The date for compliance with ICD-10 has been pushed back to October 13, 2014, from October 2013, but this doesn’t mean delaying implementation is in your best interest.
The move to ICD-10 is a dramatic change that should not be taken lightly because this change permeates many layers of a hospital, clinic, or practice. This extends to vendors’ ability to support ICD-10 and payers’ ability to process claims accurately and on time. The ICD-10 pilot identified end-to-end testing as the most challenging area of the conversion.
To use the extra time proactively, the following questions should be considered to help you successfully complete the migration to ICD-10.
1. Do you know what interacts with ICD-9 or ICD-10?
Create a basic checklist. According to a HIMSS Whitepaper on ICD-10, a basic checklist for the implementation of ICD-10 should include a complete list of interfaces that are associated with ICD-9 and/or ICD-10 codes. This also includes reports that may be generated from primary and secondary systems which use ICD-9/ICD-10 as a data element, or reports created and sent to external agencies or organizations.
2. What should be tested and reviewed?
Once pertinent information is compiled, the next step is to determine what needs to be tested. The following questions should be considered:
- Are code sets being used, and if so, do they need to be adjusted?
- Are the interfaces configured in any way specifically to ICD-9?
- Can vendors or payers accept one data stream with both ICD-9 and ICD-10 codes, or does a second interface need to be added?
- Can parallel testing be performed adequately by coders to provide realistic results?
- Can the interfaces handle the extra data that comes with switching to ICD-10, or could there be performance degradation?
- Are GEMS, or general equivalent mappings, in use with ICD-9-to-ICD-10 mapping?
After testing, potential scenarios need to be reviewed, including:
- What to do with patients who are admitted under ICD-9 diagnoses and codes but discharged under ICD-10?
- How will statistics look when analyzing prior data under ICD-9 and current data with ICD-10?
3. Who should be included in the scenario testing?
Part of the challenge includes competing organization priorities, which restricts many organizations from participating. Some recommendations from the ICD-10 pilot include creating a test plan in which multiple clinical scenarios can be checked during end-to-end testing as a collaboration across the healthcare groups.
Now is the time to assess, test, implement, and evaluate all systems and determine whether contingency plans are needed in preparation of the ICD-10 Big Bang. Are you ready?
More assistance and information on the conversion to ICD-10 is available in the ICD-10 playbook on the HIMSS website.
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