1/30/2014 ICD-10: A Roadmap for Small Clinical Practices

http://www.medscape.org/viewarticle/809674_2 1/13

ICD10: A Roadmap for Small Clinical Practices CME/CEDaniel J. Duvall, MD, MBA; Joseph C. Nichols, MD; Gail E. Eminhizer, CMM, CGCS, HITCMPP; Carla S. Bartlett, RNCME/CE Released: 08/30/2013; Valid for credit through 08/30/2014

Daniel J. Duvall, MD, MBA: Hello. I am Dr Dan Duvall, medical officer with the Hospitaland Ambulatory Policy Group at the Centers for Medicare & Medicaid Services (CMS) in

Baltimore, Maryland. I would like to welcome you to this program titled "ICD10: A

Roadmap for Small Clinical Practices."

(Enlarge Slide)

Joining me today is Dr Joseph Nichols. Dr Nichols works on behalf of CMS as a contractor

with Noblis, the project management office contractor responsible for implementing ICD

10. He is also the principal of Health Data Consulting and a boardcertified orthopedic

surgeon by training. He is currently involved full time in health care information

technology.

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1/30/2014 ICD-10: A Roadmap for Small Clinical Practices

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technology.

Joseph C. Nichols, MD: Thanks, Dan.

Dr Duvall: Gail Eminhizer is the practice administrator with Digestive Health Associates ofNorthern Michigan and is the committee chair for PAHCOM, the Professional Association

of Health Care Office Management, Chapter Support.

Gail E. Eminhizer: Thank you.

Dr Duvall: Thirdly, Carla Bartlett is a registered nurse and director of continuous qualityimprovement at Fairfax Medical Facilities, Inc., a federally qualified health center in

Fairfax, Oklahoma.

Carla Bartlett, RN: Thank you.

Dr Duvall: Welcome to all of you.

(Enlarge Slide)

Dr Duvall: The goals of this program are to identify the internal staff, functions, andprocesses within small independent clinical practices that will be most directly affected by

the conversion to ICD10; to explain how to plan and implement training, software, and

procedural changes associated with conversion to ICD10 within a small clinical practice;

and to discuss when and how to initiate testing of ICD10 systems, both internally and

externally, to ensure a smooth transition by the deadline.

(Enlarge Slide)

ICD10 is an enhanced or mature version of ICD9 that more accurately reflects current

medical practice. This allows reimbursement to better reflect the intensity of patient

needs.

(Enlarge Slide)

When does the ICD10 transition take place? In other words, diagnoses and inpatient procedures needto be coded with ICD10 for services occurring on or after which date?October 1, 2013

January 1, 2014

October 1, 2014

January 1, 2015

Submit

Joe, could you provide a brief explanation of ICD10 to make sure everyone is up to

speed?

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Dr Nichols: Sure. ICD10 is really an international standard for the definition of healthservices that is mandated in the United States for all healthcare entities that are covered

under the Health Insurance Portability and Accountability Act (HIPAA).[1] In the United

States, it includes diagnostic codes, which we call ICD10CM, as well as inpatient

procedure codes, which are called ICD10PCS.[2] Why are we converting from ICD9 to

ICD10? ICD9 is currently 30 years old and is a little outdated. If we continue to use ICD

9, we will not be compatible with other countries because they already use the ICD10

standard. By and large, we are one of the few countries that has not yet made the

transition.[3]

ICD10 better supports the medical concepts that are really important in terms of

understanding the nature of health conditions. It provides improved ability to understand

risk, severity, and complexity. All HIPAAcovered entities are required to use ICD10 by

the compliance date of October 1, 2014.[2] That means that all claims with dates of

service for professional claims by HIPAAcovered entities on or after October 1, 2014, and

all inpatient claims with dates of discharge on or after October 1, 2014, should be

compliant with ICD10.

