ZirMed ICD-10 Survival Guide
A Guide to Making the Transition from ICD-9 to ICD-10
Disclaimer
The information furnished herein by ZirMed, Inc., is proprietary and confidential and is distributed to ZirMed
clients and authorized business partners for their exclusive use of ZirMed solutions. This document shall not be
duplicated, published, or disclosed in whole or in part without the prior written permission of ZirMed.
 2013 ZirMed, Inc.
Contents
ICD-10 OVERVIEW ........................................................................................................................................... 3
WHAT YOU NEED TO DO ................................................................................................................................ 6
THE ZIRMED PLAN ........................................................................................................................................ 18
INDUSTRY ICD-10 RESOURCES................................................................................................................... 22
Your ICD-10 Survival Guide
ZirMed’s ICD-10 Survival Guide provides our clients with a roadmap to guide and educate them through the
implementation of and transition to the ICD-10 mandate. We will also provide ongoing information on our
strategy, direction and timeline as we address the ICD-10 regulation. We will keep you informed of any
solutions and strategies developed by ZirMed and the industry during the duration of this regulatory mandate.
The tools in the Survival Guide can:
 Increase understanding of ICD-10
 Increase awareness of the challenges that ICD-10 brings to Providers and Vendors
 Provide tools, best practices and helpful hints you can use as you take your ICD-10 journey
ICD-10 OVERVIEW
What Are ICD-9 & ICD-10?
ICD-10 stands for International Classification of Disease, Tenth Edition. This coding system, created in 1989
by the World Health Organization (WHO) to replace ICD-9, is the foundation from which the U.S. ICD-10-CM
(clinical modification) was built. It codes for diseases, signs and symptoms, abnormal findings, complaints,
social circumstances, and external causes of injury or diseases.
The International version of ICD should not be confused with national Clinical Modifications of ICD that
frequently include much more detail, and sometimes have separate sections for procedures. The US ICD-10
CM, for instance, has some 70,000 codes. The US also has ICD-10 PCS, a procedure code system not used
by other countries, that contains 87,000 codes.
The Final Rule
The Department of Health and Human Services (DHHS) published a final rule on January 16, 2009 for the
implementation of these new Code Sets:


International Classification of Diseases, 10th Edition, Clinical Modifications (ICD-10-CM) Diagnosis
International Classification of Diseases, 10th Edition, Procedure Coding System (ICD-10-PCS)
Inpatient Hospital Procedure Coding System
Covered entities (health care providers, health plans [payers] and healthcare clearinghouses) must comply
with the new code set regulations for dates of service (dates of discharge for inpatient claims) on and after
October 1, 2014.
The Final Rule may be viewed here.
Benefits of ICD-10
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Better quality of care
Greater accuracy in reimbursements
Better prevention and detection of healthcare fraud and abuse
Population health analysis
Better quality in research/clinical trials
More detail
More precise coding
The Codes Defined
ICD-10 codes are defined by specific characteristics.
Differences between the code sets
The currently used ICD-9-CM code sets consist of 3 volumes. Volumes 1 and 2 contain diagnosis codes and
volume 3 contains inpatient hospital procedure codes. The new 10th version includes a naming convention
change. ICD-10-CM contains diagnosis codes and ICD-10-PCS contains inpatient hospital procedure codes.
The ICD-10-CM and ICD-10-PCS codes sets (commonly referred to as simply ‘ICD-10’) are complete
replacements of their ICD-9-CM Volumes 1, 2 and 3 (commonly referred to as simply ‘ICD-9’) counterparts and
contain more granular detail, as well as major structural differences.
ICD-10 codes are different from ICD-9 codes
 They provide greater detail in describing diagnoses and procedures
 There are more ICD-10 codes than ICD-9 codes
 ICD-10 codes are longer and use more alpha characters
 System changes will be required to accommodate ICD-10 codes
More information about ICD-10 naming conventions can be found on the AAPC website.
ICD-9 CM Vol. 1&2 vs. ICD-10 CM (Diagnosis Codes)
The ICD-10-CM diagnosis code set includes significant improvements over the International Classification of
Diseases, 9th Edition, Clinical Modifications (ICD-9-CM), especially in coding primary encounters, external
causes of injury, mental disorders, neoplasms and preventive health.
The new system contains almost five times the number of diagnostic codes. Alphabetic characters have been
added to many ICD-10-CM codes, and the potential number of digits within a code has increased from five to
seven. All these changes mean that ICD-10-CM will significantly affect information technology, physician
documentation, and coding productivity. In some instances, ICD-10-CM is referred to as simply ICD-10, ICD10,
or just I-10.
ICD-9 CM Vol. 1&2
3-5 digits
Mostly numeric. When letters are used, they
are either V or E
No clinical distinction for left vs. right
EXAMPLE:
842001 Wrist sprain and strain of carpal
ICD-10 CM
3-7 digits
All codes are alphanumeric. The lead character is
always alphabetic.
