5) ICD-10 Testing Tips
credit: CMS & HHS, 7.24.15
ICD-10 Preparation for Mental & Behavioral Health and Substance Usage Providers
“While ICD-10 is less than 75 days away, you still have time to get ready. But you must get ready now.
Getting the Most Out of Testing
To get the most out of testing for your practice, you should:
- Review testing requirements to understand the scope and format of the testing available
- Focus on your highest-risk scenarios, such as claims processing and the diagnoses you see most often
- Prioritize testing with health plans, concentrating those that account for the majority of your claims
Avoid common billing errors, such as:
- An invalid National Provider Identifier (NPI)
- Invalid Health Care Procedure Coding System (HCPCS) codes on professional claims
- Invalid postal ZIP codes on professional claims
Test as often as you can!!
CMS Provider Testing Tools
CMS offers the following tools to assist with testing:
- National coverage determination (NCD) and local coverage determination (LCD) conversions from ICD-9 to ICD-10
- The 2015 versions of the Integrated Outpatient Code Editor, which include ICD-10
- The ICD-10 Medical Severity Diagnosis-Related Groups (MS-DRGs) conversion project, which is available along with payment logic and software replicating the current MS-DRGs. Also on this webpage are the:
o ICD-10-CM MS-DRG Grouper
o Medicare Code Editor (available from the National Technical Information Service)
o MS-DRG Definitions Manual, which allows you to analyze any payment impact from the conversion of the MS-DRGs from ICD-9 to ICD-10
You Can Test – Even If Your System Is Not Ready
If you don’t have an ICD-10-ready system installed yet, you can still conduct meaningful testing. One good way to start is to look at the ICD-10 codes for the top 10 conditions you see. Consider volume of conditions and those that account for most of your revenue. Look at recent medical records for patients with these conditions and try coding them in ICD-10 for practice. Do the records include the documentation needed to select the correct ICD-10 code? You can use any cases of insufficient documentation to create a checklist for clinicians to consult.Review testing requirements to understand the scope and format of the testing available
To learn more about getting ready, visit the cms.gov/ICD10 for free resources including the Road to 10 tool designed especially for small and rural practices, but useful for all health care professionals.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for and CMS ICD-10 Industry Email Updates and follow us [CMS] on Twitter.” (source: CMS)
Leigh-Ann Renz is the Marketing & Business Development Director of PIMSY EHR and is very passionate about helping practices prepare for the upcoming ICD-10 transition. For more ICD-10 resources, especially geared towards mental / behavioral health, see our ICD-10 Resource Center. For information about electronic solutions for your practice, check out Mental Health EHR.