(Enlarge Slide)

Dr Duvall: Thanks, Joe. Providers and others affected by ICD10 have many questions. A

good place to start getting answers is the CMS website [2] which presents resources

tailored to practice size and setting. Additionally, the site includes answers to specific

questions and recommendations about specific concerns. The companion online video

lecture for this program, "ICD10: Small Practice Guide to a Smooth Transition," is

another good resource and is easily accessible on Medscape Education. Additionally,

trade and medical associations may offer materials, training, and guidance.

(Enlarge Slide)

Converting to ICD10 is doable. It is not optional, but it is doable. Any covered entity as

defined by the HIPAA of 1996[1] will be affected. If you deliver healthcare services in the

United States or US territories, this affects you.

(Enlarge Slide)

Many providers assume that the CMS, their hospital administration, or even their vendors

will provide explicit instructions for the process of converting to ICD10, but the

responsibility lies with providers to comply with the deadlines for converting to ICD10.

However, there are many resources to help you get there.[4] With just a little planning, you

can move forward in a way that makes the most sense for your practice.

(Enlarge Slide)

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(Enlarge Slide)

The timetable for ICD10 has a few points on it like the end point for conversion, but CMS

does not specify interim milestones or other details. Gail, what can you tell us about the

timeline to ICD10 conversion?

Ms Eminhizer: There is really no rigid timetable for converting to ICD10, but it is nevertoo early to get started. There are certain things that you can begin doing right now.

Some of what you need to do will depend on the size of the practice that you are in. The

transition will be easier for smaller practices, I think, than for some of the larger or mid

sized practices. The fewer people involved, the less complicated it is to get things done.

Ms Bartlett: I do think that the size of the practice matters. Larger practices may havemore challenges than the smaller practices. They have more to take into consideration,

such as cost, timing, and coordination of both internal staff and external partners.

(Enlarge Slide)

Ms Eminhizer: The type of practice or the specialty that you are involved in is also goingto come into play. Some specialties or types of practices are going to have fewer codes to

worry about and others are going to use many codes, so all of those factors will need to

be considered. Other issues, such as timing and billing for instance, also need to be

addressed.

Dr Nichols: One of the things that I hear from folks in small practices is that although itmight be simpler to implement the transition because they are not big, it is also true that

they have fewer resources to get it all done.

Ms Bartlett: That is true.

Dr Nichols: Some folks in small practices say, "We just do not have the resources for

training and we do not have project management." As we start looking at the smaller

practices, we hope that they will have a less complex transition. Nevertheless, they will

need to start thinking about how to use the resources they have in a wise and appropriate

way.

Dr Duvall: What about the type of billing system that the practice has? Does that matter?

Dr Nichols: It matters a lot. Clearly, if you are doing all the coding inside your own office,you are going to look at: "Will my superbill still work?" If you are outsourcing your coding,

is that coding entity up to speed and ready to handle ICD10? Will they be able to accept

ICD10 codes? You really have to look at how what you do in your practice translates to

how you bill, and whether it is done directly through your own office or through some

thirdparty entity.

(Enlarge Slide)

Dr Duvall: Given all of these variables that affect timing, when should people actuallystart addressing and implementing the conversion process? Carla, what do you

recommend?

Ms Bartlett: Now! Even yesterday! Seriously, it is not too soon to start. Practitioners andadministrators need to evaluate their readiness for ICD10 and move ahead with planning

and implementation right now.

Dr Nichols: Yes. When I spoke with a group on this topic recently, we showed them a

standard timeline as an example. Everyone looked at it and asked, "Wait a minute.

According to the timeline, we are already late. What do we do now?"(Enlarge Slide)

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It is already somewhat late to be getting started. Because there is less lead time at this

point, you need to start thinking about some of the things that can be handled in parallel

not everything is linear. There may be some things that can be accomplished

simultaneously to compress the timeline a bit and to initiate the key steps.

The other thing is prioritization. You may not have enough time to do everything. You may

have to put some things off a bit, especially if they are not so critical at day 1. Given that

the timeline is somewhat short at this point, some thought should be given to necessary

adjustments.

