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Proper ICD-10 preparation combines technology, testing

Technology running back-end systems can enable ICD-10 preparation by giving the right space for new, extended documentation. Testing payer and vendor compatibility also matters.

While many innovative technologies, policies and procedures for managing patient data will be on display at the 83rd AHIMA Convention & Exhibit in Salt Lake City, the most pressing topic will be International Classification of Diseases, Tenth Edition (ICD-10) preparation, as coders lead their health care provider organizations through the October 2013 switch from the current ICD-9 reimbursement codeset.

"There's a sizeable component of the membership that's either involved with classifications themselves, or are involved with implementation of the ICD-10," said Dan Rode, AHIMA vice president of advocacy and policy. "Strongly attached to that is meaningful use."

Judging from a show of hands in a packed session at the recent Health Care Compliance Association's New England Regional Conference -- and affirmed by some of an expert panel's anecdotal experience -- only about 10% of hospitals have ICD-10 preparation on the radar yet. Those that do have not progressed far.

That could be shortsighted, according to those experts. Cynthia Trapp, AHIMA member, director of coding for the Lahey Clinic and instructor of a medical coding extension course that includes a refresher on human anatomy, thinks the transition to ICD-10 has the potential to be disruptive, "bigger than Y2K" for the health care sector.

"It's very daunting, and it's going to take very careful execution," said Patrice Devoe, Tufts Health Plan director of ICD-10 implementation and infrastructure initiatives. "It's not an IT initiative, it's really a business initiative." She likened ICD-10 preparation to painting a new living space. Do it before you move in, because it becomes much more difficult to accomplish once the furniture and appliances are in place.

IT leaders play key role in ICD-10 preparation

"It's not just an IT project, although the systems you have to change are huge. I know we have over a hundred systems that we are looking at. The IT piece is kind of the easy part," Trapp said. She added quickly that she was not downplaying IT's role in the transition to ICD-10, but rather, emphasizing that the clinical coding workflow component could be even larger.

Only about 10% of hospitals have ICD-10 preparation on the radar yet. Those that do have not progressed far.

First, there's understanding a provider's interactions with external payers. A big challenge for health care providers will be syncing up with private payers and the Centers for Medicare and Medicaid Services (CMS) to comply with the change.

Technically, Oct. 1, 2013 is not the hard-and-fast end of ICD-9. All claims submitted after that for outpatient procedures performed prior to Oct. 1(or for inpatients, discharge dates prior to Oct. 1) will need to be coded with ICD-9, thus creating a period when claims using codes from both sets will be moving through the health care system. It will affect anything that codes touch, such as CMS's Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative) incentive program.

To reduce the chaos in the hospital setting, Trapp recommended tuning up information systems to bring the new codes online, working with vendors and payers in test transactions and recognizing which codeset each medical procedure requires.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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