By: Jacqueline Stack, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC,
AAPC Director, ICD-10 Training & Education

The effects of ICD-10 will be felt throughout the entire office. Think of how your facility runs today. Let's take a look at some of the different areas of the office and how they will change.

Front Desk: When a patient comes into the office, the front desk staff members are usually the first people encountered. These employees will need to explain to the patients, when they make appointments on the phone or show up for visits, that the status of participation in certain plans may change. HIPAA policies will need to be revised. The front staff will need to explain the new policies to the patient and have the patient sign the new forms. Systems will also need to be updated, which may impact patient encounters. The front desk staff will need to receive training on any changes that are made to your current systems.

Nurses: The nursing staff may need to learn new pre-authorization formats and procedure. More Advanced Beneficiary Notices (ABNs) may need to be signed by the patients under the more specific code set. Every order must be revised or recreated. Documentation must include increased specificity. The nurses may be called upon to assist the providers with questions on ICD-10, and they may need to revise how they perform intake operation for patients. Nurses may also be affected by systems updates, which would require specific training on these changes. Nurses would also need training on the ICD-10 code set and the areas where more specific documentation will be required.

Providers: The need for increased specificity within the physician documentation will dramatically increase after ICD-10 implementation. ICD-10 codes will require documentation of laterality, stages of healing, weeks in pregnancy, episodes of care, and much more. Providers will need to understand all changes to their specialty resulting from the new code set. They will likely need to adjust their documentation to meet the new requirements. Since the code set increases from 17,000 codes in ICD-9 to 140,000 codes in ICD-10, provider training may be needed for on the general code set. They will also likely need training on systems changes, especially if changes are made to their electronic health records (EHR) systems.

Clinical: In the clinical area, patient coverage may be affected by elements such as health plan policies, payment limitations, and new ABN forms. Clinical staff must be aware of these changes. Revisions will be required on any superbills in use. Paper superbills may not be a viable option in ICD-10-a one-page family practice superbill was recently updated to ICD-10, and it became a 10-page superbill. Health plans will revise all policies linked to local coverage determination (LCDs) and national coverage determinations (NCDs). ABN forms will need to be reformatted and the patient will need to be educated on these changes.

Lab: The lab is another area where increased specificity must be used. Health plans will have new requirements for the ordering and reporting of services.

Coding/Billing: The coding staff will need to evaluate a larger code set to assign a code, or assess the code assigned by the provider. The codes will increase from 17,000 possibilities to 140,000 options. As a result, code books and styles will completely change. The coders may be relied on to educate others about the new code set-which means they will need extensive training. Medical coders will also need a more detailed knowledge of anatomy and medical terminology, given the increased specificity and additional codes. Coders will need to use ICD-9-CM and ICD-10-CM concurrently for a while, until claims are resolved.

Billers will need to understand the new payer policies that will be revised and take effect under ICD-10. The billing department must be trained on new policies and procedures, as well as the ICD-10-CM code set itself. The appeals processes will likely change. Coders and billers will also be affected by system upgrades and will require training on the changes.

Managers: The managers will see many changes as well. Any policy or procedure associated with a diagnosis code, disease management, tracking, or PQRS must be revised. All vendor and payer contracts must be evaluated and updated. Budgets will need to be created. Changes to software, training, new contracts, and new paperwork will have to be paid. Managers will also need to create a training plan for other staff members, since everyone in the practice will need some formal training in the area(s) that most directly pertain to them. Considerations of the best medium of training (in person, online, on-site, etc.) are equally as important as which departments and individuals need to be trained.

Take the time now to determine how these extensive changes will affect your facility and how prepared you are for them. Doing so will help you figure out how to adapt to the new code set in a timely and calculated fashion, causing as little interruption to the revenue cycle as possible.

Jacqueline Stack, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC, AAPC Director, ICD-10 Training & Education, is a highly accomplished healthcare professional with more than 25 years of experience in healthcare administration, education, and compliance. She holds several AAPC specialty certifications and has a bachelor's degree in Health Administration. She worked previously at a large multi-physician family care and occupational health practice with two locations in northwestern PA. She enjoys sharing her knowledge and experience as a certified PMCC instructor. She has authored many articles for healthcare publications and has been a featured speaker at workshops and coding conferences across the country. She is actively involved with AAPC and has served on the NAB, various steering committees, and held the offices of president, secretary treasurer, and president-elect in her local chapter.