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Last Minute Steps You Can Take to Prepare for the End of the ICD-10 Grace Period

Written by Kaitlyn Houseman | September 14, 2016

Although the ICD-10 transition officially went into effect last year on October 1st, 2015, a grace period was put into place by the Centers for Medicare & Medicaid Services (CMS). October 1, 2016, will mark the end of a one-year “grace period” that allowed unspecified ICD-10-CM codes on certain physician Medicare claims as well as the end of a three-year partial code freeze. Here's what your practice can do now to prepare.

What Does the End of the ICD-10 Grace Period Mean for Your Practice?

The end of the ICD-10 grace period means that, in a matter of weeks, all physicians in the U.S. will be expected to code in ICD-10 with a high level of proficiency and specificity.

Those who can't will likely experience a high number of rejections and denials starting soon after the end of the grace period on October 1, 2016.

Thousands of Revised ICD-10 Codes

"There will be 1,943 new codes, 422 revised codes and 305 "invalid" codes, which will have additional digits to further classify them."

With October 1st coming quickly, there isn't much time left before the grace period ends. Even if your practice is fully prepared for the transition, getting used to the new coding standards will likely result in slower processing times.

There are a few things you can do to make the transition period smoother for your practice, as well as for patients and third parties.

According to AHIMA, your practice should focus on three key areas to prepare for October 2016:

  • Mitigate Risk of Unspecified ICD-10 Codes
  • Hire a Credential Certified Professional Coder(s)
  • Check EMR Software

Mitigate Risk of Unspecified ICD-10 Codes

In an article written for AHIMA’s ICD-TEN newsletter, “Proactive practices are already conducting internal audits to identify trends in unspecified clinical documentation and diagnosis code assignment,” Christine Lee, MHA, RHIA, CCS, CPC, manager, provider practice audit services, CIOX Health, provides a host of ways that providers can make sure the new deadline passes with minimal disruptions.
Christine outlines a three-step process that can be utilized to mitigate the risk of unspecified ICD-10 Codes:
1. Review reports of top ICD-10 diagnosis codes, paying particular attention to identify unspecified codes.
2. Conduct analysis of diagnosis codes assigned by clinician and/or coder to identify any patterns or trends in unspecified ICD-10-CM (diagnosis) coding.
3. Review clinical documentation:
a. If more specific diagnosis codes can be assigned based on the documentation, provide education to the appropriate staff on proper code assignment.
b. If documentation is not complete for desired level of diagnosis specificity, provide clinical documentation improvement education to clinicians.

Lee also stresses the importance of hiring a credentialing coding professional to evaluate code assignments, identify software errors, and conduct advanced ICD-10 training for non-specific documentation and coding problem areas.

If hiring a full-time coding professional is out of your budget, you may want to consider bringing in a temporary coding consulting or considering outsourcing your revenue cycle management.

Another critical step in preparing for the end of the ICD-10 grace period is checking your EMR software. Lee states that "since the 2015 CMS and AMA announcement regarding unspecified ICD-10 codes, physician practices have tended to maintain the status quo—relying on EMR software to suggest correct ICD-10 codes."

Check your EMR software to see if any glitches could be causing coding errors leading to claims rejections and reimbursement delays. 

AHIMA's ICD-TEN article lists these ICD-10 diagnosis areas as examples of specific encoder software issues that have been identified:
  • Motor vehicle accidents
  • Joint replacements
  • Traumatic fractures, tibia spine

Helpful Resources to Help You Prepare

The CMS website provides a variety of helpful tools to help your practice prepare in addition to AHIMA and AAPC.

If you haven't already taken advantage of the many online training sessions available and/or hired someone to provide training on-site, then you may want to consider it. 

Practices should have clear procedures in place to meet the ICD-10 coding guidelines, in addition to a plan to provide thorough training on an on-going basis for the new coding methods and regulations.