Best Practices: ICD-10 and 5010 – What These Changes Mean for Your Practice, and How to Implement the Transition

Judy Capko March 9th, 2011

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Regulatory requirements that affect the medical practice are changing rapidly.  The primary focus may seem to be on EHR systems and meaningful use to obtain those stimulus funds, but there are other mandatory system changes that need to be addressed now, starting with the conversion to both the 5010 HIPAA and the ICD -10 code set.

Current regulation requires the use of version 5010 HIPAA electronic standard transactions beginning January 1, 2012.  Ideally, system changes and upgrades should be occurring now or in the near future to allow adequate internal testing and testing with external partners such as clearinghouses and payers.   The regulations allow the use of the 5010 transactions prior to the compliance date if your external partners can accept them, so why wait?  The sooner you make these adjustments the better off you will be.   It is strongly recommended that medical practices complete their system upgrades far in advance to allow for internal and external testing and to properly prepare the practice for the change. 

Another looming change is the required conversion to the ICD-10 coding system – an important advancement in diagnostic coding.  It removes the limitations of the ICD-9, which is limited in its reporting descriptive and  does not address medical advances and adaption of technology.  The new system is more flexible and descriptive, and is expected to result in more accurate health care data reporting.

There are significant structural differences between the existing ICD-9 diagnostic coding system and the adaption of the new ICD-10 coding system. The transition to ICD-10 code set is expected to be one of the most substantial changes for physicians will deal with in the near future.  Medical practices will be required to adopt the use of the ICD-10-CM code set by October 2013.  Physicians, mid-level providers and staff will need to be trained in the application of this complex coding system.   The transition to the new code set will allow for precise diagnosis and procedure codes resulting in improved capture of health care information to enable more accurate reimbursement.  Benefits include an improved ability to measure health care services, reduce coding errors, a decreased need to include supporting documentation with claims, and the ability to use of administrative date to evaluate medical processes and outcomes.   There are a number of other equally important gains that will be achieved.

October 2013 may seem a long way off, but given the magnitude of this major conversion it is important to address this change now in order to avoid the possibility of severe work disruption and delayed or lost payments.

The first step in planning for the conversion to ICD-10 is to complete an assessment of the organization’s readiness for adapting the new codes and understanding the impact of the change on your practice. Practice leaders must meet with billing system IT representatives to develop an implementation strategy, timeline and budget to accomplish the conversion. The timeline should include testing the system and a plan for providing essential education and training for the team members. This requires aligning stakeholders and obtaining a commitment for the time and resources required to understand the system needs essential to accomplish a successful transition.

Resources are available

Resources to help you through the process of making these mandatory changes  and understanding the impact are available through the Centers for Medicare and Medicaid Services. Education and training courses are also available through the American Academy of Professional Coders (AAPC), an organization that is dedicated to providing  training programs to become a certified coder and maintain certification through continued education.  Codapedia has come to the forefront by sponsoring some free tutorials on ICD-10 to help medical practices prepare for the transition.  A number of specialty societies have also written about this subject and have developed tools to guide their members through the transition. 

In light of the major changes required to adapt to the new coding system, practices are taking a more microscopic look at their existing systems.  This is leading some practices to scrap their entire system in order to become the high tech practice of the future.  Regardless of what path you take, it’s important to get started as soon as possible. Begin by having frank decisions with appropriate management personnel and with your existing system provider to discuss how to plan and accomplish everything that is required for this major shift in reporting and managing data.

Judy CapkoJudy Capko, who contributes this monthly column to “Getting Paid,” is the founder of Capko & Company and author of the popular book “Secrets of the Best-Run Practices,” Greenbranch Publishing, September 2005. Judy has specialized in medical practice operations and marketing for more than 20 years, and is a certified risk management specialist. www.Capko.com

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