ICD-10 preparations are not one size fits all

May 28, 2015
Michelle Cavanaugh, RN, CPC, Certified Medical Reimbursement Specialist, Kareo

While ICD-10 impacts every HIPAA-covered entity, the preparations for a successful transition are not one size fits all. There are key steps every practice needs to take, but some steps will differ based on your practice’s specialty, whether you outsource your billing or not, and how you submit your claims.

In the last WEDI ICD-10 Readiness Survey, 50 percent of providers cited concerns about further delays as the reason for not preparing for ICD-10.1 This is no longer an issue with the deadline firmly set for Oct 1. There is limited time to get ready and much to do if you haven’t started. If your practice hasn’t made any preparations at this point, you will need to take the following in tandem or you won’t be ready in time.

No matter who does the billing, the first steps are the same

You may be well prepared, but you have no control over whether payers are ready to process your claims quickly and accurately, so adequate financial planning is crucial. Many industry experts believe there will be a spike in denials of as high as 200 percent.2

To mitigate the impact this might have on your practice, you need to set aside cash reserves or apply for a line of credit.

A good estimate is an amount equal to 50 percent of your average monthly revenue for up to three to six months.

Also consider budgeting for the additional expenses of ICD-10, like training and new coding books. The sooner you do this, the more time you have to spread out the costs and set aside reserves.

Every practice also needs to map its most frequently used codes. Your billing and EHR software should provide a “top codes” report and a crosswalk tool to map top ICD-9 codes to ICD-10 equivalents. It is important to remember that this may not be enough. You should also use your ICD-10 code manual to look up documentation requirements to ensure your mapped code is the best option.

These steps may vary based on specialty and practice size

ICD-10 success will hinge largely on providers’ documentation being up to snuff. Today, many providers do not document to the level of specificity required by ICD-10. It is estimated that for every 100 or so coding changes, there are about a dozen documentation changes to consider. When you look up your top codes in the ICD-10 code manual, it is important to identify those changes. Some codes now require laterality (right, left, bilateral). Other changes are unique for certain specialties. For example, in OB/GYN practices, trimester information is now required.

Understanding upcoming changes will help providers begin adjusting documentation immediately, allowing plenty of time to get used to these requirements before October. This is also where a good EHR – with templates for your specialty or the ability to customize your templates – is helpful. The templates can guide the documentation, making it more specific and accurate for ICD-10 coding.

Training is another area where your unique practice makeup needs to be considered. Everyone in the practice is impacted and will need training:

  • Providers need help with EHR changes, documentation, and coding. • Certified coders will need to get re-certified for ICD-10.
  • Billers must understand ICD-10 to watch for issues and ensure claims are accurate, as well as closely monitor claims after submission and resolve denials.
  • Practice managers will need to update policies, forms, and processes, and ensure financial security and staff preparedness.

Depending on the role, training can be anywhere from a few hours to a couple of days. Some training is free, while more complex certification training can cost up to $1,500. It’s important to lay out a plan to identify role-specific training needs. Utilize free resources from your software vendors and specialty societies where you can. Another good option is get one person thoroughly trained and have that person come back and train everyone else.

Your last step before the transition is testing. For many, your software vendor may complete end-to-end testing with clearinghouses and payers for you.

If you submit paper claims to payers who are not currently electronic, you’ll need to contact them directly for instructions on test claims. If you outsource your billing, your medical billing service should handle this for you entirely. Your best shot at a successful ICD-10 transition is to complete all of the above and always keep in mind your specialty and unique practice structure (in-house vs. outsourced billing, staff size, etc.) because preparation for ICD-10 is not the same for everyone.


  1. http://www.wedi.org/news/press-releases/2015/04/06/wedi-survey-suggests-mixed-industry-icd-10-readiness
  2.  http://www.wedi.org/docs/resources/wedi_impact_assessment_swg_white_paper_icd10_metrics_revised_111412-pdf.pdf

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