ICD-10 Readiness: Coding Is Just the Half of It

With a grace period agreed upon, it appears the new deadline for ICD-10 coding implementation is finally set to be October 1, 2015. Though the CMS (Centers for Medicare & Medicaid Services), the AMA (American Medical Association), and Congress have tangled and wrangled for years over the implementation date, the codes will allow clinicians, administrators, and payers to employ a more rigorously defined specificity when recording patient health.


Your healthcare organization may have already performed mapping and crosswalks to handle both ICD-9 and ICD-10 codes. Those that have waited are now scrambling. Everywhere, hospital and physician group system administrators are running tests to ensure their output can be transmitted, received, and read by payers.

Regardless of which HCIS vendor you use, beyond the IT readiness, there is also the matter of training providers, coders, and administrators in applying the expanded code set accurately. All of these preparations are upstream of the database. For this reason, coding is just the half of it.

ICD-10 and Your River of Data

MEDITECH, for example, has long since added capability for ICD-10 to their software. But what healthcare network uses an HCIS without customization? Think of all the ways data can be pulled from your system. Information flows downstream from your Data Repository. B/AR extracts, NPRs, department automation reports, patient satisfaction surveys, HEDIS measure reporting, meaningful use…the list is nearly endless.

The truth is, everyone working with your system has a particular view of its data, but they are probably not in a position to identify likely break points beyond their own spot on the river bank. So the question becomes how can you see past the curves in your river?

Preventing Downstream Data (and Revenue!) Logjams

Once IT and Business Intelligence have data tables appropriately loaded with ICD-10 procedure and diagnosis codes, it’s imperative to test the system to ensure accurate receipt of these codes. A good portion of downstream activity comes in the form of flat files being distributed via Secure FTP between organizations. An audit begins with a review of all scheduled data extracts and distribution of files via secure FTP transfer.

This review helps to expose the outliers, those infrequently used, ad hoc workarounds, or custom reports that pose the largest threat to a smooth transition. Similar to the rogue department head that customizes a PC with unauthorized software, workarounds have the capacity to break the system, and may create a significant revenue gap until discovered.

Using a neutral third-party consultant from outside of your current vendor/payer/administrator circle to audit your system can yield new insights. A good business process analyst can help you identify little-known extracts and suggest optimization steps for these reports to downstream healthcare service organizations.

It’s critical to identify not just that the information sent to third-party payers is accurate, but that all required information is captured and reported to avoid revenue interruptions due to coding-related denial of claims.  In the future, timely reimbursement from CMS will be based on values derived from quality and patient satisfaction scores, and coding is just the half of it. Focus downstream.

This post originally appeared on LinkedIn.

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