Dr Duvall: Is there anything in particular that should be addressed first? Items thatrequire longer time frames to change?

Ms Bartlett: If you use an Electronic Health Records (EHR) system, that could be a bigissue. Does it accommodate the ICD10? In our practice, our ICD10 software works with

our EHR system, but you would need to test it comprehensively. You should evaluate

external entities, as well. Are they going to be ICD10 compliant? If we transfer something

with a certain ICD10 code, is it going to connect with the external group as it should?

Dr Nichols: That is such a great point, because if you have dependencies on externalpartners that are critical to your timeline, you may need to reach out quite a bit earlier to

those folks. You may assume that they are ready to convert to ICD10 but they may not

be. Making sure you understand all those dependencies and where they come in the

timeline is important.

Dr Duvall: What I am hearing is that systems and software and external interactions are

the things that people should look at first.

Ms Eminhizer: Right. Well, also the internal processes within your practice. It is never too

early to start looking at the internal processes in your practice. You might look at whether

providers are documenting at an adequate level. Most of them already are, but it is never

too soon to start looking at that. I talk to my staff, explaining that ICD10 is coming.

Repeating the message at every staff meeting, every month, is very helpful because it

prepares everyone for the next transition. There is never too much you can do to keep

staff aware and cooperative.

(Enlarge Slide)

Dr Duvall: It sounds like there are a number of points that people will have to think aboutas they are constructing this timeline. Examples of timelines for small practices are

provided online by CMS on their website[5] because this is a complex issue.

(Enlarge Slide)

Many functions of the small practice are affected by the conversion to ICD10. Could you

talk a little more about some of the specific functions that must be addressed for the

conversion?

Ms Eminhizer: Every aspect of the office is going to be affected in some way or another,but certain functions are critical from the beginning. It is clearly important to look at and

start working on systems for submitting claims. Whether you use an EHR or superbills,

you have to think about how you are going to convert those to ICD10. Who is going to be

assigning codes? Are they actively trying to code in ICD10? Are they looking things up in

the new ICD10 books? (Enlarge Slide)

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Dr Nichols: Right. One of the things that a lot of people forget is that there are manymoving parts in your practice.

Dr Nichols: When you actually go through the workflow of everything that you do, you

identify new areas that might be affected. The exercise of walking through the life cycle of

daily work in your practice is very helpful and can shine a light on some of those areas

that you are going to have to look at.

Dr Duvall: We just need to ask some simple questions like, "Can you assign a code and

can you save that code?" In other words, does your system have a way of keeping track

of a code once it has been assigned?

Ms Bartlett: It is going to require some auditing and testing, and certainly we are lookingat how to code with ICD9 compared with ICD10, making sure the documentation is

there.

Dr Nichols: It is a great exercise, though.

Which of the following professional relationships is critical for effective ICD10 coding in a small clinical practice?Office manager and backoffice staff

Clinician and laboratory

Owner and IT software vendor

Thirdparty payer and frontoffice staff

Submit

Dr Duvall: Carla, your comment about auditing and testing raises some good points. Ifyou are doing that, then I would assume you have to have some sort of training first.

Could you talk a bit about the kinds of training that you think a practice would need to

implement ICD10?

Ms Bartlett: You need to think about who in your practice will need training, but there aredefinitely some good options.

Dr Nichols: Different people will need different types of training. Coders may needtraining, but office people and even clinicians are concerned primarily about the business

implications of the conversion. They want to get the job taken care of in the most efficient

way. The clinician really needs to understand what the coder will be looking for. In other

words, what sorts of things do I need to document that will make life easier for the person

who is going to be coding? What are the key concepts that I need to capture? Hopefully, I

am already doing that today; it should not be anything new.

