6 Considerations for Verifying ICD-10 Operational Neutrality

Lately, I’ve been reading and hearing a bit of chatter about “ICD-10 verification and validation strategies” with the concept of verifying “financial neutrality” and/or “benefit neutrality” a dominant concern.  One of these days I think I’ll share my thoughts on those aspects of ICD-10 testing. But the purpose of this post is to raise a few areas of ICD-10 testing that may be considered as verifying “operational neutrality” and which, if not verified as working correctly, will certainly impact “financial neutrality” and/or “benefit neutrality.”

Note: The following is relative to ICD-10 Diagnoses codes and targeted toward healthcare payers, though many also apply to healthcare providers. Consult with your knowledgeable ICD-10 coding professional for more information.

ICD-10 impacts to verify and validate include:

1. Identifying “External Causes” or “E Codes” for Other Party Liability (OPL) processing.

{These are easily identified in ICD-9. In ICD-10, it isn’t going to be as easy as looking for codes that start with an “E”}

2. Body part assignment logic associated with OPL investigations

{Besides needing a new “ICD-10 code to Body Part cross-reference table,” you’ll need to be able to link claims received prior to 10/1/13 coded with ICD-9 codes to claims received after the 10/1/13 compliance date coded with ICD-10 codes}

3. Processing of Status Codes (aka. V Codes). These are codes designed for occasions when circumstances other than a disease or injury result in an encounter or are recorded by providers as problems or factors that influence care.

{This is a challenge similar to the “E” codes noted above.  The AHIMA recently put out some good info on this topic.  See “From V Codes to Z Codes: Transitioning to ICD-10” for more info.}

4. Validating logic and output related to Episodes of Care. You’ll have to be able to link/associate claims coded in I-9’s and I-10’s.

{This is a major area to validate and actually a subject beyond the scope of this short post. Check back later for more info.}

5. Correct handling of “combination codes.” ICD-10 can represent these with a single code as opposed to two or more sequenced codes in ICD-9.

{This is an area where I think considerable assistance from your ICD-10 coding expert will be required}

6. Verifying that searching, sorting and list processing algorithms work as expected

{I’ve seen source code logic that strips leading alpha characters out and presents ICD codes based on numerical collating sequences.  These would likely require revision.}

For more information regarding how ICD-10 will impact payers and providers, be sure to follow me on Twitter: ShimCode

6 Questions & Ideas about ICD-10 Testing – For Payers & Providers

1. Have your vendors and trading partners completed testing with other firms like yours? Especially those that use your same software version? Will these vendors share their results with you? Can you fast track your pathway to comfort by understanding and leveraging the outcomes of those testing efforts? For both unit and end-to-end testing?

{Try to minimize work reinventing anything that looks like a wheel; take a piggyback ride instead!}

2. What are the possibilities for collaborating with other firms like yours who use the same software, clearinghouse and other 3rd parties?  Can you split up the knowledge, effort and share results?

{User groups and associations may be able to assist.  And ‘competitive concerns’ may be negated via virtual partnerships with firms outside of your market.)

3. What options might you want to work out with your clearinghouses regarding handling claims coded with ICD-9 AFTER the implementation date?  Reject them at the clearinghouse? Or pass them through and reject them yourself? If the clearinghouse rejects it, your trading partner may not be aware of and know details of the claim.

{Rejection is not always an undesirable thing – at least, maybe during the transition period.}

4. What’s your escalation procedure going to be for your “partners” who’re not being cooperative or are’nt sharing your same level of concern and/or not meeting your timelines?

{Bumps and problems with partners will occur – think about how you’ll address these inevitable scenarios before they occur.}

5. Certain applications are used across multiple business domains and ultimate responsibility is not always clear. It would be optimal to have a single contact/owner for each application.

{Avoid that classic saying: ‘No one knows what the problem is, but everyone knows who’s responsible for it!}

6. Explore your options for being able to easily compare results from ICD-9-coded transactions with ICD-10-coded transactions - so you can focus on failed test cases.

{Remember the goal: Ease of compliance and maintaining financial neutrality and operational neutrality!}

Simple ideas, eh?  Check back later for more tips, ideas and comments.