Clinical laterality reflected in the codes
EXAMPLE:
S63.511A Sprain of Carpal Joint of Right Wrist
ICD-9 CM Vol. 3 vs. ICD-10 PCS (Procedure Codes)
The ICD-10-PCS Procedure Coding System provides detailed codes to describe complex medical procedures.
Designed for use on inpatient hospital claims, the ICD-10 system is much more granular than its ICD-9
counterpart. It has unique, precise codes to differentiate body parts, surgical approaches and devices used. It
identifies resource consumption differences and outcomes for different procedures and describes precisely
what is done to the patient. There are currently approximately 4,000 ICD-9 institutional procedures codes in
use as compared to nearly 87,000 ICD-10-PCS institutional procedures codes.
ICD-10-PCS has no relationship with WHO, and carries in its title “ICD-10” because CMS wanted to link it to
ICD-10-CM, since both coding systems are components of the MS-DRG system under which hospitals are
paid for Medicare services. In some circles, the name of ICD-10-PCS is shortened to “PCS.”
The Current Procedural Terminology, 4th edition (CPT-4) and Healthcare Common Procedure Coding System
(HCPCS) will continue to be the code sets for reporting ambulatory procedures
ICD-9 CM Vol.3
3-4 digits
All numeric; no alpha digits
Decimal point after second digit
EXAMPLE:
47.01 Laparoscopic appendectomy
ICD-10 PCS
7 digits
Alphanumeric
No decimal point
EXAMPLE:
0DBJ4ZZ Excision of Appendix, percutaneous endoscopic
approach
WHAT YOU NEED TO DO
This section of the Survival Guide provides a roadmap to meeting your ICD-10 transition goals.
It is the size of the practice that will largely determine the amount of effort required for a successful ICD-10
transition, and the amount of planning that will be required to carry out that effort.
For Small Practices the road map to ICD-10 implementation may be easier. The planning and communication
phases are combined because communication should be less extensive in small practices. Most of the effort
should go into planning, followed by the assessment. You then move on to the actual steps of how you are
going to make the transition, and then you implement. It involves thinking about "What do I need to do?", "How
am I going to do it?", and then...doing it.
For medium practices, the process may be a little bit more complex because you may have to get more
employees involved. You may have groups that work entirely in the back office. You may have nurses who
work entirely in the front office. Some of the functions may be separated. In the medium practice, you need to
make sure that the different groups within your office are coordinated and communicating with each other.
For large practices, the process is more complex because large practices tend to have a much larger
information technology (IT) infrastructure, particularly using programs that are developed internally. Those
programs may need to be updated, and there is a cost involved. There also is a cost involved with programs
that are purchased from vendors.
Providers ICD-10 Timeline
If you haven’t started on the ICD-10 transition path, you must start today and work through a highly-condensed
project in order to meet the October, 2014 deadline.
ICD-10 Basics – What 2013/2014 should look like for you
Develop a transition plan and set a timeline for each stage. ZirMed recommends these stages, all included in
the six-category approach
When
Planning stage
March 2013
Internal Impact Assessment: Analyze the impact ICD-10 will have on your
practice and how it will affect everyone in your organization.
Phase 1 - Internal Impact Assessment
March 2013
External Impact Assessment: Understand how ICD-10 implementation will
affect your payers, vendors, clearinghouses and other partners.
Phase 2 - External Impact Assessment
May 2013
Baseline budget for ICD-10: Figure out how much the ICD-10 transition will
cost. ICD-10 will require system upgrades and training.
Phase 3 - Budget
June 2013 through
October 2014
Education: Raise awareness of ICD-10 requirements and start planning for
formal training for key personnel.
Phase 4 - Education
July 2013 through
December 2013
Business process changes: Upgrade systems, procedures and
technologies.
Phase 5 - Business Process changes
June 2013 - March 2014
Internal Testing & Validation: Test all your business processes and IT
systems. ICD-10 codes must work in all aspects of your organization.
Phase 6 –Testing
September 2013 through
September 30th, 2014
External Testing and Validation – Test your transactions and medical claims
with your Trading Partners. Phase 6 – Testing
January-September 2014
Coder/Biller formal training – Train the staff 6-8 months before the deadline.
Phase 7 - Staff Training
May 2014 and beyond
Transition Plan Follow-up and Evaluation.
Phase 8 - Transition Plan
Principles of a Successful ICD-10 Implementation Program
The following principles are based on CMS’s guidelines and are grouped into six categories.
Note: You can adjust these principles to meet the size of your practice. Small practices may not need to
perform certain steps – like planning, communication and awareness or training -- as extensively as larger
practices will.
1. PLANNING
You need to figure out what you are going to do and generally how you are going to do it.
