October 28, 2013

ICD-10 Final Preparations Include Physician Query and Coding P/P inventory and Checklists

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We’re now into our final year of preparation for ICD-10 implementation, and it seemed like a long time coming. Most of us have had a detailed implementation plan with a timeline and deliverables in place for some time now. For those of you working in health information management (HIM) and/or the coding arena, there are a few items we need to address when it comes to our overall readiness.

 

Just like planning an event, party, wedding, or other major celebration, it’s a best practice to maintain a checklist as a way to remember some key factors impacting success and who is responsible for what.

The physician query process is essential to coding and clinical documentation improvement (CDI) activities. Utilize an inventory checklist for your physician queries and compliance readiness. List the queries you currently use – many may exist in template form – and note whether they are paper or electronic. Once you have them all listed, a review of each needs to take place. This step allows for the reviewer to determine if there needs to be wording or language additions, revisions, or deletions for ICD-10. Track your steps using a checklist form like the one listed below. Be sure to also set a completion timeline for this task, as you don’t want to wait until September 2014 to do this. 

With several areas of ICD-10 requiring greater specificity, we also will see that some new physician queries will need to be created. For example, the language for a diagnosis of “asthma” now has not only greater specificity, but new terminology within the classification.ICD-10 distinguishes between type and status as well as between uncomplicated asthma cases and those in exacerbation. No longer is asthma categorized as intrinsic or extrinsic as it was in ICD-9-CM, either.

With ICD-10, identify:


Type
                                          Status

Mild intermittent or persistent          Acute exacerbation

Moderate persistent                       Status asthmaticus

Severe persistent                           Uncomplicated

Other

Unknown

 

A physician query may be needed in order to add the code indicating exposure to and use of tobacco; there is greater emphasis on tobacco exposure and use in ICD-10. Although this area is one the physician usually asks his or her patients about and documents, especially with the electronic health record (EHR).

A physician query to address documentation needs for the diagnosis category of “coma” also will need to be performed. “Coma” falls into Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (code range R00-R99). Coding of the condition also now incorporates the Glasgow coma scale in the code range R40-21 – R40-23. Specific documentation will be needed to reflect the scale and the presentation. During the coding process, assigning the level of consciousness (coma) in the presentation of the patient at the seventh character extension level is needed; at a minimum, the presentation at the facility is needed.

0 – Unspecified time

1 – In the field (EMT or ambulance)

2 – At arrival to the emergency department

3 – At hospital admission

4 – 24 hours or more after hospital admission

Accurate documentation and coding is needed for trauma and research registries.

Another task to consider as it pertains to your readiness preparations is conducting an inventory of your coding policies and procedures (P&Ps). Those P&Ps that contain ICD-9-CM codes and language need to be identified and reviewed, with appropriate action taken. Follow similar steps as those outlined above for the physician query inventory checklist.

Your ICD-10 readiness efforts, along with confirmation to your compliance leadership, should include the above two inventory checklists.

Being organized and using these types of tools will make the final months easier to handle, and success will be readily achieved.

About the Author

Gloryanne Bryant is a nationally recognized healthcare leader. A sought-after speaker, she is the immediate past president of the California Health Information Association and serves as the National Director Coding Quality and Education for Kaiser Permanente.  

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Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Gloryanne is a coding and HIM professional with 35 years of experience. She is the past president of the California Health Information Association. Gloryanne is a member of the ICD10monitor editor board and is a popular guest on Talk Ten Tuesdays.