Four Ts for successful ICD-10 implementation

The right preparation will make the Oct. 1 ICD-10 transition date a “nonevent,” said coder and independent consultant Nancy Enos during a webinar presented by the Rhode Island Quality Institute.

Enos discussed the four Ts providers should address: timing, technology, training and testing.

Timing and technology go hand in hand. Inventory all systems that currently include ICD-9 codes, Enos said. Working with your IS support team, finalize system changes, plans to test systems after the transition, monitor coding and reimbursement accuracy. “New technology also can boost productivity to help offset the losses that will occur during and after the transition.”

Providers also need to plan to implement the required information services changes. “Now is the time to contact your IT vendor” for changes for both practice management software and EHR systems. Decide who will be responsible for loading the codeset into your system. “It may be necessary to keep ICD-9 for a time while old claims wind down and quality measures continue to be tracked before and after Oct. 1.”

If you are working with an aligned partner, Enos said to consider how you will manage dual codesets and find out what additional features will be included to assist in clinical documentation.

Training is the biggest obstacle to overcome, she said. “The complexity and granularity of the ICD-10 codeset is a very real concern.” Base training on roles and what background employees have. Clerical staff need more information while clinical staff have a bigger challenge with changing documentation. “If it’s not very detailed, I would be very concerned.”

Think about the cycle of a patient in your office, Enos recommended. How many staff members play a role in the encounter and do their roles include the use of diagnostic codes? Intake staff may need a diagnostic code when calling for authorization and lab or x-ray technicians may need a diagnostic code to place orders.

“It’s never too early to encourage physicians to improve clinical documentation,” Enos said. She also said providers should consider the code chapters used most often in their practice as well as upcoming schedules. With many people taking summer vacations, you might want to make sure online training is available along with other training efforts.

Test ahead of time to make sure everything in your internal systems is working, she advised. It’s the “best way to minimize negative impact post implementation and ensure that provider practices are operationally ready. When you upgrade technology, you want to make sure it works.”

ICD-10 will lead to new features and templates in EHR systems that are unfamiliar to users. Providers should have an “in-house guru” who modifies templates, helps train and works with the ICD-10 trainer, Enos said. “Do what you can to mitigate anxiety. I can’t stress timing enough. Learn the diagnosis codesets and key words required in physician documentation.”