ICD-10 Game Day

What to Avoid for Successful Implementation of ICD-10


The launch of ICD-10 is upon us and the healthcare industry is abuzz with excitement and nerves. Coders and physicians have been training for this big day and most, not all, feel ready to handle whatever comes their way. In a sense, October 1st feels a bit like the Super Bowl, only instead of helmets, tight pants and a pig skin tossed about, these players are wearing lab coats and throwing around three to seven digit codes.

If you don’t want to be the one to fumble the ball come ICD-10 game day, here are some mistakes you should avoid to be successful with implementation.


Failing to Take it Seriously


Those players who take the field on game day without working out, stretching, hydrating and learning the crucial plays will not only NOT win, they will end up getting hurt during the game. ICD-10 training and implementation requires providers and their staff to use clinical expertise to select the most accurate and complete codes and this will take planning.

If you’re not taking this new code set seriously and are assuming your cheat sheet or software will do all of your coding for you, prepare to be tackled and squashed under the weight of 15 figurative and hulking linebackers. Let’s put it into terms you’ll really understand: not taking this transition seriously can cost you dearly, as in significantly decreased payments and loss of productivity.

Hopefully you’ve prepared for this transition because there isn’t much time left. If you haven’t, better to get some training in than no training in. The CMS has stated there are five main ways practices can prepare for ICD-10:

  1. Make a plan.
  2. Train your staff.
  3. Update your processes.
  4. Talk to your vendors and payers.
  5. Test your systems and processes.


Yes, looking over these five steps you instantly recognize that some will be fairly time- consuming, like getting on the phone with all of your payers and vendors to make sure THEY’RE up to speed. So, really, step one should be DON’T PANIC. Just get as much prep work done now as you can so you stand a better chance come October 1st in limiting your revenue loss.


Using Unspecified Codes


You may be in the habit of using unspecified ICD-9 codes, but that doesn’t mean they will fly under the radar and you will somehow be magically paid. In this new code set, if there is a more specified code available and you don’t use it, prepare to have your claim denied.

Huddle up, here’s what you do: Get in the habit today, right now, of not using not otherwise specified (NOS) codes any longer. Most of these codes end in .9. If you get into better coding habits now, you’ll have to deal with far fewer denied claims in the near future.


Dual Coding Just to be Safe


It may seem like a good idea to make sure all of your bases are covered (yes, we know that’s baseball and not football but just go with us here) and code using both ICD-9 and ICD-10, but this is a surefire way of having your claims denied. You’ll have to choose one or the other set and here are a few questions to ask yourself to decide correctly:


  1. What is the date when the services were performed, before or after October 1st? 
  2. Have all of your payers transitioned to ICD-10? 
  3. How can you properly split your claims?


The most important thing to consider is that you need to code based on the date of service NOT the date of submission. Any and all claims that have a service date on or before September 30th should be coded using ICD-9 codes. All claims with service dates of October 1st or later should contain ICD-10 codes.

Now, extra care and caution should be taken with claims that span the actual transition period.

Here’s what CMS has to say about it:


“...when claims are split for an encounter spanning the ICD-10 implementation date, you must maintain all charges with the same Line Item Date of Service (LIDOS) on the correct corresponding claim for the encounter. You must not split single item services whose timeframes cross over midnight on September 30, 2015, into two separate charges.”


Please note, this is only one example, each payer will have its own specifications on how you should handle these kinds of claims so request information from them.


Believing the CMS Grace Period Will Save You


Please tell us you’re not one of those providers that assumes the CMS grace period will grant you unconditional payments in the post ICD-10 apocalyptic world. The first truth is, this grace period only applies to Medicare claims, not private payer claims. The second truth is, you are still required to, at the very least, use a valid code when it comes to the correct family of codes. In other words, if you don’t get ANY of the code right, there is a flag on the play and your claim WILL be denied.

The best way to combat this issue is to start thinking like an ICD-10 coder now. You should also start documenting as many specifics as you can now to get great at supporting the new codes.

There’s still a few weeks left before the big game day so there’s time to train hard and get ready. And when October 1st comes, get out on that field and do your best. And remember, if you get hurt, ice, elevate, and try again.


About the Author:

Daniel Schwartz is a content strategist who sheds light on various engaging and informative topics related to the health IT industry. His belief in technology, compliance and cost reduction have opened new horizons for people in the healthcare industry. He is passionate about topics such as Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data. He can be contacted at https://twitter.com/dschwartz20


About the Editor:

Kat Quinn, MBA is a digital health start-up specialist with a focus in HealthIT and Direct Primary Care (DPC) start-ups and co-founder of SheepGuru.com, one of social media's leading DPC voices.  She holds an MBA in Health Informatics and a BS in Marketing.  Her primary objective is to help launch digital health start-ups and Direct Care practices.  Her passion is health and wellness, and she is an advocate for free-market health care.


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