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By Sarah C. Threnhauser

Today, October 1, is the official date to switch to the ICD-10 coding system for diagnoses, for billing and claims. What should you have done to prepare? And if your plans are not in place, is it time to panic?

If you aren’t completely familiar with the switch, the International Classification of Diseases (ICD) was developed by the World Health Organization (WHO) and is used to report medical diagnoses and inpatient procedures. All entities covered by the Health Insurance Portability and Accountability Act (HIPAA) of 1996 are required to use the ICD coding system for all billing and claims – this includes payers, provider organizations, and hospitals. The United States has been in the process of switching from the ICD-9 classification system to the newer tenth version of the ICD for the past few years – with many problems along the way. And in case you missed it, we’ve written about this coding switch over the past year:

  1. What Does The Transition To ICD-10 Mean For The Health & Human Service System?: An OPEN MINDS Market Intelligence Report
  2. Why You Should Care About The ICD-10 Switch
  3. DSM-5 & ICD-10 Aren’t The End Of Diagnostic Changes – Only The Beginning
  4. ‘Codeageddon’
  5. ICD-10 Transition To Impact Specialists More Negatively
  6. Medicare ICD-10 Deadline Is October 1; Surveys Indicate Less Than Half Of Physician Practices & Provider Organizations Are Ready
  7. CMS Letter To FFS Medicare Providers About ICD-10 Readiness

So what should you do to prepare? That was the focus of the session Preparing For ICD-10 From The California Provider’s Perspective, by Rachael Clausen, Executive Director, Information Technology, EMQ FamiliesFirst; Lisette Wright, M.A., LP, Executive Director, Behavioral Health Solutions; and Barbara Klear, Director of Quality Assurance and Customer Support, Welligent, at The 2015 OPEN MINDS California Management Best Practices Institute.

In reality, the transition from ICD-9 to ICD-10 affects everything from clinical diagnoses, billing, contracts, and work flow to health information technology (HIT) and compliance protocol standards – and the transition will involve moving from about roughly 14,000 diagnosis codes and about 3,000 procedure codes, to 69,000 diagnosis codes and 71,000 procedure codes. Which systems in your organization will this change touch? According to this presentation graphic from Ms. Wright, all of them.


Because the volume of information that organizations need to master is large, and knowing where to start can be a challenge, Ms. Klear noted that there are some recommendations that organizations need to consider “now” – including:

  1. Decide on either DSM-5 or WHO/ICD for diagnosing
  2. Review client diagnoses and decide on an ICD-10 code
  3. Make sure that your electronic health record (EHR) and EHR vendor are ready

Even if implementation was standard across the board, provider organizations are looking at huge internal challenges with poor change cultures, poor record-keeping practices, and an unpreparedness for audits (which are coming). But implementation isn’t going to be standard across the board. A prime example – California. Ms. Klear noted that as recently as August, counties are still waiting to see if the state will use DSM-IV or DSM-V or ICD-10 and how to cross-walk DSM-IV to ICD-10; there are also a variety of implementation strategies across counties (with some counties still developing strategies); and there is a lack of resources to update county systems.

Now that October has arrived, it seems unfathomable that organizations wouldn’t already be ready for this change – but many aren’t. The good news for those organizations is that the Centers for Medicare & Medicaid Services (CMS) have announced that they aren’t denying Medicare Part B claims for the first year. These documents should help you to ensure that your team is prepared:

  1. 2015 ICD-10 CM Official Coding Guidelines
  2. ICD-10-CM Tabular List of Diseases and Injuries
  3. ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostics Guidelines

For more on selecting an EHR that can handle these types of challenges, don’t miss the session, How To Take Your Ideal EHR From Plan To Reality: Software Selection & Implementation, given by OPEN MINDS Senior Associate Joseph P. Naughton-Travers, Ed.M. and Nancy Toscano, Ph.D., Vice President of Strategy & Organizational Improvement, UMFS, on October 27, at The 2015 OPEN MINDS Technology & Informatics Institute.

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