Ms Eminhizer: From the coding perspective, having the tools they need, such as the newICD10 book, can be very reassuring. They can begin practicing by checking out the

codes that they currently use. They may choose to watch video courses or training

videos, or attend live meetings. It is very reassuring to realize, "This is really not going to

be as bad as I anticipated!"

Dr Nichols: That is such a great point.

Dr Nichols: The big unknown is the scary part. Once you get into the process, yourealize, "Oh, this is pretty doable."

Dr Duvall: Gail, you mentioned the new book as the key tool of the coder, which itcertainly is, but in today’s world, there are also a number of software tools that can help.

Do you have any tips or pearls that might be helpful for people as they investigate some

of these existing and potential software tools?

(Enlarge Slide)

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Ms Eminhizer: I would check references first because whenever there is a transition likethis, products are developed to address the need but some are better than others. There

are definitely many different programs available, including those that are available

through medical or specialty societies and coding societies.[69]

Ms Bartlett: Your primary care association is a good resource for training. It certainly hasbeen for us.

Dr Duvall: That is an excellent point. Different specialty and primary care associationswould have slightly different experiences because things are going to be a bit different,

depending on specialty. Joe, could you talk about that from a clinician's perspective?

Dr Nichols: Yes. The specialties are going to be very different because ICD10 is verydifferent across the different specialties. For clinicians who take care of patients with

musculoskeletal issues and orthopedic conditions, there has been a very big expansion of

codes. Primary care providers may also care for patients with musculoskeletal issues. In

other clinical areas, headaches or even behavioral health disorders, in contrast, there has

been fairly little change with respect to coding. And in some areas there are substantially

fewer codes. In hypertension, for example, there are fewer codes. There is a great deal of

variability across specialties.

Dr Duvall: Would it be fair to say that most specialties will still be dealing with that small

code set that they were accustomed to dealing with?

Dr Nichols: Exactly. When we looked at all the codes historically in ICD9, we found that

5% of the codes accounted for 70% of the volume. In reality, the code set we use today is

very small. Although we will be using a few more codes in ICD10, we are still going to use

just a small subset of the overall codes. What is important is really understanding those

codes that you use. Even in musculoskeletal care, there are many codes we might never

use in our particular practice, so it is really important to understand the subset that

pertains to your own area.

(Enlarge Slide)

Dr Duvall: Good. Now, the flip side of that from the coder’s perspective is thedocumentation. The documentation and the coding go together. Are there any tips that

you might offer about how practices should approach this question of documentation and

coding?

Dr Nichols: Thanks for raising that question. I gave a talk recently to a large group,during which there was a discussion about "How do we get clinicians engaged in

documentation" because there is a perception that documentation is a "new burden"

imposed in some way by ICD10. But if you start drilling down a bit, most of the things that

require documentation in ICD10 really are the same things that we do today as part of

good patient care.

The real focus on documentation for ICD10 is really about the key things that need to be

documented for good patient care. If you document those, then the coder will have more

than enough information to identify the proper code.

Ms Eminhizer: Right, I agree. I have also found in talking with some of my colleaguesand reviewing our own medical records that everything is really already there. In most

cases, what the coder would need is already in surgical notes or hospital notes. The one

area that might be a little lacking is the office notes but it is really not a big jump from

where they are to where they need to go. With a little better focus on office notes, our

experience indicates that everything is really pretty well documented already.

Dr Duvall: Has that been your experience as well, Carla?

Ms Bartlett: That was what we were looking for when we initiated our audit. The

(Enlarge Slide)

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providers checked their documentation to see whether they met requirements for coding

in ICD10. Everything is electronic at our office now, which is new for us, so the entire

exercise is a bit of a learning experience.

Dr Duvall: Did you find, like Gail, that the documentation is pretty much all there already?

Ms Bartlett: Yes, and with our current EHR system, documentation is mostly a quickcheckbox thing, so it is not particularly burdensome.

Dr Duvall: Great. Then one of the concerns from a number of clinicians has beenwhether this conversion would require a lot of documentation changes, but it sounds like

good documentation is good documentation, and that is true whether you are talking

about ICD9 or ICD10.

