It's time for 'meatball' ICD-10 preparation

16 Sep 2015 2:23 PM | Denny Brennan (Administrator)

by Carl Natale for ICD10Watch, Sep 16, 2015 - 12:00 AM

It's time for 'meatball' ICD-10 preparation

In the popular TV show M*A*S*H, army doctors performed 'meatball' surgery on U.S. soldiers during the Korean War. It wasn't pretty. The surgeons acted quickly to save lives. They didn't do everything that they would have if they weren't within shooting distance of the front lines.

That is where we are at now in ICD-10 preparation. It needs to get done by Oct. 1. It's not going to be pretty. There won't be steering committees or impact assessments.

There will be getting it done.

The Centers for Medicare and Medicaid Services (CMS) has broken down the process to what needs to get done quickly and offered an ICD-10 quickstart guide at

Make a plan

  • "Assign target dates for completing steps outlined here" (I think by target dates they mean "ASAP")
  • Crucial: Get the ICD-10 codes, which are available:
    • Online (e.g., go to and select “2016 ICD-10-CM and GEMS” to download 2016 Code Tables and Index)
    • CD/DVD and other digital media
    • Practice management systems
    • Electronic health record (EHR) products
    • Smartphone apps
  • Consider how your clearinghouse can help
    • Clearinghouses can help by:
      • "Identifying problems that lead to claims being rejected"
      • "Providing guidance about how to fix rejected claims (e.g., more or different data need to be included)"
    • "Clearinghouses cannot help you code in ICD-10 unless they offer third-party billing/ coding services"

Train your staff

  •  Plenty of free resources from CMS
  • Also check:
    • Medical societies
    • Health care professional associations
    • Hospitals
    • Health systems
    • Health plans
    • Vendors
  • Crucial: Identify the top ICD-9 diagnoses
    • Target top 25 ICD-9 diagnoses (possibly your superbill already reflects this)
  • Code top ICD-9 diagnoses in ICD-10 codes
    • Note where more documentation is needed

Update processes

  • Crucial: Update all printed and electronic forms
  • Fix clinical documentation gaps discovered when using ICD-10 codes
  • Key coding concepts in ICD-10 documentation:
    • Laterality
    • Initial or subsequent encounter for injuries
    • Trimester of pregnancy
    • Details about diabetes and related complications
    • Types of fractures

Talk to vendors and health plans

  • Crucial: Confirm ICD-10 readiness of systems with vendors
  • Confirm that health plans, clearinghouses and billing services are ICD-10 ready
  • Check on testing opportunities

Test your systems and processes

  • Crucial: Verify your medical practices can:
    • Crucial: Generate a claim
    • Perform eligibility and benefits verification
    • Schedule an office visit
    • Schedule an outpatient procedure
    • Prepare to submit quality data
    • Update a patient’s history and problems
    • Code a patient encounter
  • Test systems with vendors, clearinghouses, billing services and health plans
    • Acknowledgement testing is available through Medicare Administrative Contractors until Oct. 1.
  • Explore alternate ways to submit ICD-10 claims if your systems aren't ready for ICD-10 implementation.

It still looks like a lot. But it needs to be done to get reimbursed after Oct. 1. Good luck and let us know how it's going.

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