Assess documentation from an ICD-10 point of view

Can you code ICD-10 from the documentation your physicians currently provide? Look at several records for each of your physicians and ask yourself whether you could assign codes in ICD-10 based on the information the physicians provided. There is going to be a learning curve, so it’s important to take these small steps early on to assess what kind of training is necessary to prepare for ICD-10 implementation.

Identify documentation that lacks necessary details, and try to get physicians to understand the need for more specificity and expansion within their documentation. This will help ease the transition during the implementation phase.

Serifs can save coders valuable time

It may sound like such a small detail, but when your information technology (IT) team is looking to revamp and redesign your system, it’s vital that you specifically request that the new system uses serif fonts. This can make a huge difference when your coders are pouring through 155,000 codes, trying to discern between “I”s and “1″s, for example. Even though it might shave off less than a minute for each record your coders have to code, multiple this by the number of records they code in a month, and you can see how those precious minutes can add up to a significant cost savings. This was just one of many helpful tips I learned during the American Academy of Professional Coders (AAPC) national conference in Las Vegas. Sheri Bernard, CPC, CPC-H, CPC-P, vice president of clinical coding content at the AAPC, shared this pointer when she presented the session titled, “Preparing for ICD-10-PCS.”  Stay tuned for more insight into ICD-10 from the AAPC conference.

What will ICD-10 cost your organization?

We know it will take a huge time commitment. We know it will require an inordinate amount of organization and coordination across departments. We know the training for coders and physicians and others in your organization will be extensive. But what is the transition to ICD-10 going to cost in dollars and cents? Consider the following excerpt from the Medical Group Management Association Web site:

The American Academy of Dermatology, American Academy of Professional Coders, American Association of Neurological Surgeons, American Association of Orthopaedic Surgeons, American Clinical Laboratory Association, American College of Physicians, American Medical Association, American Optometric Association, American Physical Therapy Association, American Society of Anesthesiology, and the Medical Group Management Association retained Nachimson Advisors to assess the cost impact of the proposed ICD-10 rule on providers.  Nachimson Advisors estimated the cost impact of an ICD-10 mandate on three different provider practices:

• A typical “small” practice, comprised of three physicians and two impacted administrative staff.
• A typical “medium” practice, comprised of 10 providers, one full-time coder, and six impacted administrative staff.
• A typical “large” practice, comprised of 100 providers, with 64 coding staff comprised of 10 full-time coders and 54 impacted medical records staff.

Total Cost Impact of ICD-10 Mandate on Individual Provider Practices

• For a typical small practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $83,290.
• For a typical medium practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $285,195.
• For a typical large practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as more than $2.7 million.

Cost Impact of ICD-10 Mandate in Six Key Areas

Requiring five times as many codes as the previous code set, the  proposed rule would impact every aspect of business operations for physician practices and clinical laboratories and produce significant added costs in six key areas:

1. Staff Education & Training.  Nachimson Advisors estimates the staff education and training costs associated with an ICD-10 mandate would range from $2,405 for a small practice to $46,280 for a large practice.
2. Business-Process Analysis of Health Plan Contracts, Coverage Determinations & Documentation.  Nachimson Advisors estimates the business-process analysis costs associated with an ICD-10 mandate would range from $6,900 for a small practice to $48,000 for a large practice.
3. Changes to Superbills.  Nachimson Advisors estimates the changes to new claim form software (superbills) costs associated with an ICD-10 mandate would range from $2,985 for a small practice to $99,500 for a large practice.
4. Information Technology (IT) System Changes.  Nachimson Advisors estimates the IT costs associated with an ICD-10 mandate would range from $7,500 for a small practice to $100,000 for a large practice.
5. Increased Documentation Costs.  Nachimson Advisors estimates the increased documentation costs associated with an ICD-10 mandate would range from $44,000 for a small practice to $1.785 million for a large practice.
6. Cash Flow Disruption.  Nachimson Advisors estimates the cash-flow disruption costs associated with an ICD-10 mandate would range from $19,500 for a typical small practice to $650,000 for a typical large practice.

