Checklist: Are you ready for ICD-10?

Go time is less than four months away
By Christy Erickson
10:03 AM
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With the Oct. 1, 2015, deadline fast-approaching, is your organization ready for ICD-10? Here's a quick readiness assessment to benchmark where you are – and where you should consider being.

Readiness checklist:

  1. Have both your Practice Management and EHR been updated to be ICD-10 compliant?
  2. If you are using the Charge module in Allscripts TouchWorksTM, have you tested submitting ICD-10 codes to your Practice Management system?
  3. If you are not using the Charge module in TouchWorksTM, have you considered implementing it to increase revenue cycle turn-around or considered updating your existing Encounter Forms to include ICD-10 codes with more specificity and using laterally to meet the ICD-10 requirements?
  4. Have you contacted all your vendors to ensure they are ICD-10 compliant, such as payers, clearinghouses, and any lab or radiology vendors?
  5. If necessary, have you loaded the ICD-10 dictionaries in both your Practice Management and EHR applications?
  6. Have you tested submitting codes from your Practice Management system to your payers and clearinghouses?
  7. Have you tested submitting orders (labs/diagnostics/imaging studies) from your EHR to appropriate vendors with ICD-10 codes?
  8. Have you identified the top 25-50 diagnoses for each specialty (based on volume and/or high revenue) and trained appropriate staff on ICD-10 criteria for coding, billing, and clinical documentation?
  9. Have you optimized all preferences and enhancements within TouchWorksTM to assist in the ICD-10 transition such as Billable Indicators and Clinical Qualifiers?
  10. Have you reviewed current clinical documentation and identified gaps for ICD-10 requirements?
  11. What else do you need to know and consider?

The preceding is just a short list of items to consider to ensure that your organization doesn’t experience challenges starting October 1st, such as payment denials, increased A/R days, and workforce overload. I’d like to focus on the clinical documentation that will need to go along with the actual ICD-10 transition. Many organizations have completed the initial items on the readiness checklist, and some were even ready a year ago prior to the delay.

Still, the ICD-10 implementation can present a significant challenge to your providers’ documentation workflows.  Each claim will not only need to have the appropriate codes, but will also require the clinical documentation from the patient visit to support the submitted ICD-10 codes. This is not any different than how ICD-9 codes work other than the obvious… ICD-10 requires more detail!

Specialties that will primarily be affected the most with the ICD-10 transition include Orthopedics, Family Medicine, Pediatrics, OB/GYN, Cardiology, and Behavioral Health. ICD-10 coding and clinical documentation will require more detail than we experienced with ICD-9. Some examples of the increased documentation include:

  • Laterality
  • Episode of Care (initial encounter, subsequent encounter, sequela)
  • Anatomical detail
  • Type of injury
  • Severity
  • Approach

Many believe this is only related to ICD-10, however, the increased documentation requirement stretches across many other healthcare initiatives, such as Meaningful Use, value-based purchasing, and hospital admission/re-admission reporting. A clinical documentation improvement program can offer several benefits for organizations, which extend to a variety of healthcare initiatives.

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