December 8, 2014

In ICD-10 Codes We Trust: Holiday Wisdom for Small Practices

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As attention turns toward end-of-year activities such as the holidays, giving back, and spending time with family, physicians may find themselves on the receiving end of a few freak holiday accidents.

The new and sometimes jaw-dropping granularity of ICD-10 codes represents a daunting new level of detail that will become pervasive in  the industry come October 2015. It’s time to get serious and work smart to prepare for the changes that will be introduced through these codes. The devil may be in the details, but there is much wisdom right now that is up for grabs for resourceful practices.

Rest Easy with W21.01 (Lack of Adequate Sleep)

Striking a viable work/life balance is often challenging at the end of the year. We find ourselves stretched thin between meal prep, holiday shopping, and travel. Yes, there actually is an ICD-10 code for that: W21.01, Lack of Adequate Sleep. In the past months, especially leading up to the previous ICD-10 implementation date of October 2014, many practices have experienced sleeplessness associated with getting ready for ICD-10. Strangely, there isn’t yet a specific code for that!

Any practice that has been working on efforts to shift to ICD-10 and is actually in the test phases of its implementation plan right now should be in congratulatory mode. It’s an achievement to be at this stage, as not many practices have advanced so far. In February of this year, MGMA reported that only 10 percent of practices felt that they were adequately prepared for the transition. When it comes to ICD-10, be sure to unlock the power of the iterative process. Practices should be taking the time between now and October 2015 to continually test, train, and push forward with what they learn from those first few rounds of tests to identify future problems that may arise as the new ICD-10 codes are used.

Code Ratios and W61.49 (Other Contact with Turkey)

Is the knee bone connected to the thigh bone? Hopefully no one will have to find out as a result of any of those aforementioned freak holiday accidents. Where poultry is concerned, ICD-10 does actually have a code for turkey-related accidents that may happen in the kitchen.In the wake of Thanksgiving celebrations and any avian-related incidents that arose during November, it’s hard to suppress a giggle (or gobble) at just how much specific detail is included in the new codes. Beyond turkey anatomy, however, ICD-10 is a game-changer in terms of code ratios. Reporting and business intelligence functions within the electronic health record (EHR) system can be used to find common codes used by any practice. Find out what the top 20 most frequently used codes are for your practice and dive into the code ratios.

The differences in coding in ICD-9 versus ICD-10 can be shocking. For example, a procedure that was documented with one documentation code in ICD-9 may now translate to three codes in ICD-10. In more extreme cases, sometimes the ratio is 1:20, or one code may even translate out to hundreds. For surgery on a broken kneecap, two ICD-9 codes used to suffice. Now, a much more detailed level of knowledge of anatomy that may be involved. It’s important to pose hypothetical situations to see if coders are able to translate a broken kneecap to codes that now specify where the break is, what type of break it is, which leg, which condyle, etc. Also, are there documentation processes or workflows that need to shift to provide adequate accommodation for this new level of detail?

W21.01 (Struck by Football)

At this time of year, leisure activities are a popular way to manage the stress of working so hard on that ICD-10 readiness plan. For fans of the neighborhood game of flag football, W21.01, Struck by Football, is an actual ICD-10 code. Whether it was the touchdown that got negated by a penalty or the payment for the cost of the emergency room visit, denied claims are a fruitful place to focus your team’s efforts on ICD-10 readiness. Denied claims aren’t paid as quickly and extra staff time must be spent to research, correct, and resubmit. Associated costs can quickly escalate in this area. Practices should look at their 20 most commonly denied codes and figure out the right processes through which they can be addressed. In addition, make sure the same kind of teamwork that happens in football carries over in preparedness efforts. Be sure to actively collaborate and test with trading partners. This will have huge benefits come 2015.

The shift to ICD-10 is a significant change that will affect every practice. By embracing the iterative process of education, training, and testing, practices and their partners can be ready for anything. In the interim, treat the effort like a marathon, not a sprint. Get the rest and relaxation needed to come back to work on your ICD-10 plan strong and in good health as we all prepare to ring in 2015.

About the Author

Michael Bearnson worksin the Medical Business Solutions Center of Excellence at ADP AdvancedMD and has functioned as the ICD-10 project manager for the past two years. He has over 20 years of experience with business process improvement.

Contact the Author

Follow him on Twitter at @ICD10Posse.

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