Managing simultaneous ICD-9 and ICD-10 charge codes.

For providers large and small, the reality is that both before the Oct 1st deadline (when providers are phasing into ICD-10, yet payers still require ICD-9 codes on the claim) and after the deadline (when certain payers such as Worker’s Comp and others still expect ICD-9 codes), a charge needs to contain the correct diagnosis codes from both code sets.

While both your EMR and RCM systems have the ability to store, process and manage both sets of codes, you still have some critical decisions to make and certain scenarios to test.

Here are some workflow questions every medical group must answer:

1. Will you be processing charges from a single clinical system or multiple clinical systems?
2. Will those charges be processed manually or electronically?
3. Will your process for managing ICD-10 codes during the transition period vary depending on the capabilities of the Clinical system(s)?
4. Will you be dual coding in the EMR, or will you code in ICD-10 and expect one of your IT systems to translate the ICD-10 codes into ICD-9?
5. If you will be dual coding in the EMR, will you send both the ICD-10 and ICD-9 codes to the RCM system?
6. If you will send both ICD-10 and ICD-9 codes to the RCM system, how will that impact your current Charge Interface(s) and do any interface modifications need to be made.
7. If you are going to code only in ICD-10 in the EMR, which system are you expecting to translate the ICD-10 code to ICD-9?
8. If you are relying on the GEMS map for translation and you comfortable with the Diagnosis Translation logic?
9. If you need to customize the GEMS Diagnosis Translation logic, do you have the systems that are capable of doing that?
10. Do you have access to create Test Messages from your clinical system(s) interfaces that include the various Diagnosis scenarios, which you can use for round trip testing?
11. If you are a multi-practice facility, do you plan an enterprise-wide ICD-10 implementation, or do you plan to phase in your practices?

For the next several months, your provider’s charges are going to need to be associated with both the new ICD-10 codes and the legacy ICD-9 codes. The time, complexity and the extent to which your organization will need to operate in both worlds depend on your size, specialty, payer mix and the breadth of services you bill for.

Ensuring that the process for managing these codes in your clinical system syncs up well with your revenue cycle system is critical for a smooth transition to this new coding world.

As always, we’d love to see your comments on these questions and anything else ICD-10 related. See you next time here at RCxRules ICD-10.