Start Setting The Stage Now For A Smooth Icd-1o Transition

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June 30, 2004

The transition to the ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) coding system is expected to take place within the next few years. The new system will bring greater coding accuracy and flexibility to hospitals, health systems, and payers and will present opportunities for detailed record keeping and enhanced documentation to support accurate payment.

Although the implementation of the new coding system may not happen until October 2007, hospitals, health systems, and payers need to begin preparations for the transition now. An HFMA educational supplement, sponsored by 3M Health Information Systems, discusses how hospitals and health systems can start addressing the implications of the new system for cash flow, information technology, clinical systems, staffing, and vendor and payer relationships.

Implementation Issues for PFS and HIM

The transition to ICD-10-CM may lead to coding delays that can affect a hospital's cash flow and days in accounts receivable. Hospitals can mitigate these delays by adopting the following measures:

Plan early. Patient financial services (PFS) and health information management (HIM) department heads should begin working as early as possible to anticipate, plan for, and avert problems relating to slower coding. Such planning should be a top priority for an organization as HIM will be the area where initial slowdowns will occur. Those slowdowns and the resulting loss of productivity (and, therefore, reimbursement and charge capture) can have a domino effect across an organization.

An organization should work proactively to measure and analyze potential slowdowns in productivity and throughput. To prepare for anticipated slowdowns and implementation issues, hospitals may want to add staff (temporary or otherwise) as necessary and perform "dry runs" of the coding process.

Train coders, PFS staff, and physicians. Coders will have a lot of new information to absorb, so their training should begin as soon as possible. In particular, the ICD-10-PCS requires a higher level of expertise in anatomy and physiology than does the ICD-9, a requirement that some coders may find particularly challenging.

To plan for training needs, hospitals should perform a comprehensive gap analysis, which, in this context, should include an analysis of the education levels, skills, and readiness of coders to adapt to a system change. This analysis of coders' skills will give an organization enough time to help individuals get up to speed with the knowledge they need to transition to ICD-10.

PFS staff should be trained to understand the technical and procedural changes that will take place, and procedures and processes should be established to help facilitate PFS and HIM communication as that communication channel will be tested more than any other in an organization.

Hospitals also should educate medical staff on the impact of the ICD-10 transition on their activities, especially with respect to how they can interact optimally with the HIM department regarding documentation matters.

Review billing and coding policies. Both broad policy issues and practical aspects of these policies and procedures should be carefully evaluated in light of the ICD-10 transition. A task force representing key stakeholder groups should contribute to this process.

Working with Software and Vendors

To support the ICD-10 transition, vendors with software applicable to coding, billing, and claims will need to offer new programs or significantly modify their current billing software to support the ICD-10 system. Affected systems include reports, clinical decision support, HIM functions, physician orders, billing, quality assurance, contract management, utilization review, and registration/pre-admission.

Take the following steps to address vendor and software issues relating to the transition:

Determine as early as possible what steps you'll need to take with vendors and how to facilitate a rapid transition on the vendor and software side.
Perform a gap analysis and action plan that will ensure your organization does not fall behind in bridging the requirements of software, information technology, and vendors
Map out the organization's entire information system, paying particular attention to those areas that relate to coding, billing, and claims.
Investigate and prepare for the distinct possibility that dual systems or mapped systems will need to be in place for a number of areas for a period of time.
Plan for the possibility that you'll need to add more information system staff during the transition.
Work with vendors to ensure that interfaces in the above-mentioned areas allow codes to pass through so that billing can be accomplished. Careful attention to these interfaces will streamline the switch to ICD-10.
Bear in mind the vendor's ability to ensure a smooth transition to ICD-10 when considering contract renewals.

The coding changes driven by the shift to ICD-10 will touch most aspects of hospital operations and patient care and will create challenges for most healthcare providers. On the other hand, with careful, clear-eyed planning, hospitals can come through this transition in a very good position to manage the reimbursement and regulatory challenges of the next decade.

SOURCE:

ICD-10: Capturing the Complexities of Health Care, an HFMA educational supplement sponsored by 3M Health Information Systems.

Additional Resources

About the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), the Centers for Disease Control's National Center for Health Statistics
PFS Body of Knowledge, an HFMA PFS Forum project to articulate the skills and technical knowledge needed to understand today's revenue cycle. (available to PFS Forum members only)
HFMA e-Learning courses, including medical terminology

If you have questions or comments about HFMA Wants You to Know, contact editor Laura Noble.

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