As the Oct. 1 deadline looms, physician's offices across the country are gearing up for the transfer to ICD-10. However, not every office is quite ready for the big day. According to a survey by the Medical Group Management Association, only 10 percent of offices said they were ready for ICD-10's debut. There are a number of ways an office can prepare for the switch. Perhaps the most effective way is by implementing testing procedures in the final weeks leading up to the ICD-10 migration. This practice will offer your staff a realistic idea of their preparedness and where there is any room for improvement.
Primary testing methods
The American Medical Association suggested splitting office testing into two distinct categories: internal and external.
For internal, there are a few areas in which your staff will use the ICD-10 codes, including:
- Database architecture: This refers to both the design and continued maintenance of a database.
- Reporting codes: The method for submitting either diagnosis or institutional procedure codes has been updated.
- Code grouping: Certain codes have to be grouped together for payment. For instance, injuries are now grouped by anatomical site rather than their type.
- User interface: The actual layout of databases will also change, and it's important staff have the ability to maneuver the interface.
Regarding the external practice, it's important that offices know if and when they are getting paid. This can be a complicated process, one that involves several different parties. As such, the testing regimen should include larger swath of entities, including:
- Local and national governments: These organizations require reporting forr various purposes. That includes public health reporting and data exchanges with both Medicare and Medicaid.
- Healthcare payers: These individuals will have concerns regarding components like risk analysis, support policies and general coverage rules. Offices will need to work on communicating code scenarios as a way to develop better relationships during the transition. The same level of communication will also help resolve early errors and other concerns.
- Hospitals: Testing health care information exchanges will help assess whether every component is being handled properly. It will also help to further develop the necessary interoperability standards.
Part of the ICD-10 preparation process should also involve content-based testing. Here, staff will utilize fictional scenarios to test the practical application of the new coding system. These scenarios can often be geared toward a specific practice, which can bolster overall comprehension.
Here is one practice scenario (courtesy of the Centers for Medicare & Medicaid Services):
- Patient: Complaining of stomach pain and gassiness.
- History: 47-year old male patient is suffering mid-abdominal epigastric pain. Pain is severe and associated with nausea and reduced appetite. He has lost 13 pounds in the last month. Patient pinpoints cause to eating 12 sausages at a Sunday church gathering just five days prior to visit. Patient also drinks up to six beers per day, having previously drank 10 to 12 before cutting back in the last half-year.
- Examination: Patient's temperature is 99.8 degrees Fahrenheit, and there is slight jaundicing of skin. Patient's abdomen is tender across upper portion.
- Assessment: Probable cause is acute pancreatitis; patient is admitted to hospital through on-call specialist. Blood is drawn in office.
- Clinical documentation: Pain should be specified, including region and duration. The same applies to alcohol-related disorders. ICD-10 requires physicians to distinguish between alcohol use, alcohol abuse and alcohol dependence.
ICD-9 diagnosis codes:
789.06: Abdominal pain, epigastric
789.60: Abdominal tenderness, unspecified site
782.4: Jaundice NOS
303.90: Other and unspecified alcohol dependence, unspecified
ICD-10 diagnosis codes:
R10.13: Epigastric pain
R10.819: Abdominal tenderness, unspecified site
R17: Unspecified jaundice
F10.20: Alcohol dependence, uncomplicated
The CMS has also provided ICD-10 code books online. Simply download the tables on the left-hand side and look for the 2012 ICD-10 CM and GEMS, as well as the 2012 ICD-10 PCS and GEMS. There are also additional practice scenarios located online, and they test a number of different specialties and code adjustments.