February 25, 2014

“ICD-10: Is There a Doctor in the House?”

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Are physician offices and those owned by health systems more vulnerable to missing the ICD-10 compliance deadline of October 1, 2014?

That issue was raised by Thomas Ormondroyd of Precyse during yesterday’s Talk-Ten-Tuesday broadcast. Ormondroyd worries because at this HIMSS conference, taking place now through Friday in Orlando, Fla., attendees at pre-conference sessions attended by Ormondroyd appeared to to be inquiring about how they could prepare their physicians to adopt the new coding system more than they had been at previous HIMSS conferences.

 

Ormondroyd’s concern is that physicians, as well as non-physician clinicians, coders and non-coders, are assigning their own codes or using unspecified codes, and could be doing the same in an I-10 world since, according to Ormondroyd, “many providers were never taught ICD-9, but ‘learned by doing,’” he said on the broadcast.

“This (ICD-10 education) is the opportunity to not just make them coders, but rather to teach them the core principles and rules around coding,” said Ormondroyd. “ICD-10 also allows them the ability to fully capture true severity of illness and medical necessity of the care provided, due to ICD-10 being more clinically-based than ICD-9.”

The Crunch:

So the crunch could be on as physicians and hospital-owned physician practices scramble to implement to ICD-10.

“Yes, hospital-owned physician practices may find themselves in a tight spot,” writes Betty Hovey, director of ICD-10 development and training for AAPC, in an email to ICD10monitor. “The hospitals are vested in the facilities and ensuring that ICD-10 is initiated in all areas, but their focus is a bit different.”

Hovey explains that physician practices have to ensure that they have the knowledge they need to move forward under the new code system.

“Our aim for physicians and other providers is not to kill them with codes, but train them in how to tweak their documentation to meet the standards of ICD-10,” says Hovey, explaining that clinical documentation improvement (CDI) is a primary topic in the healthcare industry and a necessity for a physician practice.

Triage at Work

“Clinical documentation is the catalyst for coding, billing, and auditing and is the conduit for the quality and continuity of patient care,” says Hovey. “We have online courses in multiple specialties to assist physicians and other providers with clinical documentation improvement. We have also begun to hold them onsite for clients as they have become more popular.”

Hovey believes that physicians and other providers need to understand the documentation necessary to meet the new granularity in ICD-10, not necessarily all the codes that documentation will bring.

“We also recommend documentation assessments to give specific pinpointed directions to the physicians and providers on their documentation for their top used diagnosis codes,” says Hovey. “These can be performed externally or by their own staff once they are proficient in ICD-10, and compare the medical record documentation today with the codes of ICD-10 for tomorrow and see where the physician or provider needs to improve.”

Hovey also maintains that coders who are working in physician offices can take the top diagnoses used by physician and make index cards with the condition, the key documentation points for the condition in ICD-10, the code category or code block in ICD-10, and maybe a full code to give an example.

In explaining this approach, Hovey suggests that once the cards are made, coders laminate them, hole-punch them, then put a ring binder through them and give each physician a customized set of their own.

“These kinds of things don’t have to be costly, but can really pay off for physicians’ offices,” says Hovey. “As CMS repeatedly stated in its most recent webcast on ICD-10 readiness last week, there will be no delay, so physician offices need to ensure that they will be ready on October 1, 2014.”

Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.