ICD-10-CM Final Implementation: October 1, 2013

The final implementation date for ICD-10-CM has been set for October 1, 2013, and it is important that every medical practice, whether large or small, begin to formulate a "game plan" for ICD-10-CM implementation. A systematic approach is the best method in a successful conversion to ICD-10.

The impact from a three- to five-digit level of specificity up to a seven-digit level of specificity is enormous. In addition, before we can convert to ICD-10, we must convert from the 4010 electronic transaction standard to 5010 by January 1, 2012. Version 5010 addresses currently unmet business needs, including, for example, providing on institutional claims an indicator for conditions that were "present on admission." Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1.

Ramping up for ICD-10 will be costly. Physicians will have to bear the cost of changing their systems and, perhaps, even their practice management software. The unknown is whether information systems vendors will be able to accommodate ICD-10-CM. Add to that the burden and cost of retraining coders, physicians, and others, and the potential loss of productivity, even if it's just a temporary setback. Implementing ICD-10 is more than a matter of calling the software vendor and flipping the switch; you have to look at your office processes, your front office staff, your billing and coding staff, as well as the physicians. And then there are the payer contracts, a lot of which are tied to certain diagnoses and conditions. Now we also have quality reporting and quality measures, which insurance carriers are expecting.

Ongoing changes in implementation of ICD-10 require taking a closer look at internal systems to ensure the organization has the capability of moving forward with implementation. Does your organization have enough hard drive space to house two codes sets (ICD-9-CM and ICD-10-CM) simultaneously for a period of time before and after implementation? The organization must orient information systems technology (IT) personnel as to specifications necessary for the code sets for successful transition.

Preparation must include information on the length of characters necessary for ICD-10-CM and ICD-10-PCS codes. Prepare not only for the extra digits but also to include the alphanumeric entries. Concerns to share with IT on this area include:

• character case-sensitivity
• placement of decimals for reporting
• increased number of codes and characters
• supporting ICD-9-CM and ICD-10-CM simultaneously
• the conversion from 4010 to 5010

Make sure that IT performs a comprehensive review of information systems and an audit for ICD-10 implementation by inventorying all the databases in the organization, giving special consideration to implementation hurdles such as:

• how to accommodate mapping;
• how to stop assignment of ICD-9-CM codes from being used after implementation;
• how to interface between coding conventions;
• and what the timelines are for the testing of system readiness.

The ICD-10 planning phase is the time to determine whether current systems can accommodate the required software changes. Waiting to address these issues could very well hinder implementation, could be costly, and could interrupt cash flow in the organization without thoughtful preparedness.

All systems, whether the practice management system, the electronic medical record system, or other systems or databases in the organization that house coding data must be able to handle the change for successful ICD-10 implementation. By performing this assessment, it will ensure an accurate budget can be developed and the organization has the tools necessary when ICD-10-CM "goes live."

Today, claims are often delayed because carriers need to ensure that the procedure was medically necessary. If ICD-10 is used appropriately, more specifics of the diagnosis will be captured. Keep in mind that 2013 is not that far away, and the sooner your organization begins planning for ICD-10 implementation, the smoother transition it will be.