Assignments
 Create an ICD-10 project plan
 Establish a project management structure
 Establish a plan to communicate with external partners
 Establish a risk management and contingency plan
Results
 Ensure executive leadership understands the magnitude, and significance of the ICD-10 change
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Assign overall responsibility and decision making authority for managing the overall ICD-10 transition.
Plan a comprehensive and realistic budget.
Ensure involvement and commitment of all internal and external stakeholders.
Create and adhere to a well-defined timeline.
2. COMMUNICATION AND AWARENESS
This is more important in larger groups. In smaller groups, it involves getting your staff together and discussing
your current practice and what things are going to need to change for use of ICD-10 in the future.
Assignments
 Create an ICD-10 communication plan
 Communicate the transition to all stakeholders
 Assess training needs and develop a training plan
 Meet with staff to discuss effects and assign responsibilities
Results
 Ensures that all of your internal and external key stakeholders understand their responsibilities required
for a successful ICD-10 implementation.
 An ICD-10 Communication and Awareness Plan will identify key audiences, messages, roles and
responsibilities, timelines, communication methods and communication evaluation techniques.
 An overall timeline, identification and delivery of training materials for management and staff resources.
This is a critical component of this phase and it also includes the identification of targeted audiences,
and an assessment of their training needs.
3. ASSESSMENT
You need to really understand where ICD-9 is currently used and where ICD-10 will be used, and what
changes in your practice will need to be made. This is where you really try to work out more of the details.
Assignments
 Assess business and policy impacts
 Assess technological impacts
 Conduct a risk analysis and create a remediation strategy
 Evaluate vendors
Results
 The identification of clinical and business processes and supporting systems that must be changed to
accommodate ICD-10.
 The assessment phase will identify changes to clinical documentation and medical coding procedures
within the clinical practice.
 Identifies potential impacts to physician reimbursement
 The identification of mission critical vendors and electronic trading partners to ensure that they meet
your clinical and administrative functional requirements is a key output from this phase.
4. IMPLEMENTATION
How are you going to go from your current ICD-9 world to the future ICD-10 world in a step-by-step fashion?
Assignments
 Identify system migration strategies
 Implement business and technical modifications
 Prepare and deliver training
Results
 Determine if/how your practice will work with vendors for implementation
 Coordinate with vendor the updates necessary to accommodate ICD-10
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Finalize system/technical requirements
Coordinate system remediation and conduct testing with partners based on updated system logic.
5. TESTING
Before you implement something, you need to know and make sure that it works. You do this every time you
are implementing something new, in medicine, coding etc.
Assignments
 Complete Internal testing
 Complete External testing
Results
 Ensure ICD-10 compliance across internal policies, processes, and systems.
 Ensure ICD-10 compliance across external trading partners and vendors.
 Complete unit testing, system testing, and performance testing.
 Complete specific ICD-10 end-to-end testing as described in the ICD-10 Final Rule.
6. TRANSITION
How do you actually make the jump and what do you need to look for while you are making that transition?
Assignments
 Prepare and establish the production and go-live environments
 Deliver ongoing support
Results
 Monitor the impact of ICD-10 on your business operations and revenue
 Prepare your practice to take corrective action
 Identify Operational impacts and strategy and key transition components with respective action.
 Identify Go-Live tasks and associated actions
 Post-Implementation audit processes and procedures
CMS has more detailed timelines and guides on its website:
 Small and medium practices: Timeline | Implementation Guide
• Small practices have one to five physicians and provide either single specialty or multispecialty
services
• Medium practices have six to 20 physicians and provide single specialty to multispecialty
services in a standalone clinic not affiliated with a larger health care organization.
 Small hospitals: Timeline | Implementation Guide
• A small hospital has fewer than 100 hospital beds and employs specialized staff and equipment.
 Large practices: Timeline | Implementation Guide
• A large practice has more than 20 physicians, with an independent administrative structure for
billing and eligibility verification.
 Vendors: Timeline
• Vendors include software vendors, clearinghouses, and third-party billing services.
Note: The deadlines shown in the Implementation Guide are out of date, but you can use the dates in the table
above as a guide.
ZirMed’s 8-Phase Recommended Approach
Phase 1 - Internal Impact Assessment
Survey your existing internal people, processes, and technologies that use ICD-coded data and/or code sets
and/or support data that will be affected by the new ICD-10 codes and processing requirements. The survey
will identify which people, processes, and technologies will be impacted and what changes need to be made.
Phase 1 - Internal Impact Assessment and Get-Well Plans
Begin Date
Date Complete
Collect information on how ICD-9 codes are used. Wherever you
use ICD-9 now, you will need to transition to ICD-10.
