ICD-10‘s first anniversary [The return of October 1]

ICD-10 is in production, but as its one-year anniversary approaches, providers should be aware of some additional items that will need to be addressed for this October.  

  1. The ICD-10 Coordination and Maintenance Committee has lifted the partial code freeze and thousands of new codes have been added for fiscal year 2017. 
  2. The Medicare grace period on code specificity for Part B post payment audits will end October 1, 2016. 
  3. Payers may begin to adjust medical policies based on the new specificity offered by ICD-10.

This means that organizations will need to take steps to incorporate the new codes into their systems and operations and continue to focus on clinical documentation improvement to enable coding at the highest level of specificity.  Many of these activities should already be familiar as annual code updates occurred under ICD-9. 

The Workgroup for Electronic Data Interchange (WEDI) has identified the following actions that organizations should consider in their planning: 

  • Review the 2017 code set information available on the CMS web site.
  • Determine the applicability of the new or revised codes specific to your practice or facility.
  • Assure applicable codes are incorporated into internal applications and processes.
  • Verify that vendor products support the new codes.
  • Assure that clinical documentation contains sufficient detail to code at the required level of specificity.
  • Communicate with payers to identify potential changes to medical policies.
  • Look for bulletins from Medicare, provider associations and other organizations.
  • Monitor industry trade publications for materials related to ICD-10.
  • Assure staff is aware of the upcoming changes and educate as needed.
  • Assign a point person to plan and monitor preparations and key performance indicators. 
  • Start early.
  • Test.  (Note: Don’t rely solely on software vendors for testing.  Often, software is customized at the customer location.  Business processes can also have an impact.  Just because a product was tested extensively elsewhere, it doesn’t mean it will work the way you expect it to in your environment.) 

The above is not intended to be a comprehensive list of activities, but it should provide some starting points for planning.   For additional information about ICD-10 preparations and testing please visit the WEDI website at www.wedi.org.

About the author:  Jim served on the leadership team that oversaw the creation of the 2013 WEDI report.  Jim is a past recipient of WEDI’s Chairman’s Award, Distinguished Service Award and the Andrew H. Melczer Excellence in Volunteerism Award.  He is frequently quoted in industry publications and speaks nationally regarding industry issues related to health IT. He also served as a commissioner with EHNAC.