Four Phases to Help you Begin Your ICD-10 Preparations Right Way

Start your initial plan of conversion straight away so you can project your practice's timeline.

Medical practices that have got an early start to ICD-10 transition say that it's not an easy task as far as the process's vast nature is concerned. So if your practice has been putting off its preparations, it is time to get onboard the ICD-10 train.

Procrastinators should be careful: ICD-10 will go into effect on October 1, 2013, and CMS will not provide you a grace period post that date. To put it in other words, you will be better placed of you have your ICD-10 systems ready prior to that date so that your claims continue to flow smoothly. Experts warn that if you're not ready, your claims may not flow at all.

Key: The transition will have no effect on CPT code or HCPCS code use. Both of these coding systems will remain to be used as they are now.

4 phases help you begin preparing right away

At a medical practice, every month is a busy month. But then it's very important that you make time for your ICD-10 preparation sooner rather than later. An important takeaway message from today's session is the totally critical importance of not delaying in getting this implementation process started.

You should institute a well-planned implementation process to be ready in year 2013 rather than hastily scrambling your ICD-10(http://www.supercoder.com/icd-10/icd-10-bridge) program together at the last minute.

Here's how you should do it: break your ICD-10 implementation planning program into four phases. Here're the goals for each phase with suggested timelines:

Phase 1: Implementation plan development and impact assessment, suggested to span from the first quarter of year 2009 through the second quarter of this year

Phase 2: Implementation preparation, suggested to take place between the first quarter of this year and the second quarter of 2013

Phase 3: "Go live" preparation, should potentially take place between the 1st and 2nd quarters of 2013

Phase 4: Post-implementation follow-up, suggested to occur between the fourth quarter of 2013 and fourth quarter of 2014.

Normally, your phase one work should be approaching completion or at least be well on its way. For those of you who may not have gotten started yet or who have hardly gotten started, I urge you to move forward with this as soon as possible.

Reason: You will not be able to schedule phases through four until phase one is done, and you need to be able to calculate the resources you will require for those subsequent phases. Till you know the scope of the effect of ICD-10 in your organization, you do not know how much time and resources will be required to finish the preparation activities; as such you do not want to wait too long prior to making that assessment.

ICD-10 Will Bring One-To-One Equivalents

As we get ready to embrace ICD-10 Codes, many of you might be dreading the transition. But rest assured. Many a time you'll find simple one-to-one relationships between old and new codes. That is the case for hyperplasia; but even then you need to stay alert. You'll still need to carry over the same coding conventions.

For example, think that your ob-gyn suspects hyperplasia. She detects and documents 'endometrial thickening' during an ultrasound examination. What diagnosis should you use here?

Just because your ob-gyn documents endometrial thickening doesn't mean the patient has endometrial hyperplasia (621.30, Endometrial hyperplasia, unspecified; or 621.31, Simple endometrial hyperplasia without atypia). Many coders commit this mistake.

Remember this pitfall: If you encounter the same scenario in 2013, you shouldn't necessarily report the straight forward hyperplasia equivalents N8500 (Endometrial hyperplasia, unspecified) and N8501 (Simple endometrial hyperplasia without atypia). Take note how these definitions are exactly the same.

Coding tips: Do not be swayed by 'endometrial thickening'. You shouldn't code this as hyperplasia as physicians do not always consider the thickening of the uterus "abnormal;" as a matter of fact, it is just a monthly 'ramp up' for all women. Don't report hyperplasia until the ob-gyn has carried out a biopsy, and you have a pathology report that confirms this condition.

Solution: As you have no code to describe the patient's condition, you should report 793.5 (Nonspecific abnormal findings by ultrasound of genitourinary organs). Endometrial thickening is a finding and not a diagnosis. As such, you should locate the diagnosis code in the signs and symptoms section of ICD-9. If you take a look under 'thickened endometrium', this'll lead you to 793.5.

In the ICD-10 alphabetic index, you will not see 'thickened endometrium' referenced at all so you would usually rely on the choices given by one of the equivalent tables that have been produced (such as the ICD-10 bridge found at a coding resource like Supercoder/) based on the ICD-9 code 793.5.

Word of caution: If you look up 793.5's ICD-10 equivalent, you will find that the National Center for Health Statistics still lists R93.4 (Abnormal findings on diagnostic imaging of urinary organs), which is incorrect because the uterus is not a urinary organ.