International Classification of Diseases, (ICD-10-CM/PCS) Transition
- Begin planning now!
- Develop a project plan and integrate planning for the transition into your regular programmatic activities
- Seek leadership support and an executive sponsor early in the process
- Define the resources you will need and advocate for them as soon as possible
- Leverage existing communications network in your organization to spread the message that ICD-10 is coming
- Leverage an organization-wide structure to “house” ICD-10 efforts to ensure inclusiveness and prevent siloed effort
The ICD-10-CM/PCS transition deadline is swiftly approaching. Being prepared will be the difference maker in how well your organization weathers this important shift in coding. The key for a successful adaptation of the new coding system must begin now. Incorporating gradual trainings for healthcare professionals on the changes are strongly recommended in order to mitigate any foreseeable issues moving forward.
Public health entities’ systems, processes, and people rely heavily upon the receipt of already coded ICD-9-CM data. The ability to crosswalk or bi-directionally map between an ICD-9 code to an ICD-10 code is essential for the maintenance of public health surveillance activities and data. The National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) have aided in this by creating the General Equivalency Mappings (GEMs), which serves as the authoritative reference for code conversions. However, given the expansive nature of the new ICD-10 codes, an identical one-to-one matching to ICD-9-CM codes will not be possible because one ICD-9-CM code frequently translates to numerous ICD-10-CM or ICD-10-PCS codes. GEMs merely assist as a tool to provide the most optimal linkage between code sets.
Step 1. Assess your impact and needs. You should begin by assessing where your program will be impacted. There are three main areas of impact to consider as you plan for the transition: 1- How will this affect the People who utilize ICD-coded data? 2- How will this affect the Business Processes that wrap around the use of ICD-coded data? and, 3- How will this affect the Systems that touch ICD-coded data? Please see Resources page for helpful planning materials.
Step 2. Develop an implementation plan. Based on the areas and level of impact and need that you identified in Step 1, plan out what activities need to be completed and what resources are needed to address all of those impacted areas. Be sure to include post-implementation monitoring activities to ensure that the enacted transition activities had the desired outcomes and relevant mitigation strategies. People – Consider what training/orientation to the new code sets your staff will need (e.g., do you have coding professionals who need to be proficient in ICD-10 coding? Do you have data analysts who need to understand a very small set of ICD-10-CM codes? Please see list of Training options). Business Processes – Consider where and how your existing operational processes and work flows need to change to accommodate the new code sets. For example, pay careful attention to how you will map between code sets and conduct trend analyses over time and across code sets, and consider whether or not your program has the in-house expertise to do that work (if not, consider joining forces with other similar programs/organizations via the ICD-10-CM/PCS Transition community on phConnect). Systems – Identify all of the existing ICD-9-CM touch points for your system and determine how those touch points will need to change. For example, does your system need to convert ICD codes from one code set to another within the system, or does it just need to be able to receive and process ICD-10 code sets?
Once you have planned all of these activities, estimate what financial and staff resources you will need and how long it will take to complete the activities.
Step 3. Implement the plan (including any end-to-end system testing). Once you have a plan and a timeline, begin following the plan. If you require major structural changes to your system, make sure you allow enough time to conduct end-to-end system testing, validation and traceability.
Step 4. Post-implementation follow-up. Once we arrive at October 1, 2014, you should implement your monitoring steps to ensure that the revised systems, applications, tools and supporting processes are receiving, processing, binning, storing, and otherwise working correctly with the new code sets.