ICD-10 Countdown for Your Medical Billing Business

The US Department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures with ICD-10 codes, effective October 1, 2014. ICD-10 implementation will radically change the way coding is currently done and will require a significant effort to implement.

ICD-10 Timeline: Meeting the Compliance Date​

10-step Plan by American Medical Association

On October 1, 2014, the health care industry will be required to use the ICD-10 code set to code all diagnosis and hospital inpatient procedures in administrative transactions and for various other uses.

Follow these timeframes as you work with your vendors on upgrading your system and your clearinghouses, billing service, and payers to test and transition to the ICD-10 code set. A successful transition will ensure you are able to use the ICD-10 codes on the compliance date and will help you avoid rejected claims and cash flow interruptions.


Step 1 – Impact Analysis:
Estimated Time to Complete: 3 – 6 months
Review information about the ICD-10 code set in order to gain a basic understanding of the changes from ICD-9 to ICD-10. This understanding will be needed in order to conduct an impact analysis and determine how the move to ICD-10 will affect your business practices and systems. You will also need to complete an inventory of all your systems, electronic and manual, that use the ICD-9 codes. These same systems will need to be upgraded to ICD-10. This activity should be started early. Understanding the full scope of the work ahead and its impact will help you focus on the important tasks.


Step 2 – Contact your Vendors:
Estimated Time to Complete: 2 – 3 months
Contact your vendors for specific details on the installation of the ICD-10 upgrades to your systems, including dates and any costs. Be sure to ask your vendor if they will maintain updates to the ICD-9 and ICD-10 code sets during the transition period and if they will be providing any crosswalk tools between the two code sets.


Step 3 – Contact your Payers, Billing Service and Clearinghouse:
Estimated Time to Complete: 2 – 3 months
Contact your clearinghouses and/or billing service, if you use either, and payers for preliminary information on when they expect their ICD-10 upgrades will be completed and when they will be ready to begin testing transactions using the ICD-10 codes. You will want to contact them again when you have a date for the installation of your system upgrades. 
You also should to talk to your payers about any possible contract negotiations that may need to be done as a result of moving to the ICD-10 code set. Be sure to ask about any changes they may be making to their review, auditing, coverage, and medical policies and how the changes will impact coverage decisions and reporting requirements.

Step 4 – Installation of Vendor Upgrades:
Estimated Time to Complete: 3 – 6 months
Undergo installation of upgrades from your vendor. Keep in mind that the timing of the system upgrades will be dependent on your vendor’s readiness, both with respect to product development and scheduling. Other systems not related to your administrative transaction systems, such as quality or public health reporting, will need to have any necessary upgrades for ICD-10 completed as well.


Step 5 – Internal Testing:
Estimated Time to Complete: 2 – 3 months
Once the upgrades are completed, you will need to conduct internal testing of your systems to ensure you can generate necessary transactions with the ICD-10 codes. Allow extra time to resolve any issues that may arise and work with your vendor to address these.


Step 6 – Update Internal Processes
Estimated Time to Complete: 2 – 3 months
Any internal processes used to support coding need to be updated, such as “superbills”, encounter forms, quality data collection forms, public health data collection forms, etc. Take this time to review clinical documentation to ensure it captures the necessary details of the patient’s diagnosis. Practices may want to look at the most common diagnoses reported in the practice.


Step 7 – Conduct Staff Training:
Estimated Time to Complete: 2 – 3 months
Coding staff will need to receive training on the ICD-10 code set prior to the compliance date. You will want to determine the best time to have staff trained so they are well prepared when the implementation date arrives. You may also need to consider staggering staff training to prevent down time in the practice. Coding staff may wish to practice internally using the ICD-10 codes on sample claims, such as current claims, prior to the compliance date. Clinical staff must also receive training on ICD-10, although it does not need to be at the same detail as training for the coders. Due to the greater level of detail in the ICD-10 code set, clinical staff will need to provide sufficient details about the patient’s condition so the coder can accurately code.


Step 8 – External Testing with Clearinghouses, Billing Service, and Payers:
Estimated Time to Complete: 6 – 9 months
Contact your clearinghouses, billing service, and payers to conduct external testing with them. Testing with your trading partners (e.g., clearinghouses and payers) will ensure that you can properly send and receive the ICD-10 codes in transactions.

Step 9 – Make the Switch to ICD-10:

October 1, 2014
All services and discharges on or after October 1, 2014 must be coded using the ICD-10 code set. Transactions that continue to use the ICD-9 codes will be rejected.
ICD-10 codes cannot be used prior to the October 1, 2014 compliance date.

After October 1, 2014:
Monitor the submission and receipt of transactions to ensure they are working properly with the use of the ICD-10 codes. You will also want to review your reimbursements to determine if they are what you expect for the services you billed.

Visit the AMA’s website for more resources for implementing the ICD-10 code sets. www.ama-assn.org/go/ICD-10