ICD-10 Conversion Guide: Things to Consider Prior to Deadline!

Disclaimer: What follows are some general tips to help guide one’s transition to ICD-10-CM. This is not a comprehensive list and will not ensure proper ICD-10 implementation. Adhering to ICD-10 implementation by Oct. 1, 2015, remains the responsibility of individual providers and wound clinics. For further information and guidance, contact the Centers for Medicare & Medicaid Services (CMS).*

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RELATED CONTENT
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Category: Processes With Your Medicare Administrative Contractor (MAC)
Checklist Items:
• Review your MAC’s ICD-10 website. While the ICD-10 information and resources provided by MACs may vary from state to state, all information should be consistent with CMS policy regarding ICD-10.
• Complete tasks for your practice or wound center that will ensure compliance and compatibility with ICD-10 policy as well as the ICD-10 updates your MAC is instituting.
• Perform ICD-10 testing with your MAC. CMS conducted a national testing week in March 2014 and is planning future testing events for direct submitters (providers and clearinghouses).

Category: Electronic Health Record (EHR) Vendor Testing
Checklist Items:
• Prepare test cases to validate with your EHR vendor.
• Perform internal testing of systems and workflow processes using ICD-10 diagnosis codes.
• Conduct external testing with vendors and payers using data that contain ICD-10 diagnosis codes.
• Practice coding in ICD-10 and validate supporting clinical documentation processes.

Category: Clinic & Billing Practice Processes
Checklist Items:
(1) Obtain the following information from your clearinghouse, billing service, or system for the most recent 12-month period:
• Your claim rejections and denials by ICD-9 diagnosis code and payer.
• The most common unspecified ICD-9 codes you submit by payer.
2) Pinpoint the ICD-9 codes with the highest rate of rejections and denials, by claim count and dollar volume, for each of your largest payers.
- Categorize primary reasons for the denials and rejections.
- Note changes you can make to your documentation and billing processes to address the fundamental causes for the denials and rejections.
3) Modify your processes, where applicable, to address the underlying causes of the claim denials and rejections. Isolate the earliest link in the revenue cycle where the error occurred and target your fixes at this sticking point.
4) Identify your commonly billed unspecified ICD-9 codes, by claim count and dollar volume, for each of your largest payers. Strive to reduce the number of unspecified codes you submit, where appropriate. Look for diagnosis codes that better capture patient complexity of care.
5) Gain familiarity with the ICD-10 codes you will most frequently use by reviewing the following sources of information:
- 2015 release of ICD-10-CM codes and descriptions published by the National Center for Health Statistics;
- 2015 General Equivalence Mappings Diagnosis Codes and Guide from CMS;
- CMS crosswalks from your system vendors and largest payers.
Note: Your wound center documentation should natively code in ICD-10. Only use crosswalks and mappings as a point of reference. By natively coding in ICD-10, your practice will be in a better position to select specific codes reflecting patient complexity of care.
6) Evaluate a sample of your clinical documentation. The sample should include common conditions seen at your practice where the underlying ICD-9 codes map to multiple ICD-10 codes. Determine if all key concepts relevant to patient care were captured in sufficient detail within the sample to support the selection of appropriate ICD-10 codes.
7) Review documentation best practices for common conditions in your area of practice. Refer to the “Primer for Clinical Documentation Changes and Clinical Scenarios” provided with your action plan.
8) Increase your level of documentation in those instances where key concepts are not being captured in sufficient detail to support the selection of an ICD-10 code that best reflects the patient complexity of care.

Category: Revise Paper Forms & Templates
Checklist Items:
1) Incorporate ICD-10 codes into paper forms and tools that reference diagnosis codes: 
• Preadmission/precertification
• Referral
• Authorization
• Orders
• Super bills/patient encounters
• Inpatient and Outpatient Scheduling
• Quality Reporting
• Public Health Reporting
• Other paper forms and tools you use that capture diagnosis code information.
2) Review the “Primer for Clinical Documentation Changes” included with your action plan and adjust the following templates to accommodate all the necessary information:
• Patient Registration and History
• Assessments
• Care Plans
• Other documentation templates used by you practice.
3) Modify Policies & Procedures
• Identify your most common services that may trigger reviews or denials related to medical necessity. Adopt procedures to isolate ICD-10 diagnosis codes needed to make a coverage determination for these common services prior to claims submission.
• Track patient complaints, payment delays, denials, and increases in authorization volume for at least three months beginning on the compliance date. By logging this information, your practice will be in a better position to spot and address problems more quickly. 

General Considerations
Checklist Items:
1) Train physicians on proper documentation specificity for top diagnoses. These may be associated comorbid conditions as well.
2) Start coding both ICD-9 and ICD-10 effective immediately to ensure plenty of practice.
3) Perform documentation audits to identify problem documentation. If documentation is not specific, it may lead to numerous queries that will delay billing.
4) Plan for initial productivity loss. Do you need staffing?
5) Purchase the codebooks.
6) Communicate with your health information directors to see if they might assist during the transition.
7) Have someone dedicated to reviewing charts on a regular basis.
8) Look at 100% of remittance advices to identify cause of rejected claims.
9) Review all insurance coverage policies for future effective policies that will “go live” on Oct. 1.
10) Establish communication mechanism with you EHR vendor. There may be problems to iron out.
11) Make sure the EHR is not carrying forward resolved issues on the problem lists.

*Certain items from this list were compiled from CMS recommendations.