These helpful links can help you launch your ICD-10 efforts

Have you ever had a To-Do list that’s a mile long, and you just don’t know where to start? This implementation timeline is going to feel less like a mile and more like a Marathon. I thought it might be helpful to pass along some links that really do a deep dive into ICD-10. Hopefully these resources will get you started on your journey to ICD-10:

• Centers for Medicare & Medicaid Services: www.cms.hhs.gov/icd-10
• American Health Information Management Association: www.ahima.org/icd10
• American Academy of Professional Coders: www.aapc.com/icd-10
• Centers for Disease Control and Prevention: www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm

How will productivity standards shift in the face of ICD-10?

As if you don’t have enough to worry about between staying on top of CMS guidelines and different reporting rules for various payers, now you face the challenge of learning and assigning ICD-10 codes while meeting strict productivity standards. Will these standards change once we get closer to the October 1, 2013 implementation date? Will coders be held to unrealistic expectations in maintaining productivity standards? And if the pressure to code a certain number of records in a given day revolves around getting paid, how will providers get paid when the accuracy of the coding is compromised by the rush to get the bills out the door? How do you think productivity standards will change at your practice or facility?

Time to brush up on your anatomy and clinical knowledge

Coders’ clinical knowledge is going to be more critical than ever before. Your ability to glean information from physician documentation and translate these notes into meaningful codes in ICD-10 is going to be paramount due to the degree of specificity inherent in this new coding system. Make clinical education for your coding staff members a priority. When physicians perform surgeries and document their approach, can your coders recognize whether this was transluminal? This is the kind of granular detail that you will need to determine when assigning ICD-10-PCS codes. You may need to possess the clinical knowledge to infer whether the procedure was transluminal or not just based on the documentation of the approach, for example.

Get ready for the big talk … with your physicians

Have you ever had to plan for a difficult conversation with a friend or loved one? You feel stressed out about having to bring up a painful topic, and you think of every way to broach the subject. You put it off as long as you can, but you know the conversation needs to happen. Well, all these same feelings might come rushing back when you think of having to sit down with your physicians to talk about ICD-10. They might not understand all the implications of the new coding system or in some cases, they might not even be aware of ICD-10 and the October 2013 implementation deadline.

For some, this chat with physicians may be imminent. For others, it may have already taken place. But I wonder about the different approaches HIM and coding staff will take to introduce ICD-10 to their physicians. Is there one way that might be particularly effective? Is there one phrase that will really get their attention and convey the magnitude of this transition? If you would like to share your strategy, please weigh in!

If you’re not ready to dive in, start by getting your feet wet

We’ve read the words of caution and heard the urgency of the message: Don’t put off planning for ICD-10. And while there is no one-size-fits-all plan for implementation, there is one tip that everyone should bear in mind: It’s too early for coder training in ICD-10. Think about how well people retain information over time. Can you remember all of the coding guidance in Coding Clinic from six months ago? Can you remember the top 10 tips you learned at your last in-service training? Now imagine trying to remember all the knowledge you might gain in a week’s training four years from this point.

So what should coders be doing right now? Look at the basic coding conventions and the most obvious differences involved with the new coding system. For example, start with small nuggets of information and build on that slowly. Do you know what an Excludes 1 or an Excludes 2 note indicates?

Excludes1: Denotes “not coded here,” meaning coders should never report the excluded code at the same time as the code above the excludes1 note (e.g., the congenital form versus an acquired form of the same condition).

Excludes2: Denotes “not included here,” meaning that the condition excluded is not part of the condition represented by the code even though a patient may have both conditions at the same time. When an excludes2 note appears under a code, coders can report both codes together, when appropriate.

That wasn’t so bad was it? So for the coding side of this transition, start now but start small.

The switch to ICD-10 doesn’t have to be painful – does it?

Over the last couple months, I have tried to get a sense of how far along people are in the ICD-10 planning process. The verdict? While it’s definitely on the radar, it seems as though most have not actually taken any action toward forming an ICD-10 team or forming an implementation timeline. Something tells me that the mere thought of all the aches and pains that come with this change makes people shudder and look the other way. Of course, there are so many other reasons that might be a factor in putting off planning for the new coding system. Are you in the middle of implementing an electronic health record system? Are you up to your ears in physician queries and documentation improvement initiatives? What has kept ICD-10 on the back burner at your practice or facility?

Don’t neglect January 1, 2012 deadline for 5010 implementation

Even before you implement ICD-10 in 2013, you will need to make sure that the 5010 electronic code sets are in place at your facility. You must implement the 5010 code set by January 1, 2012. As an extension of your ICD-10 implementation team, consider organizing a subcommittee to address the 5010 transaction code sets.