June 1, 2015

A Physician Roadmap to ICD-10

By Donald Bialek, MD, MPH and Tom Ormondroyd

  With the sustainable growth rate (SGR) bill now signed into law, it is time for physicians to really focus on their preparations for the upcoming ICD-10 implementation. ICD-10 will affect every aspect of a physician’s practice, including patient encounters, clinical and financial workflow, as well as compensation and reimbursement. It requires more accurate documentation and gives physicians more diagnostic choices to capture new data in order to ensure they are paid for the complex work being performed.

An ICD-10 roadmap can help physicians minimize productivity loss, avoid financial pitfalls, and ensure they receive proper financial and quality credit for the care they provide. Physicians will require a focused education and training plan, tailored to the “need-to-know” aspects of ICD-10. Just as it was unnecessary to use all of the codes in ICD-9, this will certainly be true of ICD-10.

Physicians first should focus on the clinical conditions that they see most frequently, then concentrate on specialty and common co-morbidities of their patients. Attention to clinical documentation is critical. ICD-10 is meant to capture more detail, and it is mandatory that the documentation supports this granularity to ensure accurate reimbursement and the capturing of the true severity of each patient’s illness. Also, getting it right the first time helps avoid time-consuming questions from coders and clinical documentation improvement specialists later in the process. Education is a personal experience, not a one-size-fits-all approach. Educating oneself in ICD-10 strategies varies from person to person, but usually the process takes 3-12 hours. Planning for that time and choosing an approach that fits are both crucial to ICD-10 success.

When beginning ICD-10 education, a physician should have four training goals:

  • Focus on large topic areas – ICD-10 has 8-10 core documentation concepts that can be applied to any disease, such as site, specificity, laterality, timing, manifestations, stage, and status.
  • Target risk-heavy and high-volume areas – only address gaps in current practice.
  • Concentrate on specificity and underlying conditions – document more than the first diagnosis to establish severity of illness and medical necessity.  
  • Incorporate electronic medical record (EMR) training to be optimized for ICD-10 with the use of templates, prompts, and automatically incorporated data already in the EMR in the clinical note. Using documentation templates improves physician efficiency and helps the physician be more timely and complete in documenting each visit. 

It is important for physicians to spend time preparing for ICD-10 now in order to avoid repeatedly correcting denied claims or enduring bad outcomes from an audit due to incomplete or inaccurate documentation. A good initial design generally is preferable to trying to repair things after the fact. ICD-10 presents significant changes to the medical coding vocabularies. It is focused on clinical needs so that essential clinical information about each patient can be captured. It is important to ensure that EMRs capture the necessary information to do this.

 

The ICD-10 transition deadline is just months away, and it is time to address these areas of concern.

About the Authors

Donald Bialek, MD, MPH, is a member of the Precyse Advisory Council. A seasoned expert in the healthcare field, he has been instrumental in bringing clinical and operational perspective to his work in quality, physician engagement, clinical operations, and informatics.

Tom Ormondroyd is the vice president and general manager of Precyse Learning Solutions and is the creator of Precyse University and Precyse University DNA. He also oversees several business lines, including ICD-10 Consulting and Educational Services.

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