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ICD-10: Planning
for a Successful
Implementation
Contents
1. Introduction to ICD-10
2. Implementation Calendar
3. Getting Ready
4. Preparation Checklist
5. Resources
1
What is ICD-10?
10th revision of the International
Classification of Diseases (ICD) method
of coding:
◦ The patient’s state of health, and
◦ Institutional procedures
Allows for:
◦ More information per code
◦ Better support for care management and
quality
◦ Improved ability to understand risk and
severity2
Transition Facts
All HIPAA-covered entities must use
new code sets as of October 1, 2015
CPT coding is not affected by the
transition
ICD-10 CM/PCS consists of:
◦ ICD-10-CM for diagnosis coding
◦ ICD-10-PCS for inpatient procedural
coding
3
Diagnosis Coding
Captures more specific data from clinical documentation: left side v. right side, initial v. subsequent encounter, routine v. delayed healing
4
Structure Changes
5
Side-by-Side
6
7
Quarterly Calendar
Quarter 1: Technical Preparedness◦ EHR system updates, Meaningful Use,
CRISP
Quarter 2: Back Office Preparedness◦ Staff training, vendor contact, A/R cleanup,
coding review, financial planning
Quarter 3: Full Practice Readiness◦ Implement new tools, review physician and
staff roles, testing
Quarter 4: Implementation and Revenue Cycle Management◦ Claims accuracy, payment processing,
monitoring KPIs8
Project Plan
Develop a comprehensive plan to govern
the transition process
All personnel must be aware of the
extent of this change
Assign clear responsibility for each step
Develop a comprehensive, realistic
budget
Involve all stakeholders (physicians,
vendors, payers, clearinghouses)
Include a transition timeline and adhere
to it 9
Sample Template from the
AMA
10
Transition Checklist
Identify current systems/structure/processes that use ICD-9 codes
Contact all EHR/PM vendors about updates and testing
Develop implementation plans with billing service and clearinghouse
Talk to payers about transition and potential contract changes
Review changes to workflow
Assess training needs
Budget for time and costs; consider ways to mitigate financial risk
Conduct full end-to-end testing
11
Impact Assessment
Analyze how codes are used
throughout the practice
◦ Billing/submitting claims, eligibility checks,
referrals
Identify commonly used ICD-9 codes
and explore related ICD-10 codes
Identify paper and electronic forms to
accommodate new structure
12
Systems Update
Contact Vendors
◦ EHR/PM systems should be updated and
support may be available
◦ Clearing house and/or billing service will
need to be reviewed
Complete Systems Tests
◦ Internal and external once all updates are
installed
13
Minimizing Challenges
Eliminate coding backlogs prior to Oct
1, 2015
Prioritize medical records for coding
Provide refresher training
◦ ICD-10 accuracy
◦ Practice workflows and new efficiencies
Pre-determine steps for addressing
errors and vendor issues
14
Resources
MedChi Network Services◦ [email protected] or 888-507-6024
Centers for Medicare and Medicaid Services◦ cms.gov/ICD10
Maryland DHMH◦ dhmh.maryland.gov/icd10info
American Medical Association◦ ama-assn.org/go/icd-10
Specialty Societies Payors Vendors
15
Questions?
Colleen George
Practice Services Administrator
MedChi Network Services
16
888-507-6024 (phone)
888-507-6034 (fax)
References
American Medical Association: The Current State of ICD-10 & Preparing for It◦ http://www.ama-assn.org/ama/pub/physician-
resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-code-set.page
Centers for Medicare and Medicaid Services: ICD-10◦ cms.gov/ICD10
Department of Health and Mental Hygiene, ICD-10 Transition◦ https://mmcp.dhmh.maryland.gov/SitePages/ICD
-10%20Conversion.aspx17