Ms Bartlett: Absolutely.

Dr Duvall: Great. Joe, let me ask you to talk about another concern among clinicians, andthat is about the time that training in ICD10 is going to take. Is it going to be intrusive in

terms of the work of the practice?

Dr Nichols: Clearly, some time will be required for training, particularly on the codingside, because ICD10 is a fairly significant change. However, coders have done a fairly

good job of getting trained and coming up to speed. There are plenty of training materials

and resources online through AHIMA, AAPC,[6,7] and other organizations that provide

training. I am not worried about coders because they have tons of material available to

them and they have taken advantage of those resources, by and large. I have spoken

with many coders and they are pretty aware. In contrast, office staff may need some

training about any changes to their roles and how those changes are likely to affect the

overall processes in the practice.

(Enlarge Slide)

On the clinical side, it is about understanding what concepts are now required for ICD10.

We should probably be documenting them already today, but if we do not capture those

as a normal part of our care, then that will have to be addressed.

(Enlarge Slide)

Let me give you an example. For example, we know that musculoskeletal codes account

for almost 60% of the ICD10 codes, right? There are a huge number of codes on the

musculoskeletal side and there is concern about complexity, right? There are thousands

of new codes, but if you really look at those codes, there are a lot of recurring patterns.

(Enlarge Slide)

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"Right vs left" accounts for 30% of all the ICD10 codes. Everything else is essentially the

same. In addition, for every fracture we see, for example, you have to indicate whether it

is an initial encounter, subsequent encounter, or sequelae. Multiply that times each

fracture, and then for every fracture, you need to indicate level of healing: normal healing,

delayed healing, nonunion, or malunion. Once you start doing that, you can see why there

are so many codes, but the concepts are pretty basic.

The other thing is a lot of those concepts can be moved up during the course of a patient

visit. In other words, the clinician may not need to say whether it is initial or subsequent

encounter. That concept can be captured as part of the initial intake. Likewise, which side

(left or right), and whether it is normal healing can be included as a standard part of

intake. In obstetrics, whether it is the 1st trimester, 2nd trimester, or 3rd trimester, and

weeks of gestation can all be captured without the clinician’s direct input, which can

lessen some of that burden on the provider.

Ms Eminhizer: Right. That brings up a good point as far as training the staff. Those kindsof concepts need to be discussed with the intake staff, the medical assistants, and anyone

else who can be looking for those concepts to help with the documentation.

Dr Nichols: Exactly.

Dr Nichols: Much of the burden can be lessened by having staff know some of the keythings that need to be captured in the medical record.

Dr Duvall: It does not sound like that is really going to be a big issue. It requires work butis not an obstacle that cannot be overcome easily.

(Enlarge Slide)

How about the question of software upgrades and other issues related to changes in

software? This is another area of considerable concern.

Ms Eminhizer: I would recommend checking with your current software vendor rightaway about where they are with respect to ICD10. Many of the vendors are already

putting together webinars and other types of events to proactively keep their clients

informed. It is a really good idea to pay attention to those and to attend when possible.

(Enlarge Slide)

Some of these presentations are prerecorded, so if you are in a small office and feel that

you cannot take time during the day, you can probably find the session online. I definitely

recommend making sure that you know where your EHR and practice management

vendors are with regard to ICD10 conversion, but also any clearinghouses that you may

use. Clearinghouses are also a big part of the overall transition. You need to know what

they are doing to prepare for conversion to ICD10.

(Enlarge Slide)

Dr Duvall: Working with clearinghouses is a great example of working with an external

partner, and I would assume that there are many other partners that should be

considered, even for small office practices. Carla, could you comment about external

partners?

Ms Bartlett: I am a nurse, so we order laboratory tests and diagnostic procedures. We

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have to ask whether the other end is going to be prepared to accept that same ICD10

code. The hospitals where you send patients for different procedures and testing, any of

your labs, including reference labs if you use them, will all have to be ICD10 compliant.

