ICD-10: Dos and Don'ts
The 10th revision of the International Statistical Classification of Diseases and Related Health Problems, also popularly known as ICD-10 is a medical classification list published by the World Health organization (WHO). ICD-10 consists of an all-inclusive list of diseases, signs, symptoms, geographical factors linking diseases, social circumstances, etc.
Comprehensively prepared, this large collection of more than 14,400 medical codes permits physicians the world over accurately diagnose diseases, as well as track new ones. Today, most of the medical offices and healthcare practitioners are seeing the benefits of implementing ICD-10 first-hand, but there are still some organizations struggling to adapt to the sweeping changes brought in by it, and thereby failing to implement it properly for better functioning and regulatory compliance.
The ICD-10 Code Structure
The ICD-10 code structure is built in such a way that physicians, practitioners, and the healthcare billing department can easily detect what the code stands for. Codes mentioned under the ICD-10-CM code set can have three, four, five, six, or seven characters. Most three-character codes are used as headings for creating new codes, and a code using only the first three digits cannot be further subdivided. On the other hand, a code with more than three characters generally adds more specific details regarding a diagnosis, including anatomical site, etiology, and severity (fourth, fifth, and sixth digits).
The final seventh character represents the main difference between ICD-10 and its previous versions. A seventh character is assigned primarily when the main diagnosis falls under Chapter 15 (Pregnancy, childbirth and the puerperium) or Chapter 19 (Injury, poisoning and certain other consequences of external causes). The seventh character, therefore, provides more information about individual care episodes.
Dos & Don't of ICD-10
The start date for ICD-10 implementation was October 1, 2015, but the effect of ICD-10 implementation can be seen even now, as more healthcare practitioners struggle with the sweeping changes brought in by the ICD-10 transition at their workplace. We understand how healthcare works, and our top 6 things to consider in ICD-10 implementation will help you make the ICD-1O transition period easier for your employees without affecting your revenue cycles.
Know Who Your Stakeholders Are
The ICD-10 transition, if not already done, will affect all your staff members and their individual workflows. For most practices, this list of stakeholders includes service providers, coders, billers, managers, and outside partners such as diagnostic labs, software vendors, etc. It is imperative that you ask each stakeholder to conduct an ICD-10 impact assessment as soon as possible, so they can form a cohesive idea about how much impact they would receive because of the ICD-10 implementation, allowing them to prepare, train and, test beforehand.
Don't Prepare for Each and Every ICD-10 Code
The number of codes you would have to deal with under ICD-10 will increase by the thousands! So how does one prepare for each one individually? The answer is quite simple really, as the best way to prioritize ICD-10 conversions is to focus on only the ICD-10 codes that would impact your business. This will not only help you make the best out of your limited resources but also instill greater confidence amongst your workers. At the same time, always refrain from creating a cheat-sheet of sorts for the most commonly used ICD-10 codes, as with a cheat-sheet, physicians can get more comfortable than they necessarily should, which could later lead to the wrong assignment of codes.
Appoint a Project Manager
You should always appoint a project manager to lead your team through the ICD-10 transition. Make the person responsible for leading the initiative when it comes to working with individual team members so as to pinpoint relevant workflow changes, the timeline available to make these changes, as well as the overall costs associated with the changes.
A great project manager should be able to break down communication silos between different teams, helping everyone realize the importance of ICD-10 implementation and its overall impact on daily processes.
Don't Leave Budgeting for Later
One of the biggest mistakes that healthcare businesses make is that they leave the budgeting costs associated with ICD-10 implementation till very late. Most stakeholders are unaware of the fact that ICD-10 transition comes with a cost attached to it and therefore fail to include the same within their budgeting spend, which in turn leads to problems later on. Some of the costs associated with ICD-10 implementation include -
- Training materials, courses, and programs to teach ICD-10 awareness
- Practice management and other EHR software
- Legal fees which need to be paid in order to update policy documents and contracts
- Cash flow reduction due to changes brought in by ICD-10 implementation, since coding time, backlog, and turnaround time would increase
Implement a Training Plan for Each Team Separately
You should always strive to design a training plan which fits the role each and every team plays in your organization. ICD-10 affects everyone's job differently, so it's better to be forewarned than having to deal with the ICD-10 implementation closer to your set deadline. You should also ensure that there is enough time on hand to update the different policies and procedures that affect your workflow, such as coding procedure updates, claim rejection auditing workflows, etc.
Test Frequently Before Going Live
ICD-10 transition is not an easy task, and since there are so many interconnected departments involved in the transition, it is imperative that you run several real-life test scenarios leading up to the ICD-10 implementation deadline at your business to identify the problems. You should also make it a point to test your entire revenue cycle so as to understand which cogs need tweaking since revenue should not take a major hit because of the upcoming ICD-10 implementation.
The Benefits of Implementing ICD-10
ICD-10 brings in the most significant number of changes in the history of ICD, and although disruptive in nature, it also promises to allow easier implementation of future revisions, while providing higher-quality information and better healthcare service care, quality, and efficacy. Some of the benefits include -
- Better automated tools for the coding process
- Reduced claims adjudication and submission costs
- Lesser faulty and improper reimbursement claims
- Greater interoperability between different healthcare teams
- Significantly reduced coding errors
- Better chances at detecting and preventing healthcare fraud and abuse
- Significantly easier to educate customers and patients on costs and the outcome of various treatment options
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