ICD-10: Happy Anniversary

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…

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