Smoothing the Path to ICD-10 Transition

 In Articles, ICD-10, Provider Notes

The delay of ICD-10 implementation until at least October 1, 2015 provides a tremendous opportunity to use the extra year to gain a better understanding of the vital documentation changes for providers and explore operational modifications to the practice necessary for ICD-10 implementation and potentially valuable to the practice.

ICD-10-CM contains about 68,000 diagnosis codes (up from 14,000 in ICD-9-CM). It looks like a big change, but when you consider the explicit use of laterality (right, left, bilateral) makes up 26,626 of the code increase and explicit use of trimesters in pregnancy tripled the OB codes, the increase is understandable.


Who will be most affected?

If your specialty is OB/Gyn, orthopaedics, psychiatry, gastroenterology, cardiology, general surgery or physical therapy, you should prepare for a significant number of new coding rules, including laterality and other documentation necessities to ensure accurate coding. Primary care, optometry, dermatology, otolaryngology, lab and DME all face moderate changes. Dental has the lowest impact of the ICD-10 change. If you are in one of the high impact specialties, it is time to get to work understanding the changes.

Start asking questions now.

Will there be a change in how you complete medical records? If you use any type of EHR system in the office, you need to know how ICD-10 codes will be captured. How are ICD-9 codes captured today? Are the codes entered (e.g., typed in or selected from a drop down menu)? Ask your EHR vendor about the system’s capabilities for ICD-10 and when the new code set will be available for testing.

How will you code your claims under ICD-10? If you currently code by using an ICD-9 book, then you should purchase the ICD-10 code books now. Take a look at the top 25-50 codes used in your office and begin developing a crosswalk list to the ICD-10 codes. Alternatively, check your software for an ICD-10 look up functionality.

What other areas will be affected?

A key area of concern is how workflow will be affected by the transition. A thorough review of the current workflow and the potential areas for failure must be assessed months before the transition deadline. When you conduct your workflow assessment, you should address the following:

  1. Who assigns diagnosis codes now?
  2. Who should assign diagnosis codes?
  3. How are diagnosis codes assigned?
  4. Do you need additional or newly skilled staff?
  5. Are any revisions needed to charge documents (paper or electronic)?
  6. Are there any software programs involved in the process that need to be reviewed? Practice management and EMR systems are obvious, but don’t forget about lab systems, registries, and most importantly interfaces that send diagnosis codes between various systems.
  7. What is the timing of the planned changes to any software systems? Will there be time to train and practice with the new update?

Begin now! Don’t wait!

Migration to ICD-10 will be time consuming, costly, and challenging… but potentially beneficial. Learn, ask questions, revise forms/templates and refine your workflows.  Use the transition as an opportunity to improve the efficiency and effectiveness of your clinical documentation as well as your billing processes.

For more information, contact the author Amy Dunatov at

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