The Ultimate ICD-10 Transition Tool

As everyone in our industry knows, there is a great deal of energy and a wealth of opinions, pro and con, around the impending transition to ICD-10. While the scope and complexity of the change for larger providers and payers is daunting, the trickledown effect for smaller practices can be no less intimidating.

The good news is that large or small, the information you need to navigate your way through the ICD wilderness is available from the Centers for Medicare & Medicaid Services. What’s more, it’s free!

Let’s take a quick tour of the CMS website ( and review some of the most useful tools. On the main ICD-10 page, you’ll find a menu on the left with a list of links that provide access to a wealth of information, and help you target your area of interest.

Timelines & Checklists
“Implementation Timelines” is a great place to start; it’s divided into “Timelines” and “Checklists” and categorized for large and small/medium practices, small hospitals and payers. The Timelines are at-a-glance graphics that break transition activities into broad categories, such as Planning, Communications, Testing and Training, by month and year. Many of the tasks are slated for 2013, so if you’ve been shuffling your feet and procrastinating, you’ve got some catching up to do. The Checklists offer similar information (tasks and timing) for the list makers and checker-offers among us. Both of these sections will help you assess where you are and where you should be in the process, and what resources you may need to avoid setting your hair on fire come next September 30, 2015.

Practices Big & Small
After getting a feel for the overall process, take a look at the “Resources” topic that is appropriate for your business (Provider, Medicaid, Medicare, Payer or Vendor). These sections contain tools you will need to manage the transition, if you are a smaller provider, or the materials to build your own change management pathway if you are a large provider, payer or vendor. For example, the “Provider Resources” page is divided into educational resources, including some video presentations and webinars, introductory guides, FAQs, and more detailed implementation guides and communication tips. If you have a small medical practice, click on the “Road to 10” link in the first paragraph and view information such as codes that will be specific to your specialty; webcasts; and even a few clinical training scenarios. In addition, you can build a customized action plan based on a few simple choices that describe your practice, level of technology, staffing and area of focus. The Payer and Vendor Resources are a bit less instructional and more informational, honing in on implementation materials, FAQs and more basic building blocks for crafting a transition program; Payers and Vendors likely have transition staff that might want their own ICD-10 tinker toys to play with.

Inpatient & Outpatient
If you are a “Yes, but where’s the meat?” type of person, the GEM file links are the technical goody bag you’ve been looking for. Click on the menu selections for ICD-10-CM (for outpatient providers) and ICD-10-PCS ( for hospital inpatient use) to view not only the GEM files, but code descriptions, code tables and index, reimbursement mappings, etc. Payers and larger Providers will want to develop or purchase a code mapping tool based on the GEM files. Depending on the amount of historical conversion required in your business, you’ll need a tool that can map comprehensively forward or backward. Either way, the raw materials are here for the taking. And, in case you’re not the type that enjoys poring over tables and codes, here is an interesting, and reassuring tidbit from the CMS “Myths And Facts” publication (

Just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD-10-CM/PCS doesn’t necessarily make it more complex to use. In fact, the greater number of codes in ICD-10-CM/PCS make it easier for you to find the right code. In addition, just as you don’t have to search the entire list of ICD-9-CM codes for the proper code, you also don’t have to conduct searches of the entire list of ICD-10-CM/PCS codes. The Alphabetic Index and electronic coding tools are available to help you select the proper code. The improved structure and specificity of ICD-10-CM/PCS will likely assist in developing increasingly sophisticated electronic coding tools that will help you more quickly select codes. Because ICD-10-CM/PCS is much more specific, is more clinically accurate, and uses a more logical structure, it is much easier to use than ICD-9-CM. Most physician practices use a relatively small number of Diagnosis Codes that are generally related to a specific type of specialty.”

CMS has even provided resources for those that have already implemented the ICD-10-CM code set, such as updated equivalency mappings, additions and deletions, and reference manuals. Some other links worth cruising are Statute and Regulations, where you can find the specifics of the ICD-10 Final Rule, of particular interest to Payers with significant transition costs; and the ICD-10 MS-DRG Conversion Project which contains material for using the GEMs to convert the draft MS-DRGs to ICD-10-CM and ICD-10-PCS, as well as some pilot software to assist with conversion.

Regardless of your level of interest or engagement in the conversion process, the CMS website has ample information, educational and/or practical, to carry you safely through October 1, 2015, whether you are building a code mapping tool, or looking for help with your own small practice implementation action plan. And of course, best of all, it’s free!

ADVANCE thanks the Reed Group Disability Guidelines Editorial Staff.

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