Updated on: March 14, 2016

ICD-10: Awareness Education

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Original story posted on: May 2, 2011

ED. NOTE: ICD-10 is the most significant coding change many of our healthcare organizations and providers will experience. Preparing for it will require different approaches for each. A series of continuing articles by Rose Dunn will address how these two entities should prepare for ICD-10.

 

The pending implementation of ICD-10 is the most significant coding change many of our healthcare organizations and providers will ever experience. Some healthcare executives have not yet embraced this major coding change, nor have they addressed its likely future impact on their healthcare organizations. We’ve heard that “it’s a medical records thing” or “don’t fret, it’ll be postponed again.” Unfortunately, both of these perceptions couldn’t be further from the truth.

As a collaborative effort, IT and HIM should be leading ICD-10 awareness education, starting with senior leadership and medical staff leaders. During the awareness education phase, the following stakeholders should receive orientation outlining the widespread anticipated impact of ICD-10:

  • Administration;
  • Medical staff leaders;
  • Access managers;
  • Patient Financial Services directors;
  • Case Management coordinators;
  • Clinical Documentation Improvement Specialists;
  • Home Health executive directors;
  • Skilled Nursing Facility administration;
  • Managed Care contracting executives; and
  • Information technology team.

These individuals serve as the primary decision-makers for every the organization.  They need to recognize the effect that inadequate preparation mightay have on their organization’s fiscal health condition.  The content of the education should explain the following:

  • The need for an edict to install and transmit claims using the 5010 transaction by Jan. 1, 2012. Failure to do this will cause claim rejections, payment delays and cash flow interruptions.

 

  • The new structure of ICD-10 and how it differs from ICD-9, emphasizing the documentation required to code encounters accurately and completely under the new system. The new requirements will affect the medical staff’s documentation practices and may create extra work at the back end for the coding team, demanding the creation of queries to obtain additional detail and getting the physicians to provide it. Provide a few examples demonstrating the unique features of ICD-10, such as laterality, anatomical specificity, surgical approaches and devices, and the new set of terminology.

 

  • The increased number of ICD diagnosis and procedure codes as compared to ICD-9 diagnosis and procedure codes. The additional codes will serve to introduce the benefit of using GEMs (General Equivalence Maps). The GEMs will allow those who use data to plan strategies to identify the many additional ICD-10 conditions and procedures represented by only a few ICD-9 codes today. This is known as a forward map (ICD-9 to ICD-10). Additionally, it should be understood that payers likely will use reverse map GEMs (ICD-10 to ICD-9) to determine how to pay claims submitted with ICD-10 codes.

 


 

  • The notion that the granularity of ICD-10 codes is likely to identify associated conditions and specific conditions that may not tie to medical necessity requirements, therefore resulting in reduced payments or denials, respectively. This issue will be important for the chief financial officer to understand so he or she can estimate what reserves might be necessary to cover reimbursement shortfalls that may result from the use of this coding system.

 

  • The organization may need to plan temporary or permanent capacity additions. The additions may be necessary in the form of technology to accommodate dual databases or to replace systems that will not accommodate ICD-10. Also, additional staff may be required to assist with the assessment of organization systems, to perform the more detailed and time-consuming coding, to work with physicians on documentation efforts and to validate that appropriate payments are received. These capacity additions are always of interest to administrations, which try to hold FTE counts to an effective minimum.

 

  • The impact on translating managed-care contracts that currently are paid under an ICD-9 code or MS-DRGs based on ICD-9s – plus how that may change with MS-DRGs based on ICD-10.

 

  • The necessity to inventory and identify computerized applications that may need to be upgraded to accommodate ICD-10 codes, keeping in mind the possibility that some applications may not be upgradeable and therefore will require replacement. Leadership will need to understand that these upgrades will require testing, and those efforts may require additional resources such as consultants or temporary staff to help.

 

  • Lastly, senior leadership will need to understand that as with any major change, the pending shift may provide opportunities for process improvement or workflow changes that address the new coding classification system and any weaknesses that now exist. These efforts no doubt will optimize the existence of effective and accurate coding.

 

Entire organizations need to understand how ICD-10 will add to the richness of coding data and to prepare for the impact this classification change will have on fiscal health. Educational efforts will need to extend beyond senior leadership to most middle management leaders as well.

Once leadership understands the many facets of ICD-10’s anticipated impact, it likely will recognize the need to appoint one or more senior leadership champions to support the efforts of a carefully selected team of individuals who plan the required actions and lead the organization through this transition. The selection of the project team members and establishing a charter will be the subject of our next article.

 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, AHIMA-approved ICD-10-CM/PCS Trainer

Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, is a past president of the American Health Information Management Association (AHIMA) and recipient of AHIMA’s distinguished member and legacy awards. She is chief operating officer of First Class Solutions, Inc., a healthcare consulting firm based in St. Louis, Mo. First Class Solutions, Inc. assists healthcare organizations with operational challenges in HIM, physician office documentation and coding, and other revenue cycle functions.