Authorizations/pre-certifications
Physician orders
Medical records
Superbills/encounter forms
Practice management and billing systems and databases
 Determine how the codes are entered
 Determine if the ICD-9-CM code is a diagnosis or procedure code
 Determine if it is maintained in-house or by a vendor
Coding manuals
Public health reporting
Are there areas not using ICD-9 codes that could benefit from ICD-10 coding after Oct. 1, 2014?
Evaluate how ICD-10 will affect your practice
Medical Coding
 Training for medical coders
 Increased time to process medical claims
 Managing the increased queries for physicians and clinicians
Physicians and Clinicians
 Clinical documentation
 Quality improvement
 Case management
Information Technology
Upgrades
 Internally (home grown)
developed applications
Reporting
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External applications (Review contracts for commercial
information system applications)
 Generating reports
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File exporting
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File importing
Data entry
 Inputting
Data warehousing
Decision support
Research
Financial Management and Revenue Cycle
Pre-Authorization
Charges, Coding
Eligibility
Claims/Billing
Scheduling
Collections/Follow-up
Payment Posting
Denials Management
Education/Training
Admitting/Registration
Reimbursement Structures
 Contract negotiations
 New reimbursement policies
Business Practices
Productivity
Referrals
Authorizations/pre-certifications
Patient intake
Physician orders
Patient encounters
Clinical Documentation: The increased specificity will require that patient encounters are documented with
greater detail.
Impacts
 Staff training
 Physician workflow
 Patient volume
 Forms, documents, and encounter forms must be revised to reflect ICD-10 codes
 Processes for ordering and reporting lab/diagnostic services to health plans
Evaluate if clinical documentation can support ICD-10 specificity
Prepare clinical documentation improvement (CDI) strategies
Identify how to improve workflow and productivity
Identify how ICD-10 codes could be leveraged to improve business
Ensure vendors can accommodate your ICD-10 needs
List and review contracts
Evaluate vendor offerings and capabilities
Contact vendors
Questions to ask your existing vendors
 Will a mapping or crosswalk strategy be used between ICD-9 and ICD-10 code sets?
 What is your timeline for system modifications and what do those modifications include?
Make sure testing is part of the timeline
 Will you continue to support all applications and products after ICD-10 transition?
 Are there new hardware requirements with ICD-10-related software changes?
 What are the costs involved? Will existing contracts cover modifications and upgrades?
 Will customer support & training be provided for new ICD-10-related functionality, and is there a
charge?
 Is there a phased approach for implementing ICD-10?
Questions to ask new and potential vendors
 How does your product simplify my organization's transition to ICD-10?
 How does the functionality offered by your system compare with my current system?
 Does your implementation require a complete system conversion?
 Based on what I already have in place, how much will it cost to convert to your system?
 What are the costs of maintenance for your product?
 Who in this area is using your current system?
 Talking to vendors' existing clientele in your area about their experience with that vendor may help you
identify if the vendor's services are a good fit for your organization.
 What kind of product quality guarantees do you offer, & are these guarantees included in the contract?
 What is your timeframe for implementation?
Questions to ask about maintaining both code sets
 Will the product or service handle ICD-9 codes and ICD-10 codes at the same time?
 How long will both code sets be supported?
 Does data storage capacity need to be increased?
Will the ICD-9 data be accessible? For how long? Who can access it?
Draft a timeline with your vendors
Go back to ICD-10 Basics – What 2013/2014 should look like for you
Phase 2 - External Impact Assessment
The purpose of the External Impact Assessment is to determine which systems and organizations that are
outside of the provider control (i.e., vendor's health plans, registries, HIE and other trading partners) will be
impacted by the transition to ICD-10 and what changes the provider will need to make. The specific focus will
be on acquiring readiness plans, obtaining potential costs and minimizing operational disruptions.
Phase 2 - External Impact Assessment
Begin Date
Date Complete
Understand how ICD-10 implementation will affect your payers,
clearinghouses and other partners.
Your staff: Even the processes and procedures handled in-house can be impacted by external players:
 Medical coding: There's a good chance you're going to invest in a computer assisted computing (CAC)
system. At the least you're going to upgrade systems that handle medical codes. Your medical coders
need to be part of these interactions to make sure anything new works for your medical practice or
hospital.
 Business processes: Billing and practice management systems will be replaced or upgraded. Again,
staff members who work with it need to be consulted. And they need to work with billing services,
clearinghouses and healthcare payers.
 Technology: Just about every system that needs an upgrade comes from a vendor.
Contact Payers and Clearinghouses
Maintain open dialogue
 Communicate the current status of your organization's ICD-10 implementation efforts.
 Share contact information for all key personnel involved in ICD-10 implementation activities.
 Establish regular check-in meetings to review transition progress and address challenges.
- Formal conference calls
- In-person check-ins
- Email updates
Revise and share implementation timelines
 Outline the steps needed to move forward
 Timing for each activity
 Include testing
 Sync timelines
Questions to ask healthcare payers
 Are you prepared to meet the ICD-10 deadline of October 1, 2014?
