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The Biggest Myths Surrounding ICD-10, and Why Preparing Isn’t Optional for HHAs

Author: Alex Morganti Date: 21-11-2014 12:11:23 PM

On April 1 of this year, a single piece of legislation was signed into law that pushed ICD-10 implementation back to October 1, 2015. For those home health agencies that had already invested time and money into preparing for the CMS-mandated switch, this development hit like the king of all April Fool’s jokes.

It’s very unfortunate that this delay occurred (yet again), because now providers are wondering if the transition to ICD-10 will ever actually happen. With profit margins already fairly slim, how can agencies be expected to throw money into preparations for an industry update that may never reach fruition?

There are certainly calls for the elimination of the government’s ICD-10 mandate altogether, and with them the propagation of several misguided myths:



Myth #1:  


At this point, we’ll just transition directly to ICD-11, so why bother preparing for ICD-10?

You might have heard petitions to skip ICD-10 altogether and jump directly to ICD-11, since the latter is slated to be released by the World Health Organization in 2017. But what you may not realize is that the US will not adopt the unedited code set directly from the WHO. As it did for ICD-9, the US will use the WHO’s unabridged product to create its own Clinical Modification, which is an edited version better suited to serve the American health system. The US worked on its ICD-9-CM adaptation for 16 years before it was ready to mandate the industry switch. So, if the WHO won’t be finished with ICD-11 until 2017, and the US will need some time to make its own modification…you can do the math. ICD-11 won’t be ready for a long, long time.

Not only that, but skipping ICD-10 entirely would prevent providers from being able to build on the knowledge and experience they would gain from using it. Each version of ICD serves as the foundation for the version that follows it, so leaving out ICD-10 would be like building a staircase with a missing step.

It’s also important that the US join its fellow world leaders in the use of ICD-10 so that there is an international standardized way of communicating healthcare data. HIT Consultant argued that because the US is one of the last industrialized nations still using ICD-9, its ability to track and respond to the global Ebola threat was severely hampered. This is a great example of what ICD-10 is really about: understanding health trends worldwide and using this knowledge to improve healthcare.


Myth #2:  


Even if ICD-10 is not delayed again, what’s the big deal? It’s really more of an IT problem.

Some agencies seem to think that their EMR software vendor is going to “take care of” ICD-10 preparations for them.

Wrong. Achieving ICD-10 readiness will be an agency-wide project, and will require the efforts of nearly every department and employee. Think of your agency’s ICD-10 transition efforts in the following terms: “If a person or process is involved with ICD-9 now, he/she/it will be affected by the switch to ICD-10 on October 1.”

Implementing ICD-10 is so much more than a software problem – it is a complete overhaul of the coding foundation on which nearly other system is based. Workflows will change, documentation will change, additional staff education will be required; there is almost no aspect of your current operations that will go unmodified.


Myth #3:  


My coders don’t really need to know ICD-10. My EMR / clearinghouse gave me a crosswalk.

ICD-9 to ICD-10 code crosswalks are not a replacement for your coding team understanding the new code set. Some codes in ICD-10 are going to be more specific; some less so. Some will be broken down into several codes, and occasionally several ICD-9 codes will be packaged into one ICD-10 code. What this means is that your coders are going to need to select codes based on the patient’s clinical documentation, and the person selecting the codes will need to understand the syntax and organizational rules of the new code set.

Imagine what things might be like if your agency were still using an ICD-8 crosswalk today, and none of your coders understood ICD-9. You’d be in trouble, right?

It’s true: no one can guarantee that ICD-10 will go into effect on October 1, 2015. As we saw in April, all it takes is one carefully worded sentence buried in a bill to undo months of planning. But with their reimbursement tied to ICD codes, home health agencies can’t afford to be unprepared. Putting off training and planning may save your agency money in the short-term, but those savings won’t make a difference if you’re unprepared once ICD-10 hits.

If you were procrastinating last year, you should view the recent delay as an opportunity to prepare your agency. The following tasks will be vital to achieving readiness:

     1. Conduct an agency-wide impact assessment to determine affected operations and staff

     2. Determine the ICD-10 readiness of your vendors and payers

     3. Ensure your clinical documentation is comprehensive to reduce coder queries

     4. Develop contingency plans in case the transition does not go smoothly

     5. Conduct internal and external testing to verify that changes you’ve made are working properly

If you’re overwhelmed and don’t know where to start, or you’ve reached a roadblock in your planning, give us a call and talk to one of our experts about what the process entails. We have the tools and knowledge you need to get it right the first time!


This article was originally written for the PPS Plus Software website. PPS Plus Software is a market leading provider of OASIS analysis software for the home health industry. 

Author: Alex Morganti Date: 21-11-2014 12:11:23 PM