In Private Practice: 10 Steps to ICD-10: Are your documentation, billing and electronic health record systems ready for Oct. 1, when new diagnosis codes take effect? Use these tips to prepare.

Janet McCarty; Neela Swanson; Denise Dougherty

doi:10.1044/leader.IPP.19032014.36

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In Private Practice | March 01, 2014

In Private Practice: 10 Steps to ICD-10Are your documentation, billing and electronic health record systems ready for Oct. 1, when new diagnosis codes take effect? Use these tips to prepare.

Janet McCarty, MEd, CCC-SLP; Neela Swanson; Denise Dougherty, MA, CCC-SLP

Author Notes

Article Information

The ASHA Leader, March 2014, Vol. 19, 36-37. doi:10.1044/leader.IPP.19032014.36

The long-awaited Oct. 1 transition to ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) from ICD-9 will affect documentation, billing and electronic records in all health care settings and for all payers. If you’re an audiologist or speech-language pathologist in private practice, you have just under seven months to prepare for this major undertaking.

The current 30-year-old system is limited to 14,000 codes, contains outdated and obsolete terminology, and produces limited data. ICD-10 allows for more codes and greater specificity—and, therefore, improved tracking of data related to disease incidence and prevalence—and can track 68,000 codes.

Here are the steps to get ready for the ICD-10 transition.

Step 1:

Review available resources.

ASHA has developed several online sites (see sidebar on p. 37) to help clinicians map current codes to new codes.

Step 2:

Review how you use ICD codes.

You are probably using ICD-9 for any clinical documentation, billing, electronic health records and other materials. Make a list of documents, products and contracts that you will need to change to ICD-10. Your list might look like this:

Superbill
Documentation and billing software
Report forms
Payer contracts
Patient contracts/communications
Practice management systems
Website posts
Descriptions of your services
Marketing materials

Step 3:

Develop a timeline and budget.

The changeover will involve several steps and take time. For example, determine when staff training will take place. Recommendations say that training should start six to eight months prior to Oct. 1—and that time is now. Print only enough superbills to last through Sept. 30. Develop and print new ICD-10 superbills by Oct.1.

Step 4:

Contact clearinghouses, billing services and practice management vendors.

Use ASHA’s resources to provide your business partners with a list of ICD-10-CM codes you want included in your information.

Step 5:

Contact payers to update contracts and replace covered ICD-9 codes with ICD-10 codes.

Don’t wait on this step: all providers need to update their payers, so you want to make sure you give the payers enough time. Many payers, such as UnitedHealthcare, added ICD-10-CM codes to policy bulletins (bit.ly/unitedhc-slpservices). Compare the ICD-10 codes payers have posted in their policy bulletins with ASHA’s ICD-10 list and your own codes. Other payers, such as Aetna, have not yet addressed the ICD-10 transition (bit.ly/aetna-slpservices).

Here are some questions to ask your payers:

Who will be my primary contact at your organization for the ICD-10 transition?
Can we set up regular check-in meetings to keep our progress on track?
Are you prepared to meet the ICD-10 deadline of Oct. 1?
When will you be ready to accept test transactions from my practice?
Do you anticipate any changes in policies or delays in payments to result from the switch to ICD-10?

Step 6:

Set up an emergency fund.

The transition may disrupt your cash flow if payers take longer to process claims as they begin working with the new system. You should expect payment delays in October. Keep your August and September claim submissions current.

Step 7:

Network with peers.

Yes, you are in private practice and you compete with peers for business—but this issue can unite you. Use the member-only online communities and listservs of ASHA and the American Academy of Private Practice in Speech Pathology and Audiology (www.aappspa.org) to ask questions and solve problems as you get ready to make the change.

Step 8:

Be proactive.

Many private practitioners faced challenges following the recent addition of four specific speech-language evaluation billing codes that replaced the generic speech-language evaluation billing code, as payers were not prepared for the new codes. The ICD-10 system changeover will create even more challenges in our practices.

To help with the transition, review your current caseload and do a trial run. In your charts, when you identify the appropriate ICD-9 code, also list the ICD-10 code you would use. Review files of discharged clients and map their codes to ICD-10. Practice completing a superbill for your current caseload using the ICD-10 codes. Use the next few months to familiarize yourself with the maps and translator tools that match current codes to new codes. By taking the time now—when you have it—the change may be less stressful.

Step 9:

Check out resources from the Centers for Medicare and Medicaid Services.

Medicare has several documents that can help you establish timelines and checklists:

Timeline preparation for a small-to-medium practice: bit.ly/smallmed-icdtimeline
Transition checklist for small-to-medium practice: bit.ly/smallmed-icdchecklist

Step 10:

Monitor systems.

Correct any errors or glitches that arise when you test your systems.

Transitioning to ICD-10-CM is a huge undertaking that affects the entire health care system. Take steps now to prepare for the change and ensure that your practice is well-positioned for the shift. ASHA staff will answer specific questions sent to reimbursement@asha.org.

ICD-10 Information at Your Fingertips

ASHA has developed a number of resources to help audiologists and speech-language pathologists prepare for the ICD-10-CM implementation deadline. Bookmark these sites for easy reference.

Most commonly used codes for audiology services: on.asha.org/icd10-aud
Most commonly used codes for speech-language services: on.asha.org/icd10-slp
ICD-9 to ICD-10 mapping tool (type in an ICD-9 code to find the corresponding ICD-10 code): www.asha.org/icdmapping.aspx
Mapping spreadsheets for audiology and speech-language pathology (lists of ICD-9 codes and corresponding ICD-10 codes): on.asha.org/icd-10-codes

In Private Practice: 10 Steps to ICD-10Are your documentation, billing and electronic health record systems ready for Oct. 1, when new diagnosis codes take effect? Use these tips to prepare.

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