 Where is your organization in the transition process?
 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?
 When will you be ready to accept test transactions from my practice?
 What will we need to test with you?
 Do you anticipate policy changes or payment delays to result from the switch to ICD-10?
Consider outsourcing some processes
-
Medical coding
Accounts receivable management
- Claims submissions
- Denial follow up
Go back to ICD-10 Basics – What 2013/2014 should look like for you
- Billing
- Clearinghouses
Phase 3 - Budget
The purpose of the budget is to help healthcare providers predict the financial impact of the transition to, and
use of, ICD-10.
Phase 3 - Budget
Begin Date
Baseline budget formulation: Figure out how much the ICD-10
transition will cost.
Focus on four areas:
- Coding
- Revenue cycle
- Project management
Software and hardware
- In-house and vendor modifications
- Upgrades
Education
- Coder training
- Clinician education
Testing-related costs
Staff
Staff time needed for:
- Implementation planning
- Training
Date Complete
- IT
- New software, systems, and equipment
- Awareness raising
- Testing
- Vendor Management
Temp staffing to assist with extra work resulting from:
- Decreased coding productivity
- Billing backlogs
- Claims denial & rejection management
- IT work on upgrades and systems - Lost time during training
Consulting Services
Forms and Reports
- Redesign
Data Conversion
- Printing Costs
Dual Coding
- Added time
- Maintaining data collection
- Analyzing data
Go back to ICD-10 Basics – What 2013/2014 should look like for you
Phase 4 - Education
The purpose of the education assessment is to determine which staff will need to gain skills using
ICD-10 or mapping tools and what pre-requisite education must occur prior to intense ICD-10
education. Start this process immediately.
Phase 4 - Education
Begin Date
Date Complete
Raise awareness of ICD-10 requirements and begin formal training
for key personnel.
Maintain regular communications with management, IT, staff, and
medical staff about:
 Differences between ICD-9 and ICD-10 code sets
 Differences between ICD-10-CM and ICD-10-PCS code sets
 Regulatory requirements
 Value of ICD-10 code sets
 How ICD-10 implementation works with other initiatives
 Impact on coding productivity and accuracy
 Budget impacts
 How the transition will impact departments
 Impact on physicians' time
 How ICD-10 coding could affect patient encounters
 Updates on progress of the ICD-10 transition
Recruit physicians and other clinicians to help champion your
ICD-10 project.
Key benefits:
 Physicians and clinicians will be more influential in getting colleagues to cooperate, which will come in
handy when they learn they need to add more detail to documentation.
 Physicians and clinicians can offer reality checks to how things really work in your practice. Something
that the IT staff or consultants may not be aware of.
Go back to ICD-10 Basics – What 2013/2014 should look like for you
Phase 5 - Business Process changes
This phase of implementation involves organization-wide upgrading/changing of business processes,
information systems, software applications, health information management systems, education of
medical billers and coders, as well as clinical documentation education for medical staff.
Phase 5 – Business Process Changes
Upgrade systems
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Business processes
Information systems
Software applications
Health information management systems
Educate staff re changes
 Medical billers and coders.
 Medical staff responsible for clinical documentation
Go back to ICD-10 Basics – What 2013/2014 should look like for you
Begin Date
Date Complete
Phase 6 –Testing
Phase 6 – Testing
Begin Date
Date Complete
Internal Testing and Validation
This phase includes testing of all business processes and IT systems within an organization. Each individual
system (EHR, practice management, reporting, etc.) must be tested. Full testing of all processes working
together must occur – from initial patient engagement to creating a claim for the patient service – to ensure that
the proper codes are included on a claim.
External Testing and Validation
This phase allows organizations to test all processes and all areas that send and/or receive information from
outside the organization (e.g., a provider sends a claim to a health plan). Test data is exchanged to ensure that
proper information is sent, correctly received and processed by the receiving organization. Each individual step
in a process is tested to ensure accurate and proper function. A complete "end to end" test – from the
beginning of a patient experience through claims payment and reporting – should be conducted for the most
frequent and most important types of services.
