On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. This opens a door full of questions for the medical community—most specifically, are patient care organizations fully prepared to make the change? With the ICD-10 compliance extension delayed until next year, health systems across the country have shifted into the “re-planning” stage. And not surprisingly, the complexity of re-planning is enormous and intimidating for many organizations. Cindy Hegner, medical practice manager at AnaPath Diagnostics, a Cheyenne, Wyo.-based independent pathology laboratory is an American Health Information Management Association (AHIMA) certified coder and approved ICD-10 trainer in her organization who recently spoke with HCI Assistant Editor Rajiv Leventhal about preparing for ICD-10, the industry’s readiness, and challenges medical practices will face in the upcoming months. Below are excerpts from that interview.
There is a thought that the industry isn't ready for the transition to ICD-10. Is this something you agree with?
That's a tough question. I know AHIMA believes that a lot of the little hospitals are not ready for ICD-10. I do agree with that. When Medicare reported a one year delay, everyone who prepared-including us-was ready to go on October 1, 2013. But my smaller clients—such as ones in rural Wyoming with only one or two doctors—did not have the training in place for ICD-10. But the majority of the hospitals in Wyoming were ready. When the deadline was delayed, it affected the effectiveness of the education that had been provided. You don't want to start ICD-10 training too soon, because it's so different from ICD-9. You can't compare the two of them together; it just doesn't work that way. The decision to delay the transition to ICD-10 made a lot of hospitals who were ready say, "now what do we do for a year?" And the answer is that you have to start your training again, because like with anything else, if you don't use it, you lose it. But I'm positive this date will stick-it won't move again. Many organizations think it will be extended, but I keep telling them that it won't be.
What is your organization doing to prepare for ICD-10?
In the next three months, I'm going to start doing an audit of our most used ICD-9 codes. As soon as I analyze my top-100 codes, I can look up the crosswalks on those codes. Then I can look at our pathology reports to check our documentation on them and see if any additional documentation will be necessary with ICD-10. Then, starting on Jan.1, because ICD-10 is more granular, I will be going over anatomy lessons with my transcription and billing staff. I want to make sure everyone has a good understanding of anatomy and physiology. And [subsequently] in March, I'll start educating my staff.
Pathology won't be using most of the codes in the book, so that's nice. A lot of the book is affected with the V&E codes that used to be in ICD-9, since they basically made a separate code for each and every type of occurrence you could imagine. But the basic codes for diabetes and neoplasms, for example, have been extended to be much more granular. Before, you might have had neoplasm of the breast, but there was no code to state if it was the right side or left side. With ICD-10, you will have a code for both the right and left for all regions of the breast.
What are some challenges you foresee when it comes to the transition to ICD-10?
For one, it will cost more because you have to train outside of clinician's regular work hours. Am I going to do that in the evening or on a Saturday? Will it be web-based, so they can do it whenever? For medical offices, that's the issue. So practices will be paying overtime, since they have their jobs with ICD-9 coding while they are learning ICD-10. Thus, there is a big cost involved. And it's very time consuming too, in terms of figuring out the programs and analyzing the software.
Do we have enough time for all this? We have to have enough time, since ICD-9 can grow no more. It's way past due. The biggest thing is to be prepared, though. Talk to your vendors and make sure they're working on the implementation. Check with your major payers. Most of the major payers are ready. Your little mom and pop insurance companies are the ones you have to worry about, so I would start communication with them now. Practice managers have to be proactive, without a doubt. If you plan ahead, Oct. 1, 2014 will be hectic day, but at least you will be ready for it.
Our vendors are ready or are in the process of soon becoming ready. A smaller software company that we use, Cortex Medical Management, is working very closely with ZirMed, a larger company, to prepare, so I know that come next year, the software I use for my revenue cycle management (RCM) program will be able to work well with what is out there. And they have to be able to accept ICD-9 as well as ICD-10 because anything serviced prior to Oct. 1, 2014 will be using ICD-9 codes. Hospitals will have patients possibly using both codes depending on when their service is. Vendors need to have their software be ready for that, too.
Who specifically needs to be educated and trained on ICD-10? How do you plan to handle this?
Everyone in my organization will get some type of ICD-10 training. Now, some areas might not get as granular as my billing and transcription people, but they'll at least know what an ICD-10 code is, why it's being used, and how that works into the whole process of what we do here in our lab. Everyone will have to have some type of training on it. Someone is usually designated for that in a large organization, but in a small organization, companies on the web, or your community college could be useful resources. AHIMA has a wonderful education opportunity too. You just have to be careful that whoever is training you knows what they're talking about.
How do clinicians feel about the transition?
They aren't happy because they are going to have to be clearer in their documentation. As a coder, I have always felt that documentation is the number one priority for a clinician, because if the service is not documented, it can't be billed. When ICD-10 comes along, it will take time for everyone—probably a good month or more before you're really comfortable with the whole process. I've experienced downtime with an Epic's interface, and you just have to work through it. The biggest thing is, if you're prepared, it will be so much easier in the end.