Harmony Healthcare International (HHI) Blog

The ICD-10 Transition: The Biggest Fear for SNF Providers

CMS-ICD-10With an implementation date of October 1, 2015 looming, the transition to ICD-10 is in full swing.   In speaking daily with Skilled Nursing Facility Operators and Administrators, it is apparent that while many leaders understand that ICD-10 is coming, they lack a proper transition plan to ensure that their Skilled Nursing Facility (SNF) is fully prepared for the change.

As a long-term care professional, my biggest fear for SNF providers is the potential billing problems, and subsequent cash flow dilemmas, that will arise from an incomplete understanding of ICD-10.

While October is still months away, you need to start preparing for the transition now.  Here are some useful tips to help you prepare and avoid falling victim to future billing issues:

Attend a SNF specific training and send multiple departments

Finding a classroom training or webinar is easy.  Finding one that is specific for SNF providers requires a little more research.  Today’s SNF patient population is unique and challenges will be different than that of hospitals, physician practice, ambulance providers, and home care.

Speak with your software company/companies

While your MDS / billing software might be “front & center,” many providers have separate software for eMAR, ADL coding, therapy and more. Ensuring accurate ICD-10 coding across multiple platforms will be that much more difficult than doing so across a single system.

Ready to start coding?  Learn some of the basics

Codes will include the following format:

  • Digit 1 is alpha (A-Z, not case sensitive)
  • Digit 2 is numeric
  • Digit 3 is alpha (not case sensitive) or numeric
  • Digits 4-7 are alpha (not case sensitive) or numeric
  • “X” is used a placeholder for codes that contain fewer than 6 characters and a 7th character is required

How will this new coding system impact the skilled nursing facility?  ICD-10 will eliminate a vast majority of common coding practices currently utilized, including the utilization of the V-Code to identify encounters for therapy, the 18 aftercare codes for fractures, the “late effects” codes and the Hypertension table.  It will add the “X” placeholder and change the timeframe in the reporting of a Myocardial Infarct.

Begin coding with your current long term population

You will need to have an ICD-9 code for dates of service up to and including September 30, 2015 and an ICD-10 code for dates of service including and after October 1, 2015.  All patients should be dually coded by the October 1, 2015 ICD-10 deadline.  Begin coding on this patient population.  The staff will quickly become comfortable with the transition and will also help update diagnosis lists in the process.

Don’t forget about your other key business partners

It is good practice to ensure that other business partners are prepared.  Among these are your pharmacy, mobile radiology provider, lab, and Part B provider.  Meet with them well in advance of October 1 and ensure they are preparing for a smooth transition.

Examine your workflow closely

Examining the workflow of how ICD-9 codes are currently assigned is a good place to begin.  Who assigns codes? Which members of your staff understand coding the best?  What codes come from the hospital?  Are they just being copied?  Are MDS, therapy, and billing in sync on diagnosis hierarchy?

Triple check, Triple check, Triple check!!!

The Triple check process will be your best friend in ensuring accurate coding.  A sound process to compare the UB-04 to the MDS assessment to the clinical documentation and therapy notes will enhance the accuracy of your claims and ensure timely payments. In my next article, I will look more closely at some specific workflow processes that can help you prepare for the October 1 deadline.  

For more information on ICD-10 training for your SNF, please review our education schedule here. If you would like to discuss individualized training for your facility, please call our office at (800) 530-4413.

Don't forget to register for the Nation's Leading Long-term Care Conference:


Topics: ICD-10

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