Go back to ICD-10 Basics – What 2013/2014 should look like for you
Phase 7 - Staff Training
Phase 7 – Staff Training
Begin Date
Date Complete
o
Assess needed training and education; Identify the level of
education and awareness needed for each set of staff members
Subjects:
- ICD-10 Coding
- Anatomy
- Physiology
- Pharmacology
- Medical Terminology - Procedures
Pick best training options
- Formal classroom sessions
- In-house sessions
Education
- Coder training
- Clinician education
Testing-related costs
Staff
Staff time needed for:
- Implementation planning
- Training
- Remote, online sessions
- Awareness raising
- Testing
- Vendor Management
Temp staffing to assist with extra work resulting from:
- Decreased coding productivity
- Billing backlogs
- Claims denial & rejection management
- IT work on upgrades and systems - Lost time during training
Consulting Services
Forms and Reports
- Redesign
Data Conversion
- Printing Costs
Dual Coding
- Added time
- Maintaining data collection
Identify which staff members will need what training
- Analyzing data
Three levels of training:
ICD-10 code training
 Medical coders
 ICD-10-CM/PCS code set
 Anatomy and physiology refreshers
 In-house trainers
o Medical coder with ICD-10 training
o Train co-workers
o Skills:
 Public speaking skills
 Comfortable with change and learning
 Ability to organize and plan training sessions
 Desire to do more than coding
 Coding champion
 Staff member with ICD-10 training
 Educate and create awareness among the non-coding staff
 Help understand what vendors are selling
 Plan implementation and testing
 Dual coding
 Assign ICD-9 codes and ICD-10 codes before Oct. 1, 2014
 Advantages:
o Medical coders can practice their ICD-10 knowledge
o Clinical documentation deficiencies are exposed
o Extensive internal and external testing can be done
 Non-coding staff members
 Educate IT staff about requirements and structure of ICD-10 code sets
Procedural training
 New procedures and systems
 How to use new software and tools
o Electronic health records (EHRs)
o Computer assisted coding (CAC) systems
o Practice management systems
 New forms such as superbills
 New billing and claims procedures
 New documentation procedures
Clinical documentation improvement (CDI) initiatives
 Impact on documentation
 CDI strategy
Schedule training
 Arrange sessions for staff
 Spread training so coding shifts covered
 Plan training slots for yet-to-be hired personnel
Investigate training vendors
Budget resources
 Cost of training sessions and materials
 Time for staff members to learn.
 Cost of staff or temp workers who cover while your people are in training sessions
 Cost of outsourcing medical coding while staff coders are in training sessions
Go back to ICD-10 Basics – What 2013/2014 should look like for you
Phase 8 - Transition Plan
Every Organization should appoint a Post ICD-10 Committee to review implementation results, evaluate
success against established criteria and to identify what works and doesn't work, especially in revenue cycle,
HIM, and IT areas. Prior to October 1, 2014 this committee should determine the measures to be tracked and
collect baseline information on those measures. Following the go-live date, healthcare professionals will need
to employ lessons learned from the 5010 conversion and not become complacent following the go-live phase.
There will be significant post-implementation issues, such as claims denials and rejections or coding backlogs.
The post ICD-10 Committee must quickly identify these issues, establish feedback loops and work the
established solution path to completion.
Phase 8 – Transition
Begin Date
Date Complete
Processes affected
Coders - productivity will be impacted significantly with more codes and higher complexity in identifying codes
from clinical documentation.
Providers – will be required to answer more questions from coders for more specific documentation
requirements.
Revenue Cycle - will need to analyze reimbursement to ensure payment and that organizations are paid
accurately as anticipated.
Finance – focus on cash and increased cost due to unforeseen circumstances in delayed revenue, decrease
in productivity and technology hiccups.
Impacts/Lessons:
Lessons learned from 5010 implementation suggest that although vendors claim readiness, there will be post
go-live adjustments required.
Post vendor evaluation
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Do the products perform (some legacy systems maybe strained with the number of codes / logic)?
Do products still provide value (logic /lookups /displays of data may not be useable with the number of
codes & length of descriptions)?
Did vendors communicate well during the process or were they not “transparent?"
How are the workflow tools working?
What about payers that did not transition?
What is the plan for conversion and how will information be communicated and contracts negotiated
once 2 years of claims history is available?
Vendors are also subject to limited resources and will be hard pressed to be proactive in the Post GoLive phase.
Contingency Planning
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Lines of credit for payment interruptions
What to do if payers aren’t ready
What to do if vendors aren’t ready
Go back to ICD-10 Basics – What 2013/2014 should look like for you
An Industry Tool for Converting Codes
General Equivalence Mappings (GEMs) can assist in converting data from ICD-9-CM to ICD-10, including both
forward and backward mappings. For information on GEMS and their use, see the CMS ICD-10 web page.
(Click on 2013 ICD-10-CM and GEMS or click on 2013 ICD-10-PCS and GEMS in the list on the left side of
the page to find the most recent GEMs.)
THE ZIRMED PLAN
ZirMed provides industry-leading software solutions and award-winning client service for the healthcare
industry, with a proven track record of leadership.
A recent KLAS report indicates that providers rank ZirMed the highest in the industry in terms of how well we
guided them through 5010 and their confidence level in how well we will guide them through ICD-10. ZirMed
has participated extensively with various national organizations including X12, WEDI, CAQH and others on
past regulatory initiatives and has employees that serve as co-chairs or workgroup participants on several
initiatives within these organizations.
We are participating with several national pilot initiatives to conceptualize approaches to ICD-10, identify
challenges, establish best practices, and to educate the industry on methods to successfully make the ICD-10
transition.
