How to keep ICD from turning into OMG!

We at Aym Technologies have had many calls, emails and support tickets in the last few months from customers as they make their final preparations for the ICD10 conversion happening in October.  Given the fact that this transition has been looming for many years now,and has been delayed so many times I stopped counting, its understandable that many are confused and frustrated.

Below are some simple thoughts and strategies that we hope will be helpful when making this transition.

1. Evaluate your readiness – Take a deep breath and step back from the all the drama and ask yourself 2 simple questions
     a. “do I know what the ICD10 diagnosis should be for all of my consumers, or do I at least know where to look for help.”
     b. “do I know that my billing software, or the portal I use, is ready to send my billing on 10/1”

If you can answer these two questions confidently then you are already well on your way.  If you cannot answer both with confidence, then please contact us, we are here to help you.

2. Understand that no one has this 100% right.  There will be problems – ICD9/DSMIV and ICD10/DSM5 are not a one-to-one crosswalk for all diagnosis types.  In fact many of the diagnosis used in IDD and MH for decades are changing, or worse yet, are mapped to 5 or more ICD10 codes.  Many providers are left confused and frustrated by this because they lack the professional staff, and the funding mechanism, needed to re-diagnose their consumers under DSM 5.  Most payers that they reach out to for help tend to dismiss this transition as a “billing thing” or “just a coding problem”.  It is actually much more fundamental than that.  It is a seismic shift in the way that we approach diagnosis.

But again I say, deep breath, step back and look at the fundamentals.  If you are mainly a Medicaid provider billing services to an MCO (or other similar entity) then all you have to do is play the match game.  What I mean by this is that your main job is to ensure that the ICD10 submitted in your billing file matches the one that the payer has selected for your consumer inside their system.  EVEN IF IT SEEMS WRONG.  I know that sounds hard to believe, but its true.  Being right isn’t as important as being the same as the payer you are billing.  There will be time to get things right after the transition has settled down, but right now you just have to make sure that you use the same code that they are using.  Many payers have published their ICD10 crosswalks, and still others have already updated their portals with ICD10 codes already.  Seek out that information and use it to make your job easier.

3. TEST – you really need to test with everyone that you submit claims to.  If you are an Aym customer, rest easy, we have been testing for many months.  If you use another vendor or clearinghouse, you need to make sure they have tested ICD10 claim files with all of the payers you submit files to.

Now, if all three of these items are done, just sit back, buckle up, and try to enjoy the ride!