May 01, 2014
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from Jennifer Della’Zanna, AAPC ICD-10 trainer and a member of AHIMA and the Association for Healthcare Documentation Integrity.
For those of us in the health information management field, “March madness” had a very different meaning. Watching the Senate vote on HR 4302, otherwise known as the “doc fix” bill, we bit our nails as the vote climbed toward the 60 required votes to pass it. Most people in the country were unaware of the little piece slipped in at the last minute that would delay ICD-10 for at least another year, and most news reports didn’t mention it either. Whether you heaved a sigh of relief or shook your head in disbelief at yet another postponement of the new code set, you are probably wondering what to do now.
If you are among the majority of practices that were on track for preparation of the transition on October 1, 2014, don’t despair. Any training is not wasted. Staff who have received training in the new code set know that many of the differences between ICD-9 and ICD-10 are a few new concepts that are easily mastered and a new alphanumeric structure to the codes. The key to ICD-10 is mastery of the guidelines, and these have not changed much more than we are used to them changing from year to year. Some simple tasks will keep coders active in using ICD-10, and with practice they will be better prepared next year for the change than they would have been this year. These same tasks can also help a practice that might have been behind schedule for the original implementation date to catch up.
“Dual coding charts” means to code them in both ICD-9 and ICD-10, and it serves two purposes. It keeps coders in practice and helps to highlight areas ripe for provider documentation education. Any staff educated in the new code set should pull 10-15 coded charts a month and recode them using ICD-10. After the coding exercise, discrepancies in documentation will be apparent. Instances of non-specific coding should be inspected for improved documentation opportunities. Of course, you don’t have to wait until ICD-10 implementation to include increased documentation on a patient’s chart. Make the changes now and repeat the exercise every couple of months to see if the documentation improvements make a difference in the ability to more accurately code the charts in ICD-10.
There is no better way to learn a new skill than to teach it to another person. Staff who have received training should be encouraged to pass on their knowledge to other staff members. Already-trained staff members are also prime candidates to keep the office on track for the new implementation date. Keeping up to date on any new changes within the field, creating an implementation timeline and making sure the practice hits the milestones on time will give the entire office a sense of progress and organization that will make the goals easier to achieve. As the new implementation date arrives, look again for more opportunities for formal training of new staff, as well as any opportunities for refresher courses and continuing education for those who have already been trained.
Physician staff members should take the opportunity to become familiar with the similarities and differences within the codes frequently used within the practice – in small bites. Absorbing the steps needed to properly document conditions within the specialty will take care of the majority of work needed for physician documentation improvement. Unusual cases can be dealt with as they arise, but taking care of everyday codes will make the new code set seem less frightening and, by the time implementation gets here, there will be fewer things to learn. Keep in mind, we’re not talking about paragraphs of more documentation – sometimes it only requires a few tweaks to current wording.
Talk with your electronic health record and practice management software vendors – and keep those lines of communication open. Make sure they are on track with preparations for implementation on their end. Ask the vendor to come out and educate your staff about changes they’ll be making and how they may affect current office procedures. Make sure you can schedule end-to-end testing as the implementation date nears. Remember that the new implementation date will change vendor plans as well. By the time ICD-10 implementation takes place (at least another year), new guidance on meaningful use will certainly arise. While vendors may have been on track to be ready for implementation in 2014, by the time final implementation occurs, even more improvements to their systems may be mandated. A little understanding on everybody’s part can go a long way toward a smooth transition.
If you were behind on your timeline, now you have time to catch up. As one trainee said on the day after the vote, “My ICD-10 tracker just went from red to green!” Use the time wisely to keep that tracker in the green. If you were on track – congratulations! But don’t let that momentum die. Keep your place at the vanguard of leaders in the field. We need leaders during this transition, especially as there are so many other challenges within the health information technology and management fields that will occur over this year and the next. There is no reason to panic, but there’s still no time to waste. Make a plan and implement it!