How to assess the impact of ICD-10 implementation on a medical practice

Written by: 
Carl Natale -

For the procrastinating physicians, it's time to figure out how ICD-10 coding will affect medical practices.

The American Medical Association (AMA) covers the assessment nicely as part of its free educational resources. I found some tips from the Centers for Medicare and Medicaid Services (CMS) and created a hybrid check list.

Start your assessments with:
List work processes and current electronic systems that use ICD-9 codes. The AMA suggests looking at:

  • Claims submission
  • Billing system
  • Posting payments
  • Clinical documentation, e.g., patient reports, electronic medical record
  • Patient registration system
  • Checking patient’s eligibility
  • Verifying referral/prior authorization
  • Writing referrals
  • Writing orders
  • Encounter forms
  • Coding tools, e.g., “superbills”, programs, books, resource materials
  • Quality reporting
  • Public health reporting
  • Disease registry/disease management
  • Health insurance contracting
  • Laboratory systems
  • Where else?

Evaluate how ICD-10 will affect your practice

  • Identify the diagnoses most frequently used.
  • Look up these diagnoses and review the potential new codes for the best match.

Identify staff who work with ICD-9 codes and how their job relates to those codes

  • Look for them in the previous list of affected departments.
  • Understand how your clinicians and coding/billing personnel communicate.
  • What words do they use to describe their routine protocols to medical coders/billers?

Identify possible work flow changes needed to implement ICD-10 codes (e.g., data collection forms, encounter forms, superbills)

  • Medical coding
    • Training for medical coders
    • Increased to time to process medical claims
    • Managing the increased queries for physicians and clinicians
  • Physicians and clinicians
    • Clinical documentation
    • Quality improvement
    • Case management
  • Information Technology
    • Internally (home grown) developed applications
    • External applications (Review contracts for commercial information system applications)
    • Generating reports
    • Inputing
    • File importing
    • Data warehousing
    • Decision support
    • Research
  • Financial management and revenue cycle
    • Productivity
    • Reimbursement Structures
    • Pre-Authorization
    • Eligibility
    • Scheduling
    • Admitting/Registration
    • Charges, Coding
    • Claims/Billing
    • Collections/Follow-up
    • Payment Posting
    • Denials Management
    • Education/Training
  • Business practices
    • Referrals
    • Authorizations/pre-certifications
    • Patient intake
    • Physician orders
    • Patient encounters
  • Clinical documentation: The increased specificity will require that patient encounters are documented with greater detail.
    • Staff training
    • Physician workflow
    • Patient volume
    • Forms, documents, and encounter forms need to be revised to reflect ICD-10 codes
    • Processes for ordering and reporting lab/diagnostic services to health plans
    • Evaluate whether clinical documentation can support ICD-10 specificity
    • Prepare clinical documentation improvement (CDI) strategies
    • Identify how staff will enter key words, medical notes and content in medical records.
  • Determine if hiring a consultant is needed as a part of your implementation process

You need to take this time to make sure you're going to make all the necessary changes this year. Better now than Oct. 1.