies, training and education plans and testing methods.

Map frequently-used codes

Ophthalmic Partners spent considerable time mapping the ICD-9 codes the practice uses most frequently to ICD-10. We then created a quick reference conversion guide, breaking the list down by sub-specialty to make regularly used codes more accessible. For instance, all ICD-9 codes related to cataracts and their ICD-10 counterparts are in one section. We did the same with glaucoma, cornea and so on. Having a customized ICD-10 reference guide helps narrow the scope of ICD-10 considerably because the tool contains just those codes that providers need to know, eliminating the ones that are not relevant to the practice. Not only does the guidebook serve as a “cheat sheet” for ICD-10, it also assists with education since it is organized by specialty and includes the codes the practice uses most frequently.

Train, train and train again

An upside of the ICD-10 delay is that it allows additional time for clinician and staff training. The more clinicians and staff can appreciate the specificity and meaning of the new code set, the better. This can cut down on input errors right out of the gate and prevent delayed and denied claims on the back end. In some ways, ophthalmology may have an easier transition than other specialties. For example, the ICD-10 codes now delineate site of condition—right, left, bilateral or unspecified, a level of granularity that ICD-9 did not require. If the location is not correctly reflected, it can result in a denial. Ophthalmology providers are used to identifying right, left or bilateral, so getting comfortable with this level of specificity will not be as challenging.

Consider dual coding

An effective method for training is dual coding—where staff codes a claim in both ICD-9 and 10. We created a notes field in our EHR in which our technicians can enter the associated ICD-10 codes, helping them get familiar with the new code set before the go-live date. Auditing dual coding efforts allows the practice to identify where coding work is falling short and further training is necessary.

Leverage outside resources

One benefit of ICD-10 is that all health-care organizations are going through the transition together and many valuable resources are available that can help with coding, project planning, training and so on. For instance, the AAO provides resources that address everything from new terminology to a checklist for the countdown. Taking advantage of these resources can ensure an organization adopts best practices for implementation and long-term compliance.

Although ICD-10 is delayed, practices will have to make the shift eventually and the earlier they get started, the more ready they will be. Plus, having experience with this type of conversion may prove useful in the future. The World Health Organization is already working on ICD-11, which is expected to release in 2017. Suffice it to say, transitioning from ICD-9 to ICD-10 may be only the beginning. OP

Julia Lee is the Executive Director at Ophthalmic Partners of Pennsylvania, a large multi-subspecialty ophthalmology practice providing advanced eye care in the areas of cataract and refractive surgery, cornea and external disease, anterior segment, glaucoma and related disorders and pediatric ophthalmology.