Dr Duvall: Is that as simple as picking up the phone and calling them?

Ms Bartlett: It definitely is. Yes.

Ms Eminhizer: Sometimes, though, you run into problems because they do not knowwhere they stand. It does not hurt to pick up the phone and make that call, but if you do

not receive a satisfactory answer, then you need to look further.

Dr Nichols: The first step is picking up the phone and asking, "Will you be ready?" But

you also have to ask what does "ready" mean?

Ms Bartlett: Right.

Dr Nichols: And, is their definition of "ready" going to meet your needs?

Ms Bartlett: Right.

Ms Eminhizer: One of the things that we are doing in our local community is that we areworking directly with the hospital. In previous transitions when, for instance, several of the

practices converted to EHRs, we found that training in our office and training in the

hospital were different. So we decided to try to do some things that are more coordinated

with regard to the ICD10 transition. The hospital is working directly with the provider

offices to explain how to handle the internal forms at the hospital, what their needs are,

and what each different specialty might need to do. Each specialty works through the

process, 1 department at a time, and then, the whole group will come together. We are

hopeful that this approach will help the local transition. It is not going to address the

overall transition, which will have to include other partners such as clearinghouses, but

what we are doing internally and with our own hospital system will be really helpful. I

would encourage other hospital systems across the country to look at doing something

similar. It has been a great program.

(Enlarge Slide)

At what point does it make sense to start internal testing?Right away. It is best to start now.

After coder training but before software installation

After coder training is completed and software has been installed

When all systems are ready and the interface with external partners has been achieved.

Submit

Dr Duvall: Well, with all of these interacting parts, it sounds like it may not be until toward

the end of the time frame that all of the pieces finally come together.

From a testing standpoint, since you have to test your own systems as well as those that

link up with outside entities, does it make sense to start testing before all systems are up

and running? Do you have to wait for training to be completed, wait for all of the software

before you start testing? Joe, I know you deal a lot with testing. What can you tell us?

Dr Nichols: There are a lot of different aspects to testing, which includes both internaland external testing. Internally, there is component testing and business testing, and

there are many test paradigms that can and should be run in parallel.(Enlarge Slide)

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We may want to use common scenarios to test vendors. If you are an obstetrician, for

example, you may develop a scenario about a pregnant woman getting admitted to the

hospital and having a Csection. You would actually run the scenario through your office

to see how your systems, your business, and all the different parts of the practice handle

that in the ICD10 environment. The more technical aspect of testing, of the software,

comes after that. First, you have to make sure the business aspects are up and running

because that will define your business requirements. Until you have business

requirements, you really cannot tell what the system should do.

Dr Duvall: Okay. It sounds like with scenario testing, you are looking at a patienttypescenario, but also at the processes involved. So, you are asking what happens if a claim

code is rejected or if I need to select a code? Is that correct?

Dr Nichols: Exactly. A hospital, for example, will want to understand, are we ready? Let'sdo a fire drill. Let's actually create a patient case. Let's run it from the Emergency

Department through Admissions, through Radiology, through Pathology, through the

Operating Room, through discharge, all of those different places, and let's see how that

scenario would pan out. This way, we can identify any gaps, much as you do with the fire

drill.

Dr Duvall: Gail or Carla, how is testing different when you are dealing with externalpartners? How can you assess whether their systems are working as well as your own?

(Enlarge Slide)

Ms Eminhizer: Some vendors have created test environments so that you do not have touse your real database. You could run a test case through with both your EHR vendor

and the relevant clearinghouse. Some of the clearinghouses are not quite ready for that

kind of testing yet, but some may be and most will be.

Dr Duvall: As Carla pointed out, if they are not ready, you can push them in that direction.

Ms Bartlett: Yes. As soon as I pick up that phone again.

Dr Duvall: Great. Are there specific questions that you should be asking external payers?

