Health Information Management

Tackle the tasks necessary to execute ICD-10 transition

JustCoding News: Inpatient, February 3, 2010

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Editor’s note: Learn about the latest ICD-10 news as well as strategies for implementation and coder education by accessing ICD-10 Watch.

It’s clear that the switch to ICD-10-CM and ICD-10-PCS in October 2013 will be an ‘end-to-end’ initiative across hospitals, payers, vendors, and data users. But it’s important to take a closer look at the mechanics of such a massive change and understand some critical tasks and opportunities as well. Each of the following areas will have to tackle a specific set of challenges related to ICD-10 implementation:

  • HIM
  • Physicians
  • Finance
  • Information technology
  • Payers

HIM

Documentation is one of the main concerns surrounding the transition, says Caroline R. Piselli, MBA, RN, FACHE, ICD-10 program manager at 3M Health Information Systems in Salt Lake City. “Whatever a facility can do to improve documentation now will greatly help in the transition to ICD-10,” she says. “Coders and the departments downstream of HIM will need to develop offensive strategies to mitigate a potential slow-down, look at where there are gaps and weaknesses, and make improvements.” Consider the following:

  • Physician documentation tasks, including:
    • Assessing your current documentation for completeness and accuracy and continually improve, focusing on areas with gaps in today’s environment
    • Initiating awareness beyond documentation and coding to ensure an understanding of the overall effects
    • Determining best practices to collect clinical information via technology, processes, and staff members
    • Collaborating with medical and other appropriate hospital and office staff members to determine the best process and method to foster partnership throughout the transition resulting in documentation critical for ICD-10 coding
  • Coder education in accordance with American Health Information Management Association recommendations for content and timing to:
    • Ensure an expertise in medical terminology and anatomy
    • Foster better comprehension of operative reports
    • Stress importance of comprehension and interpretation of ICD-10-PCS definitions
  • Phase in of physician documentation programs to ensure a fine tuned process is implemented well in advance of ICD-10 implementation
  • Potential slowdowns in HIM that could affect:
    • Monthly summaries
    • Operational reports
    • Accounts receivable
  • Gap analysis audits and improvement opportunities, such as: 
    • Assessing existing issues with processes, education, and documentation
    • Improving on identified issues to help facilitate a smooth transition to ICD-10
  • Education for other departments about ICD-10, including:
    • Taking the lead in collecting information about ICD-10 and educating others in the organization to enable successful transition in their respective functional area
    • Educating C-level staff members about ICD-10 and what this new coding system means for the entire organization

“The HIM department has an opportunity to be content and organizational leaders,” Piselli says. “They are the experts and can help others understand ICD-10 and its impact.”

Physicians

Documentation is really the vital element that is a precursor to accurate coding and linked to transition success, Piselli says. “Educating physicians and clinicians on the needs around documentation and working with them to make sure that by October 2013 the medical record provides what is needed for ICD-10 will be very critical.”

HIM leadership will have to take a proactive role in educating physicians by doing the following:

  • Communicating to physicians that ICD-10 codes require more specificity in the record to help them understand specific documentation needs for accurate code assignment using ICD-10.
  • Preparing for a concurrent documentation improvement program and possible increase in the number of queries.
  • Explaining to physicians that they will be using ICD-10-CM for diagnosis reporting in their offices, too. Note that physician practice staff members will need education as well.

Finance

Any potential coding slowdown will trigger a chain reaction and cause delays in sending out claims, which in turn affects cash flow, Piselli says.

“Department budgets may be hit with costs for education, new software if not covered by one’s vendor, and increases in other resources” she says. “Although ICD-10 is intended to be budget neutral, it may also be an opportunity to renegotiate commercial payer contracts.”

Execute the following steps when making your financial assessments related to ICD-10:

  • Understand potential effects related to payer readiness and interim measures used during the transition. Work with payers to make sure you understand changes throughout the transition from ICD-9 to ICD-10.
  • Anticipate effects on capital and operational budgets. Add to hospital budgets the need for potential new software, education, hardware, and transitional staffing.
  • Communicate to your organization proactive critical measures and milestones to mitigate the effects on accounts receivable.

Don’t overlook potential strategic opportunities ICD-10 may provide in other areas of your organization.

For example, the single ICD-9 angioplasty code translates to more than 1,100 codes in ICD-10, identifying each vessel as well as the approach and device. Clinical, operational improvement initiatives may be stratified to a single vessel versus many vessels. For example, a single vessel simple angioplasty may be less complex and resource intensive than a multi-vessel angioplasty with pharmacologic agents. Thus the detail provided by ICD-10 can enable following:

  • Contract negotiation
  • Resource utilization
  • Cost management
  • Strategic planning 
  • Facility profiling to state and national entities

Information technology

To prepare for ICD-10-CM and ICD-10-PCS, the information technology (IT) department must identify the different segments of the organization that rely on ICD-9-CM codes, whether they are used in applications and/or paper records.

“From registration to discharge, every system, interface, and database that stores, uses, and passes ICD-9 codes today will need to be assessed for potential gaps,” Piselli says.

Critical IT tasks include the following:

  • Taking an inventory of software, hardware, and paper locations of ICD-9 codes as well as create a list of interfaces used in the facility. Similar to the Y2K experience, the IT team will need to itemize what systems are in place at the facility.
  • Identifying which systems and interfaces create and store ICD-9 codes and make necessary adjustments to these systems and interfaces to allow the use of ICD-10 codes.
  • Determining database storage needs by asking the following questions:
    • How long will you need to store ICD-9 codes?
    • Will you need to store both ICD-9 and ICD-10 codes, and for how long?
    • Which systems need to store both, and which systems don’t?
  • Working with vendors of systems and interfaces. Make sure their software will accommodate the change to ICD-10 in a timely manner and ensure the vendor’s software will meet your storage and reporting needs.

“Then it’s critical that you make sure that all systems work well together from start to finish,” Piselli says.

Payers

Payers will also need to change their applications and systems so that they can use and process ICD-10 codes.

“Because ICD-10 codes provide more detail, payers will need to have a transition plan for claims, utilization review, care management, and other critical functions that use ICD-9 codes,” Piselli says. “The best approach is for providers and payers to partner throughout this transition.”

Communication of any changes to the providers in their network will be extremely important. Note the following important steps payers will have to take:

  • Transition applications, processes, and technology to comply with ICD-10. 
  • Assess whether key functions such as claims adjudication, care management, and utilization review might use the General Equivalency Mappings, translations, and maps as an interim solution.
  • Make necessary changes to software to accommodate ICD-10 and assessing paper documents (e.g., policies) as well.
  • Update compliance policies, procedures, and software for initiatives (e.g., medical necessity, hospital acquired conditions, pay for performance) that may be in paper and/or software format.

Coordinate with your payers and obtain a detailed understanding of changes that will take place as a result of the implementation of ICD-10. Communication among all five of these critical stakeholders—HIM, physicians, finance, IT, and payers—is essential to ensure the smoothest transition possible in 2013.

Editor’s note: Interested in learning more about implementing ICD-10? Gloryanne Bryant, BA, RHIA, RHIT, CCS, CCDS, and Stanley Nachimson will discuss critical steps in the implementation as well as the role of the HIM Director during the February 25 audio conference, “ICD-10 Implementation: Strategies and Timelines For Readiness.”



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