ZirMed is producing and publishing a series of white papers on readying provider organizations for the
transition to ICD-10, in addition to our ZirMed Survival Guide for implementing ICD-10 in your organization.
Building on a Firm Foundation
ZirMed has assembled a team of some of its finest from business, operations, and product and engineering
disciplines within ZirMed to plan and execute our activities around ICD-10. We’ve defined our goals and
objectives for a successful program, have organized activities to achieve those objectives, and have
established models to measure our success against those objectives.
System Remediation
We’re remediating our systems to be able to process transactions containing ICD-10 codes. The vast majority
of this remediation work is already done – we did it when we implemented 5010. All remediation work is
scheduled to be completed by Q1 of 2013.
Communication and Internal Training
We recognize that communication and training within our own organization is critical to the success of our
clients. Therefore, we’ve organized a highly-structured process for communicating within on all aspects of
ICD-10 and training our own people to ensure a consistent message to our client base and to the world.
Assessments
ZirMed conducts regular, scheduled self-assessments of our readiness for and execution of ICD-10. We
identify areas where adjustments need to be made, thus ensuring we remain on track to help effect our clients’
successful navigation of the transition to ICD-10.
Dedicated to Client Preparation
It is critical that our clients understand that ICD-10 is very different from other regulatory initiatives in recent
past, such as 5010 and NPI. Although these other initiatives were not insignificant, they were primarily ITfocused. They could in many cases be substantially addressed by PM vendors and clearinghouses on behalf
of the provider. ICD-10 is different.
ICD-10 impacts several business processes for a healthcare provider, including contracting, clinical
documentation, coding, and billing. Recent surveys suggest that some providers may not recognize the impact
that ICD-10 will have on their organization and the need to fully assess and plan for their readiness, expecting
that their PM vendor or clearinghouse can take care of it for them as they have during past initiatives. Other
providers may be tempted to delay their attention to ICD-10 until later in the 2013 year, or even worse, until
2014, feeling that the October 1, 2014 deadline is a long way off.
ZirMed urges providers to recognize that tangible actions are required on their part to be ready for ICD-10.
ZirMed further strongly encourages providers to begin immediately to assess the impact of ICD-10 on their
organization. ZirMed will conduct extensive outreach to our client base to inform them of the impact of ICD-10
on their business and the need to plan for their readiness.
Providing Clients Information to Get Started
Feeling overwhelmed? Don’t know where to start? ZirMed is readying several avenues to help our provider
clients prepare for ICD-10
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The ICD-10 Resource Center in our Support and Training Center gives you a wealth of industry
information on ICD-10
A series of webinars will walk you through the things you need to do to plan and execute your
readiness
The ICD-10 Survival Guide will give you step-by-step instructions to achieve readiness
ZirMed is training our own employees to be able to assist you through the ICD-10 transition
Assess
ZirMed will conduct regular assessments of the readiness of our Provider Clients, PM System Vendor
Partners, and Payer connections to stay abreast of the status of all of these parties’ activities towards
compliance and to help guide our own efforts in assisting where needed.
Testing
ZirMed is defining a testing program to test various scenarios related to ICD-10, thus ensuring the highest
possible level of success for our provider clients when transitioning to ICD-10. ZirMed will selectively test a
sample of cases through each test scenario in order to demonstrate effectiveness for that scenario. The
provider self-testing function will be available to all providers. Several aspects of the testing program are:
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Non-Standard Transaction Testing
Provider-to-ZirMed transaction and communications testing
ZirMed-to-Payer transactions and communications testing
Provider-to-ZirMed-to-Payer end-to-end testing
Provider self-testing of transactions and communications
ZirMed Timeline
Here is ZirMed’s roadmap to ICD-10 readiness:
When
Planning stage
March 2013
Set up ICD-10 Resource Center: ZirMed has added an ICD-10 Resource
Center area within our Support and Training Center that contains valuable
information regarding ICD-10 and important news and resources available to
our customers.
March 2013
ZirMed ICD-10 Survival Guide: This guide provides an ICD-10 roadmap to
guide and educate our clients through the implementation of and transition
to the iCD-10 mandate. It also provides ongoing information on ZirMed’s
strategy, direction and timeline as we prepare ourselves for the ICD-10
transition.
March 2013
Webinars: Starting in March ZirMed will be providing monthly webinars in an
effort to educate and guide our providers step by step through this transition.
The webinars will review more in-depth each of the recommended
implementation phases, as well as introducing new ZirMed ICD-10 tools and
products as they are developed.
March 2013
System Remediation: We are remediating our systems to be able to process
transactions containing ICD-10 codes. The vast majority of this remediation
work is already done – we did it when we implemented 5010. All
remediation work is scheduled to be completed by end of Q1 of 2013.
