ICD-10 Guidelines for the Health and Medical Industries

If you're in the medical or healthcare industries (especially if you're involved with billing and payments), you probably already know the American medical community is preparing to implement ICD-10, the new medical coding system. ICD-10 was originally scheduled to go live in 2013, but the American Medical Association (among others) raised such a fuss about needing more time that a new Oct. 1, 2014 deadline was set as a compromise. Hospitals and administrators aren't counting on any further ICD-10 delays, however. Even with the additional time, a lot of hurdles have to be cleared before everyone is ready. Hospital administrators and other healthcare providers should be aware of these hurdles so they can be ready to jump. Analysts say ICD-10 implementation will cost as much as $100 million for very large, integrated health systems. But the costs  of not getting it right (due to lost reimbursement and a lagging revenue cycle) could be even greater. The Cumberland Consulting Group (a project management firm that helps healthcare providers implement technology), has announced the following recommendations for ICD-10 preparedness. Whatever your role in the medical community, we suggest you get to know these suggestions and be aware of ways to ease the transition where you work. Most hospitals are now at the readiness assessment phase. The American Hospital Association canvassed its members in February 2011 and found that almost 42 percent had already finished an ICD-10 implementation plan. That means that they had already started training their doctors and staff, and they had taken steps to make their code sets more operational as they transition to ICD-10. Uncoordinated priorities impede ICD-10 implementation. Hospitals welcomed the deadline delay because they now have an extra year to prepare.  The healthcare sector as a whole, however, isn’t so lucky. 2013, the year we're getting ready for ICD-10, is already divvied up between competing priorities. Major initiatives in the use of electronic health records, telehealth implementation and enhanced security measures are keeping staff members busy in 2013. The industry is changing, and it's changing fast. Expect big changes in orthopedics and cardiology codes. Particularly on the procedure side (versus the outpatient side), orthopedics and cardiology will be significantly impacted by ICD-10. The new codes look very different from ICD-9, so there's learning curve for clinicians becoming familiar with them. Providers are advised to conduct internal research to find out which codes to look out for. Implement clinical documentation improvement (CDI) programs. Under ICD-10, records will need to be much more specific. A CDI program is a must for identifying gaps in documentation. Completing a physician documentation assessment will determine how your documentation conforms to an ICD-10 environment, where a diagnosis or procedure code will not be found without specific records of the patient’s condition. Doing so, according to Cumberland, will improve strategies for a successful switchover. Hospitals should emphasize concepts, not definitions. Hospital managers should teach concepts instead of focusing on memorizing terms. Training is the most important aspect of preparation for ICD-10, but doctors and providers are not expected to memorize the tens of thousands of new codes. Instead they should be trained on how to incorporate the concepts underlying the new codes into their documentation. Concentrate on ICD-10 prep—not on ICD-11. There’s a common misconception that ICD-10 is new. It isn’t—other countries have been using it for decades. It’s only new in the United States, which has held on to ICD-9 for too long. Now, the World Health Organization announced that it’s already formalizing the ICD-11 structure in 2015. Some in the U.S. medical community suggested skipping ICD-10 altogether and waiting two years for ICD-11. However, ICD-10 provides a good foundation and a natural stepping stone to ICD-11, so getting comfortable with ICD-10 first is the best course. Indeed, with the deadline fast approaching, it's the only course. (See also Finding Healthcare Jobs)