It’s been a year since the October 1, 2015 conversion to ICD-10, which provided a larger, more granular version of diagnostic and procedural codes. Relatively speaking, the launch went smoothly contrary to the warnings of a technological meltdown. However, in a survey done by American Health Information management Association (AHIMA) Foundation, the results showed that the coding productivity and accuracy has marginally declined since ICD-10 began for some organizations, while others experienced the same degree of coding as ICD-9. So, expectations met when it comes to a major change such as this.
As the anniversary just passed, providers should be aware of additional changes to be made with ICD-10:
1.) ICD-10 had thousands of new codes added for fiscal year 2017 by ICD-10 Coordination and Maintenance Committee.
2.) The Medicare Part B’s one year grace period has ended. The grace period promised not to deny Medicare part B claims for lack of specificity of ICD-10 coding, which allowed for some flexibility.
3.) Payers may begin to adjust medical policies based on the new specificity offered by ICD-10.
In accordance with changes, Healthcare Information and Management Systems Society (HIMSS) and Workgroup for Electronic Data Interchange (WEDI) identified actions that organizations should consider in planning for ICD-10 changes. Some of which include:
- Review the 2017 code set information available on the CMS web site.
- Determine the applicability of the new or revised codes specific to your practice or facility.
- Assure applicable codes are incorporated into internal applications and processes.
- Verify that vendor products support the new codes.
- Assure that clinical documentation contains sufficient detail to code at the required level of specificity.
- Communicate with payers to identify potential changes to medical policies.
- Look for bulletins from Medicare, provider associations and other organizations.
- Monitor industry trade publications for materials related to ICD-10.
- Assure staff is aware of the upcoming changes and educate as needed.
- Assign a point person to plan and monitor preparations and key performance indicators.
- Start early.
- Test. (Note: Don’t rely solely on software vendors for testing. Often, software is customized at the customer location. Business processes can also have an impact. Just because a product was tested extensively elsewhere, it doesn’t mean it will work the way you expect it to in your environment.)
Though the implementation of ICD-10 has had mixed reviews, its goals involved more than revenue-cycle upgrade. The new codes are essential to pave the road to value-based purchasing, improvements in healthcare data, population health management, care quality and lower costs. The benefits have yet to materialize, but experts say that a couple of more years may be needed to build up databases of medical records coded in ICD-10 to make a more fair assessment of the effects of the codes.
Here’s to looking forward to turning 2…