November 26, 2014

Do You Hear What I Hear?

By Holly Louie, RN, CHBME, PCS

As I reflect on the many comments from physicians, coders, educators, auditors, and various organizations, a message of frustration keeps creeping into the conversation. Physicians aren’t cooperating. Physicians don’t want to hear about ICD-10. I can’t get my doctors interested. As I reflect on the reasons that might exist for this perception of frustration, I thought actually investigating the message might shed light on the topic. Although the findings are not statistically valid, I believe they provide perspectives that can prove valuable as we move toward the finish line on ICD-10 implementation. 

Why? Such a basic question that has so many paths to trouble! We all know the whys: ICD-9 is obsolete, codes don’t reflect current practice, it does not provide the granularity needed, and the list goes on. So much information that does not answer the most basic question!

For many physicians, they honestly believe they are doing just fine with the obsolete code set; it is a known system that has worked for all of them for their entire careers.

They rely upon a small subset of codes in their practices, so some of the most robust ICD-10 differences may not seem relevant to them. They can document what they need to know and communicate to another medical professional. They read and interpret information from other professionals with no difficulty. They can talk to the patient, and the patient is not complaining. They have zero concerns about the quality of care they are delivering. They don’t look at or see ICD-9 codes in the medical records they use and they don’t send ICD-9 codes to their peers. To have any credibility, we must answer the why question in a way that makes sense to them. “Because we said so” is not the answer. Neither is the usual mantra that they can’t relate to in any meaningful way.

Will I get paid? My personal opinion is that telling physicians, “You will not be paid if you don’t change your documentation” at this point is shooting yourself in the head if you can’t prove what you say. The very next comment will invariably be, “Tell me what I have to do to get paid.” What can you show them that is definitive and directly linked to their documentation and your local coverage policies?

Saying they won’t be paid paints you into the corner of supposition and guessing, in most cases. Today, other than Medicare, few final policy coverage decisions have been formally published. When we evaluated the Medicare LCDs, there is not a substantive restricting of coverage for less than the most specific codes. The bottom line, based on the vast majority of final ICD-10 policies most of us have seen to date, is if you are getting paid now, you will get paid then. If you won’t be paid under ICD-10, you are likely not getting paid under ICD-9.

Although we all anticipate this may change substantially as more policies are published and claims experience builds under the ICD-10 code sets, preaching doom you cannot substantiate is the sure path to lack of credibility. Once you’ve put yourself in the position of not having credible, trustworthy education, you won’t be able to overcome that when you present future information—and not only on ICD-10. Lack of credibility is lack of credibility on all topics. 

So what does work to lower the frustration levels? What should the message be? Most important, the message needs to be 100 percent factual and based on current information you can show your physicians. You can always update as we learn. Be honest about the unknowns, the maybes, the most likely scenarios, and the known facts you can show them. Establish a plan for regular updates based on new information.  Is there a 100 percent guarantee October 1, 2015, is the date? No, but we believe it will be, so we need to keep moving toward being completely prepared for that implementation date. Do you know for an absolute fact, based on final published policies for ICD-10 compared to current documentation, they won’t be paid or reimbursement will decline? Don’t threaten something you can’t support with facts. Provide accurate information regarding their documentation and coding when you can show them the specific issues. Focus on the big picture: documentation improvement is a goal for many reasons; ICD-10 is only one of them. 

Such a profound change can be frightening. More importantly, it will likely take even more time away from patients, and that is not what any physician wants to hear. Make your story accurate, presented in a positive “can do” way; be creative in helping them get ready in manageable steps based on concrete information they can rely upon. Pick educational times that work for them, not you. Keep it short each time.

Perhaps most importantly, listen to the question and answer the question. Don’t just follow the same script that does not work. 

About the Author

Holly is a member of the Healthcare Billing and Management Association (HBMA) and chairs the ICD-10 Committee.  The committee developed definitions for readiness and end-to-end testing for successful ICD-10 implementation.  

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