The government has set a final compliance date of October 1, 2014 for the industry adoption of ICD10. We are starting to get calls from clients asking us what we are doing to prepare for ICD10 implementation. I often answer the question with a question: What are YOU doing to prepare? The technical and EDI specifications rest with us, but our clients have always been responsible for diagnosis coding. Many of you now list your frequently used diagnosis codes on your encounter form. This will not be possible when ICD10 is required due to the sheer number of codes -- from 17,000 to approximately 141,000 ICD-10 codes.

We recommend that you take the following steps to make sure that you are prepared for the new coding requirements:

1. Attend an ICD10 implementation and coding class (preferably in your specialty).

2. If you are using an EMR, contact your vendor and get the answer to the following questions in writing:

• Will the company be upgrading the software to accommodate ICD10?
• Does the software support the government's General Equivalency Mapping (GEM)?
• What enhancements of clinical documentation will be made to ensure that clinicians have the ability to capture the additional documentation required for ICD10?
• Will the company support the ICD9 and ICD 10 code sets concurrently in the testing and production stages?
• How will the software handle the issue of ICD9 codes being disabled for dates of service after October 1, 2014, while remaining enabled for dates of service earlier than October 1, 2014?

3. Begin drafting a cross walk to convert ICD9 diagnoses to ICD10.

We will be glad to run a report that lists the frequency of the diagnosis codes you currently use. This report can be used with GEM mapping software/spreadsheets to help you transition from ICD9 to ICD10. Check out the GEM resources below:

ICD10 Code Translator: http://www.aapc.com/icd-10/codes/

CMS 2013 ICD-10-CM and GEMs: http://www.cms.gov/Medicare/Coding/ICD10/2013-ICD-10-CM-and-GEMs.html

Please note that when you use any ICD9 to ICD10 translator software and the ICD9 code you are converting is less specific than the code in ICD10, you should examine the rest of the codes in that category to find a more specific code available to you.   This is especially critical if the body part being treated exists as both right and left. ICD10 now includes whether right, left or bilateral as part of the diagnosis code, itself. You should look for the code which includes the arm, leg, eye, etc. you are treating. You need to begin to develop a database of usable specific codes for your specialty.  

4. Obtain, or expand, a line of credit with your bank to cover possible cash flow disruptions.

It is expected that initially there will be decreased reimbursement due to claim rejections and claim submission problems.

Just as we managed the conversion from 4010 to 5010, we will work with HealthPac, our billing software vendor, to test internally and externally submitting claims with the new codes. We will keep you up-to-date on our progress. If you are billing through your EMR's practice management software you need to make sure that your vendor is also working diligently with your clearinghouse to make this transition by the compliance date.

CMS ICD10 Provider Transition Resources: http://cms.hhs.gov/Medicare/Coding/ICD10/ProviderResources.html