Rosalind Richmond, CCS, interim coding compliance officer for Genascis, Raemerie Jimenez, director of education for AAPC, and Cyndee Weston, CPC, CMC, CMRS, executive director of the American Medical Billing Association, discuss six ways facilities can start preparing for ICD-10 implementation.
1. Start looking at ICD-10 equivalency mapping. While the 2013 implementation date for ICD-10 is still a couple of years away, Ms. Jimenez says coders should start looking at the expectations involved in ICD-10 coding and documentation. "It would be good for coders to see the ICD-9 codes that they're typically coding now and see what the ICD-10 equivalents are going to be," she says.
Ms. Richmond says while coders should not depend on general equivalency mappings to code ICD-10 going forward, GEMs will be useful as coders prepare for training in 2012 and 2013. She says the huge increase in the number of codes through ICD-10 means that GEMs are complicated. "Trying to [explain ICD-10 with ICD-9 codes] is like trying to fit New York into Rhode Island," she says.
2. Go through a "day in the life" of an ICD-9 code. Ms. Jimenez recommends that IT personnel and coders work together to analyze a "day in the life" of an ICD-9 code. She believes many practices and facilities will underestimate the number of systems and programs that are affected by ICD-10 and need to transition to the new system. "If you just did a day in the life of an ICD-0 code and walked through every system that's affected, you'd see the systems that need to keep working correctly with the new codes," she says.
She says hospitals and ASCs may underestimate the impact of ICD-10 because they buy electronic systems piece-by-piece instead of all at once. "They don't get everything, so when they need another function, they look for a different program and apply all these band-aids to help the programs communicate with one another," she says.
3. Find a "coder champion" to lead your implementation efforts. Ms. Richmond says facilities with limited budgets — those that can't necessarily afford to send every coder away for training or bring in an expensive consultant to lead training — should ask an experienced coder to lead the implementation effort. That coder can go to conferences and workshops to become very familiar with ICD-10 and then teach the rest of the staff the essential information.
4. Talk to coders about their plans for the future. Older coders may be considering retirement as the ICD-10 implementation deadline looms, Ms. Richmond says. "Older coders don't want to learn a new classification system, especially one that is alpha-numeric," she says. These coders may have experienced the switch from ICD-8 to ICD-9 in the early 1970s and know the transition will be a significant undertaking, she says. She expects the move to ICD-10 to be even more complicated because of the numerous software applications affected by the change in each facility.
She says facility leaders should speak with coders to determine whether they plan to slog through training and implementation of ICD-10 — or whether they are planning to move to different positions or retire prior to Oct. 1, 2013. Getting a sense of coders' plans will help facilities prepare for coder shortages.
5. Expect a three-month "fog" after implementation. Ms. Richmond says she anticipates the coding industry will suffer for a few months after ICD-10 implementation. "Coders should expect a three-month fog," she says. "That didn't happen when the industry moved from ICD-8 to ICD-9 because we used the same categories, but for this transition, I anticipate it's going to be awhile [before productivity recovers]." She says American coders can learn from other countries — Canada, for example — that have already implemented ICD-10 and have seen productivity lag during the initial months.
Ms. Weston agrees that the learning curve for ICD-10 will be steep. "It's going to take more time because not only are people going to have to learn it, it's also going to take more time to code claims," she says. "This might mean a couple of minutes versus a few seconds." She says eventually some practices may be able to save time with ICD-10, especially if they code the same diagnoses very frequently, but initially the change will cut into productivity.
6. Help specialty coders expand their knowledge base. Ms. Richmond says specialty coders, or coders who concentrate on a particular specialty such as GI, may face unique challenges in the transition to ICD-10. "It will be a challenge because you won't just have to learn the GI portion of ICD-10 — you'll have to learn the whole thing in order to assign the co-morbidities," she says. "A lot of facilities assign work based on specialty to get the work out faster, so you have a lot of specialized coders." She says these coders may need to re-train in other areas as they prepare for ICD-10 implementation.
1. Start looking at ICD-10 equivalency mapping. While the 2013 implementation date for ICD-10 is still a couple of years away, Ms. Jimenez says coders should start looking at the expectations involved in ICD-10 coding and documentation. "It would be good for coders to see the ICD-9 codes that they're typically coding now and see what the ICD-10 equivalents are going to be," she says.
Ms. Richmond says while coders should not depend on general equivalency mappings to code ICD-10 going forward, GEMs will be useful as coders prepare for training in 2012 and 2013. She says the huge increase in the number of codes through ICD-10 means that GEMs are complicated. "Trying to [explain ICD-10 with ICD-9 codes] is like trying to fit New York into Rhode Island," she says.
2. Go through a "day in the life" of an ICD-9 code. Ms. Jimenez recommends that IT personnel and coders work together to analyze a "day in the life" of an ICD-9 code. She believes many practices and facilities will underestimate the number of systems and programs that are affected by ICD-10 and need to transition to the new system. "If you just did a day in the life of an ICD-0 code and walked through every system that's affected, you'd see the systems that need to keep working correctly with the new codes," she says.
She says hospitals and ASCs may underestimate the impact of ICD-10 because they buy electronic systems piece-by-piece instead of all at once. "They don't get everything, so when they need another function, they look for a different program and apply all these band-aids to help the programs communicate with one another," she says.
3. Find a "coder champion" to lead your implementation efforts. Ms. Richmond says facilities with limited budgets — those that can't necessarily afford to send every coder away for training or bring in an expensive consultant to lead training — should ask an experienced coder to lead the implementation effort. That coder can go to conferences and workshops to become very familiar with ICD-10 and then teach the rest of the staff the essential information.
4. Talk to coders about their plans for the future. Older coders may be considering retirement as the ICD-10 implementation deadline looms, Ms. Richmond says. "Older coders don't want to learn a new classification system, especially one that is alpha-numeric," she says. These coders may have experienced the switch from ICD-8 to ICD-9 in the early 1970s and know the transition will be a significant undertaking, she says. She expects the move to ICD-10 to be even more complicated because of the numerous software applications affected by the change in each facility.
She says facility leaders should speak with coders to determine whether they plan to slog through training and implementation of ICD-10 — or whether they are planning to move to different positions or retire prior to Oct. 1, 2013. Getting a sense of coders' plans will help facilities prepare for coder shortages.
5. Expect a three-month "fog" after implementation. Ms. Richmond says she anticipates the coding industry will suffer for a few months after ICD-10 implementation. "Coders should expect a three-month fog," she says. "That didn't happen when the industry moved from ICD-8 to ICD-9 because we used the same categories, but for this transition, I anticipate it's going to be awhile [before productivity recovers]." She says American coders can learn from other countries — Canada, for example — that have already implemented ICD-10 and have seen productivity lag during the initial months.
Ms. Weston agrees that the learning curve for ICD-10 will be steep. "It's going to take more time because not only are people going to have to learn it, it's also going to take more time to code claims," she says. "This might mean a couple of minutes versus a few seconds." She says eventually some practices may be able to save time with ICD-10, especially if they code the same diagnoses very frequently, but initially the change will cut into productivity.
6. Help specialty coders expand their knowledge base. Ms. Richmond says specialty coders, or coders who concentrate on a particular specialty such as GI, may face unique challenges in the transition to ICD-10. "It will be a challenge because you won't just have to learn the GI portion of ICD-10 — you'll have to learn the whole thing in order to assign the co-morbidities," she says. "A lot of facilities assign work based on specialty to get the work out faster, so you have a lot of specialized coders." She says these coders may need to re-train in other areas as they prepare for ICD-10 implementation.