2nd Quarter 2013
Education & Consulting offerings: ZirMed will provide online
outsourced education modules related to ICD-10 at a reasonable cost.
Examples of education modules may include: improving clinical
documentation to support ICD-10, ICD-10 coding (in-depth training) and
readiness planning. ZirMed recognizes that our more complex
organizations may need consulting services to help ensure a smooth
transition to ICD-10. ZirMed will provide a list of reputable organizations that
can assist with such consulting services.
April 2013
National Pilot ICD-10 Testing: ZirMed is participating in the HIMSS/WEDI
End-to-End ICD-10 national pilot initiative to conceptualize approaches to
ICD-10, identify challenges, establish best practices, and to educate the
industry on methods to successfully test ICD-10.
Phase 4 - Education
3rd Quarter 2013
Code Translation tool: ZirMed will offer clients a free tool to create code
crosswalks from 9 to 10 and from 10 to 9. These crosswalks will be able to
be used to provide insights into your code utilization. We are enhancing our
Coding Tools to fully support ICD-10 lookups as well as validations. You’ll
be able to supply ICD-9 codes either by querying existing claims in the
ZirMed system, batch-uploading a list of codes, or hand-keying a list of
codes. You’ll then be able to view the resulting matching ICD-10 codes.
3rd Quarter 2013
Testing Portal: ZirMed is defining a testing program to test various scenarios
related to ICD-10 to ensure the highest possible level of success of our
provider clients for transitioning to ICD-10. The provider self-testing function
will be available to all providers.
3rd Quarter 2013
Begin Testing with Providers and Payers: ZirMed will officially begin testing
with all Providers and Payer that are ready to test at this time. Several
aspects of the testing program are:
 Non-Standard Transaction Testing
 Provider-to-ZirMed transaction and communications testing
 ZirMed-to-Payer transactions and communications testing
 Provider-to-ZirMed-to-Payer end-to-end testing
 Provider self-testing of transactions and communications
2nd Quarter 2014
ICD-10 Transition Analytics: ZirMed is readying a new solution to help
provider manage rejections and denials to manage and automate the work
tasks that must be performed. This solution will inherently support ICD-10
and will be optimized to identify where claims outcomes deviate from the
norm or from expectations.
October 1, 2014
ZirMed will start submitting ICD-10 codes for Date of Service (DOS) or Date
of Discharge (DOD) on October 1, 2014.
October 2014
Ongoing support: After the mandated date ZirMed will be prepared to
continue supporting our customers with the same level of service you have
come to expect.
INDUSTRY ICD-10 RESOURCES
American Academy of Professional Coders (AAPC)
The nation's largest medical coding training and certification association for medical coders and medical
coding jobs, AAPC provides education and professional certification to physician-based medical coders. Here
you will find information on the ICD-10 codes and more.
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ICD-10 Information and Resource Page
American Health Information Management Association (AHIMA)
AHIMA is a health information management (HIM) professional association for medical record management.
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ICD-10 Information and Resource Page
ICD-10 Four-phase Plan Checklist
American Medical Association (AMA)
AMA is the largest association of physicians – both MDs and Dos – and medical students in the United States.
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ICD-10 Information and Resource Page
Centers for Disease Control and Prevention (CDC)
A United States federal agency under the Department of Health and Human Services, CDC works to protect
public health and safety by providing information to enhance health decisions, and it promotes health through
partnerships with state health departments and other organizations.
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International Classification of Diseases, Tenth Revision (ICD-10)
Centers for Medicare and Medicaid Services (CMS)
A US federal agency that administers Medicare, Medicaid, and the State Children's Health Insurance Program,
CMS offers a very complete website with ICD-10 information.
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ICD-10 Information and Resource Page
ICD-10 and Version 5010 Implementation Timeline
Medicaid: ICD-10 Changes from ICD-9
Healthcare IT News
ICD10Watch is a news source for all the latest developments on ICD-10 transition.
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ICD-10 Watch
Health Information Management Systems Society (HIMSS)
HIMSS is a not-for-profit organization whose goal is to promote the best use of information technology and
management systems in the health care industry.
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HIMSS ICD-10 Playbook
ICD10 Monitor (an e-news website featuring the latest ICD10 news and articles)
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ICD-10 News and Information
Medical Group Management Association (MGMA)
MGMA is the principal voice for medical group practice management professionals in the United States.
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5010 and ICD-10 Implementation
Workgroup for Electronic Data Interchange (WEDI)
WEDI is a nonprofit organization focused on the use of health IT to improve healthcare information exchange
— enhancing quality of care, improving efficiency and reducing costs. The workgroup’s goal is to become a
key source for ideas, education, and implementation information for stakeholders and develop work products
and programs to assist stakeholders in assessment, planning and implementation of the ICD-10-CM and ICD10-PCS medical code sets.
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ICD-10 Workgroup