Revenue Cycle Management Blog | GroupOne Health Source

The Effects of the ICD-10 Transition on Provider Practices

Written by Kaitlyn Houseman | June 28, 2011

Posted by Dana Deardorff 

With the ICD-10 transition approaching, you may be wondering what will change in your practice.

The ICD-10 transition affects everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), even those who do not submit Medicare claims. If you are a provider, here are a few of the many areas where the transition to ICD-10 will affect your practice:

  • More, and more robust codes. Codes will grow from 17,000 to 140,000, but remember that you only need to know the codes that relate directly to your area of specialty and/or those that you use most frequently. Code books and styles will completely change. More detailed knowledge of anatomy and medical terminology will be required. Physicians, nurses, and billing and coding staff will all need to be trained on the new codes.
  • Updated policies and procedures. Any office policy or procedure tied to a diagnosis code, disease management, tracking, or PQRS must be changed.
  • Medical record documentation. ICD-10 codes will better reflect the specificity already inherent in the patient’s medical record. Physicians will need to continue to document the patient’s plan of care to include laterality, stages of healing, weeks in pregnancy, episodes of care, etc. Other health care professionals will also need to continue to document patient information with specificity.

On January 1, 2012, all electronic claims must use Version 5010, and anyone covered by HIPAA must use ICD-10 diagnosis codes for services provided on or after October 1, 2013. To be prepared for both of these transitions, you should begin planning now if you haven’t done so already.

Determine where ICD-9 codes currently appear in your systems and business processes. Budget for training, re-printing of superbills, etc. Finally, develop an ICD-10 timeline – all good first steps to help you prepare. Don’t forget to evaluate all vendor and payer contracts and upgrade as needed.

The CMS website features a Provider Resources page for ICD-10 that includes factsheets, timelines, and additional resources to assist you with the transition to ICD-10 codes.

Keep Up to Date on Version 5010 and ICD-10.
Please visit www.cms.gov/icd10 for the latest news and resources to help you prepare!