The monetary impact will be very specific to the practice. Smaller practices may find it easier and more efficient to have their coders and other back office staff use webinars and in-office training. Others may send staff to conferences or have trainers come to the practice. In that case, you may also have to pay travel expenses.
Some experts suggest coders should receive training in anatomy and physiology, too.
In ICD-10, “the level of specificity is much greater than in ICD-9,” said Grider. “Many coders don’t have the knowledge of anatomy and physiology needed in the more clinically driven ICD-10.”
For example, in ICD-9 there are 11 codes that rheumatologists can use to code for gout. In ICD-10, there are over 200 codes with more specificity to clearly define the diagnosis (see Table 1, at left).
It is also strongly suggested all physicians be included in training. As with ICD-9, one of the major determinants of payment is what the clinician puts in the chart.
“ICD-10 is much more involved with clinical aspects, terminology, and anatomical specificity,” Chung says. “The hardest thing for coders will be to reprogram their minds and refocus toward diagnosis.” [Editor’s note: Be sure to read “2013–A Whole New World” on p. 9 and “ICD-10 from a Coder’s Perspective” on p. 18 for more information on preparing your practice for ICD-10.]
Disruptions in Practice
After the practice has a handle on who needs to be trained, another thing to budget for is disruptions caused by people unavailable for regular duties. Is it best to scale back appointments for a time? Do you pay overtime to bring people in and maintain a full schedule? Does it make financial sense to shut down entirely and get everyone trained at once?
Also, plan for the early days of implementation. Will the practice cut back on patients? Will your vendors and payors have people and phone numbers dedicated to troubleshooting problems? What is the plan for providing bug fixes? How much of these costs are included with new programs or under maintenance contracts?
“For most updates, we reduce schedules by 10% to 25% for up to two weeks,” says Dr. Hong. “This gives adequate time for problem solving and additional updating if needed. We will probably do the same thing during the ICD-10 changeover.”
Following a review of the short-term costs and dislocations, the practice should begin thinking about longer-term impacts.
Tennant suggests that physician productivity will see a decrease for the first six months following transition to ICD-10. He is also concerned that decreased productivity may be ongoing following implementation. Grider notes that the CMS foresees a productivity cut of 60% over the first year. Much of this will be related to increased clinician time for each encounter and taking longer to complete the more in-depth charting required for payment.