March 01, 2014
Area(s) of Interest: Practice Management Professional Development & Education
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from Rhonda Buckholtz, the Vice President of ICD-10 Education and Training for AAPC, a training and credentialing association for the business side of health care.
The October 2014 implementation of ICD-10 will change everything – from the way codes are reported, selected and reimbursed, to how health care providers document their services. This forces medical staff to see computers as partners rather than simple tools. The arrival of ICD-10 will standardize practices and require everyone who comes in contact with patients and records to adapt.
The industry evolves
The health care industry is about more than caring for patients, and is always evolving. In a time of increasing government oversight and audits, certified medical coders are in demand more than ever. Provider documentation has been emphasized throughout every specialty. Many privacy and security changes have occurred with the Health Insurance Portability and Accountability Act (HIPAA), which includes National Provider Identifier (NPI) and 5010 transactions upgrades. If providers are seeing constant changes with a steady stream of medical advances, then it’s safe to assume that the business of health care must change as well.
Preparation is the key to success
How would you prepare to welcome a new child into your home? You would be anxious, naturally, but being prepared would temper that anxiety as you made decisions regarding the necessary physical changes and alterations to your house and your routines.
Similarly, the ICD-10 transition may seem overwhelming, with almost 79,000 new diagnostic codes. That is why advance preparation is key. Below are key steps to making sure that your practice is ready for this monumental change.
Start with a work flow analysis
Begin preparations with an analysis of how each department in your practice will be affected and determine what level of training will be needed for each employee. Budget for such training and the resulting learning curve that employees will undoubtedly face.
The front desk staff will need to explain updated policies and forms to patients. Clinical staff must be aware of changes to Advanced Beneficiary Notice (ABN) forms, health plan policies, payment limitations and any superbills currently in use. Provider documentation and lab paperwork will need increased specificity. Coders and billers will likely need a refresher course on anatomy and medical terminology, given the increased specificity of the new code set, in addition to extensive training on the codes themselves. Managers will oversee ICD-10 implementation in the various departments, as well as revisit policies, procedures, contracts, budgets, etc. Everybody in the practice will need to be trained on updates to the computer systems and software in use.
Conduct ICD-10 readiness assessments
The next stage in ICD-10 preparations is to perform a readiness assessment. First, run a report in the computer system and sort it by diagnosis code. Next, take the top 10 most common diagnoses, and run another report listing patients that had these diagnoses appended to their records. Pull 10 to 20 charts with the most commonly used diagnosis code. Review the ICD-10 guidelines (if any) for the chapter of the diagnosis. Then review the notes for the specific diagnosis. Look at the history and documentation. Code it under ICD-10-CM. Create an ICD-10 readiness assessment report based on the results:
- How many notes could be coded completely in ICD-10?
- How many notes required additional information to code in ICD-10?
- How many notes had to be coded to unspecified?
Take the findings to all of the providers in the facility and review the level of specificity needed in the documentation to support coding the diagnosis in ICD-10. Go through all of the notes and answer all questions. Depending on the provider’s results, you can either perform another assessment on the same diagnosis or move on to the next diagnosis on the top 10 list. The facility should have a target percentage for the assessments, and all providers should meet that goal. Reports should be kept on each assessment to show progression of the providers.
Once started, the assessments should continue until the implementation date of October 1, 2014. How often they occur depends on the number of providers, number and types of specialties, and how well the providers perform. After ICD-10 implementation, these assessments should become part of the regular audit process.
ICD-10 isn’t just about coding. It changes everything about your practice. If you don’t make the transition to ICD-10 on time, you won’t get paid. It’s that simple.