After years of preparation, there are just a few weeks to go until ICD-10 goes live on Oct. 1 and the entire health care field must begin to report claims using the new coding system for all payers. This has been a very long time coming, with hospital leaders starting, stopping and starting again, prioritizing and monitoring progress on the conversion across the entire organization. With all the work already done, what’s left to do? Coder education? Check. Software updates? Check. Testing with payers? Check. Physician documentation? Check. In fact, it’s an excellent time to review the implementation checklist itself to ensure that everything is still as ready as it should be. Just as checklists have become a remarkably useful tool in improving safety in the health care field and the airline industry, checklists can play an important role ensuring that your organization is as ready as it can be for the ICD-10 rollout. After all, this is the biggest change in the coding field in the last 30 years and the stakes are high.

A few suggestions to add to your checklist in the final weeks:

Set up a communication plan for go-live in case problems arise.

Develop or update contact information for software vendors, major health plans and business partners and ensure that key personnel have access to the information, should they need to be contacted in case of problems.

Develop a plan to report any problems when the system goes live — who the points of contact will be, how to disseminate information and updates to all parties, etc.

Review and test any contingency plans for continuing operations if critical systems issues or other problems arise.

Plan for eliminating any ICD-9-CM coding backlogs prior to ICD-10 implementation. Determine whether outsourced coding personnel will be needed.

Ensure that coders have refreshed the skills and knowledge acquired in 2014, and provide access to the latest versions of the ICD-10 guidelines and Coding Clinic advice clarifying real-life scenarios.

Assess coding accuracy and provide additional training for any problem areas identified.

Refer to The ICD-10 Homestretch: A Checklist for Hospital Leaders to share with the ICD-10 transition team and discuss readiness with them. It can be found at www.aha.org/content/15/icd10checklist.pdf.

Once the ICD-10 rollout has gone smoothly, without major glitches or surprises, and the entire organization breathes a collective sigh of relief, it will be tempting to consider that attention can be shifted immediately to other priorities. Aside from claims going out the door and payments flowing smoothly, how will you know if you had a successful implementation? Try to envision what successful implementation looks like and create another checklist for post-implementation.

Suggestions for post-implementation checklist:

Monitor coding productivity and determine if staffing changes are required, including additional manpower.

Keep an eye on your case mix. Is it consistent with your expectations based on the findings from any pre-implementation dual coding or financial impact analysis?

Conduct coding and documentation audits to address any errors or gaps with additional education.

Conduct additional physician training based on coding staff identification of high-volume areas requiring additional physician queries. 

Nelly Leon-Chisen is director of coding and classification at the AHA.


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