It’s time to go into “Boy Scout” mode and get prepared for ICD-10, which launches Oct. 1.

According to Dr. Charles M. King II, physicians can expect to contend with impositions on staff time for training, a significant increase in the time it takes to complete each patient visit record, and a disruption in claims flow.

“Expect an increase in your rate of rejected claims at first,” Dr. King said at the annual Congress of Clinical Rheumatology.

He gave some tips based on his own experience preparing his own institution, the North Mississippi Health System Infusion Center in Tupelo, where he is the medical director.

First, establish a sense of urgency, particularly since training coders alone can take, on average, from 6 to 9 months. Next, have a clear strategy, complete with timeline, for when goals should be met for the conversion. Most importantly, have as much support as possible from your institution’s or practice’s leadership “because one way or another, this is happening.”

He also counseled that practices be prepared for the cost of the change which, depending upon the size of the practice, can be significant – even into the 7-digit range.

Dr. King discussed data from Canada indicating that the time to complete documentation for each patient visit using the ICD-10 code set is double that of the ICD-9 and that the turnaround on payment for claims went from 79 days to 150.

“You need to be ready for an increased rate in the number of claims rejected,” he said, pointing to the learning curve that will naturally occur as the nation adopts the new system. The ICD-9 has just over 14,000 codes; the ICD-10 has over 68,000 codes.

To minimize claim rejections, Dr. King suggested that physicians train their staff to work “at the top of their skill set” and to be scrupulous themselves when notating all patient encounters.

His two top tips for standardizing workflow and minimizing claim times:

• When checking off the boxes in the so-called “queryable” list (the one that has codified entries) that asks for the presenting symptoms in the ICD-10, Dr. King said it was helpful to keep the “nonqueryable” list (the one that allows more free-form responses) in the same order. By correlating the entries in each of these lists line by line, the documentation can demonstrate how the diagnosis was thought out, which helps put the information into a larger context and minimizes any questions from your coding team later, according to Dr. King.

• Observing proper “chartiquette” is especially helpful when there are shared electronic health records. “Clean out the closets,” he said. To keep records manageable, keep the problems listed in the same order every time, remove problems that are time limited, avoid listing endless symptoms, and remove any duplicate entries.

“If you were good at ICD-9, you are going to be good at ICD-10,” Dr. King told the audience.

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