Ms Eminhizer: You should be asking the same questions you are asking theclearinghouses and the vendors and other partners. Yes, you should definitely be

checking and probably can start with the provider representatives but do not accept a

simple "Yes, we are on the path" as an adequate response. You should determine how

they are preparing, what stage their process is, and what they are doing internally to test.

Dr Duvall: It seems to me that there are a couple of key questions that you, as a smallpractice, want to ask yourself. Carla, could you maybe summarize that for us because you

have been there?

(Enlarge Slide)

Ms Bartlett: You need to know whether you will be able to submit claims. Will you be able

to complete the medical record? And, can your EHR capture the ICD10 codes?

Dr Duvall: Great, and I'd add a recommendation to be on the lookout for surprises.Super. Another question for the panel. No matter how much you prepare in a big project,

there are always bottlenecks, setbacks, and barriers. Could you talk a bit about your

experience with regard to the greatest challenges that you have had in moving ahead with

conversion to ICD10 in small practices? And also, what have you done to overcome

those barriers?(Enlarge Slide)

Dr Nichols: When I talk to people in small practices, the primary issue is awareness.

They just are not aware of the coming ICD10 change and do not really believe that it is

going to affect them. We do not get paid on the basis of these codes, so recognizing that

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it is going to have an impact is the critical first step. What are your experiences?

Ms Eminhizer: I agree and I also hear that people think the timeline is a long way downthe road, and it really is not. They think it can wait or it is going to get delayed. I hear that

one a lot. I do not see that it is going to get delayed and I do not think we should be

waiting.

Dr Nichols: Exactly.

Ms Eminhizer: Procrastination is a big issue.

Ms Bartlett: Our providers were the same way. They were concerned at first, but after weplayed with ICD10 and did some testing and auditing, they are excited about it now and

look for it to be a benefit in the long run. It will be good to have a better coding system.

Dr Nichols: That is what I found. Folks who have started to do something aboutconverting to ICD10 suddenly breathe a sigh of relief because they realize, "Oh, this is

not nearly as bad as we thought it was going to be." Once they actually move forward with

implementation, they see that the transition will be fine. We have to make people aware

and get them to realize that it is important. Getting over that fear factor and getting started

is really the hardest part.

Dr Duvall: Great. That sounds really encouraging. What about barriers as they relate to

external partners? Do you have any comments about working with clearinghouses, for

example?

(Enlarge Slide)

Dr Nichols: Most clearinghouses are pretty far down in the process in that they need tobe ready to send and submit ICD10 codes on your behalf. There is this assumption that

clearinghouses are going to convert your codes from ICD9 to ICD10 or ICD10 to ICD9,

but that is a very false assumption. Clearinghouses are not allowed to do that because

they cannot diagnose. You have to submit the code information to them and then they

can put it in the proper transaction format. However, they cannot go into the record and

alter the patient’s condition, so you cannot count on a clearinghouse to handle this coding

change for you.

Ms Eminhizer: That is a great point.

Dr Duvall: Great. It sounds like providers will continue the documentation that they havebeen doing all along, they will make the transition to ICD10 coding, and the

clearinghouses will help them process the claims with the new codes on them.

Dr Nichols: Correct.

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Dr Duvall: No significant changes are made without some effort but a good stepwiseplan, sufficient practice, and thorough testing can ensure that your practice will be ready

when the switch to ICD10 goes into effect in the fall of 2014. Remember that the

objectives of your practice are to prevent disruptions in patient care, disruptions in

workflow and staff procedures, and disruptions to overall efficiency of practice. If you use

a stepwise approach and look at this as something that is doable, you can make that

transition without disruptions.

On behalf of the CMS, I would like to thank you all, Joe, Gail, and Carla, for participating

in this educational activity designed to help small independent clinical practices move

forward with the planning and implementation of ICD10.

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1/30/2014 ICD-10: A Roadmap for Small Clinical Practices

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