PAMED Updates
ICD-10 IS HERE.
Is Your Practice Ready? After being delayed twice, ICD-10 is finally supposed to be implemented by all healthcare organizations by October 2015. There are many enhancements and improvements to ICD-10 compared to ICD-9. Although ICD-10 has been around for nearly two decades, we are adopting it only now. The new ICD-10 will have more than 68,000 codes compared to approximately 18,000 codes in ICD-9. Some major advantages of ICD-10 include: • Improved disease management • It is very specific to the body part and site • Addresses the issue of laterality (right or left) • Improved coding accuracy and richness of data for analysis • Improvement in medical research • Supports interoperability and exchange of health data among different systems • HIPAA compliant There are significant differences in classification, terminology, meaning and definitions between ICD-9 and ICD-10. Implementing ICD-10 will be no easy task. It takes a great deal of planning and execution, and time, money and resources to get it implemented by the deadline. The Center for Medicare and Medicaid (CMS) has come up with the following implementation plan with six phases: 1. Planning 2. Communication and awareness 3. Assessment 4. Operational implementation 5. Testing 6. Transition For a better understanding of the challenges facing U.S. Markets, we can review a list of expected and unexpected outcomes from Canada’s implementation of ICD-10 between 2001 and 2005. Unexpected outcomes • Underestimation of how much work was involved • Both timelines and budgets were grossly underestimated • Magnitude of change was underestimated Expected outcomes • Training of coders alone is not sufficient • Physician involvement is crucial • Physician should correctly document all clinical aspects of the patient SUMMER 2015
ICD-10 will impact the following people and technology: • Physicians • Billers and coders • Clinicians • Information system and technology • Software vendors • Billing system • Documentation All current systems that use ICD-9 will be affected by the change, as it includes applications, software interfaces, state, federal and other reporting, vendor applications, internal and external interfaces, etc. It will also impact processes, systems, operations and finances. Of special note, financial impacts include: • Initial revenue decrease • Payment error rate due to errors in implementation • Payment delays due to claim rejections Enterprise outreach, education and communication is very crucial to the success of the project. We recommend you complete your own enterprise readiness selfassessment questionnaire, as it’s not too early to prepare for the ICD-10 transition.
Are You Ready? My facility has an implementation timeline My facility has an interdisciplinary steering committee Executive management is aware and supportive My facility has a communication plan My facility has completed an inventory of all systems affected My facility has created a budget for implementation My facility has a training plan
Your assessment should include a full review of your systems and applications, vendor readiness, ICD-10 training, technology, people and processes. Siva Mahalingam is the President of Cube Info Solutions, an IT consulting firm specializing in healthcare IT.
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