July 17, 2012

Managing Change and Embracing ICD-10

By Gloryanne Bryant, RHIA, RHIT, CCS, CDIP, CCDS

With implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) still coming and the final date yet to be determined, there is a lot of anxiety in the healthcare industry about this and questions regarding our overall readiness. ICD-10 touches many people and aspects within healthcare, from IT and systems experts to case management and clinical documentation improvement (CDI) to compliance, finance, revenue cycle, contracting, payers, providers, health plans, health information management (HIM) and more. That is a lot of change for a lot of your, or our, workforce. Taking steps to handle this change can and should be a part of your strategic readiness planning for ICD-10.

The Centers for Medicare & Medicaid Services (CMS) has held “Open Door Forums” on ICD-10 implementation for several years now and repeatedly has indicated that ICD-10-CM/PCS transition will require substantial changes affecting many systems, processes, and people – hence the agency’s advice not to “delay getting started.” CMS indicated two years ago that we should “implement change management strategies to empower stakeholders to accept and embrace transition to ICD-10.” These words certainly still ring true today.

Some people welcome change and handle it well, while others find change to be threatening – not only to them individually, but also to their department or organization. Change often carries a negative image if not addressed properly. Yet successful adaptation to change is crucial to the success of any person or organization.  The perception about the change will be at the center of acceptance and ensuring that stakeholders possess an open, positive attitude and approach to the change. Thus, there are things one can do to help others embrace the change and turn some of the negativity into positive energy – while also diminishing the anxiety and apprehensiveness surrounding the matter. Keeping communication lines open and sharing information is a positive way to help your workforce handle things. In particular, members of the high-impact workforce, like coding professionals, will need regular information and engagement in education and training preparation. Also necessary in managing change is to speak to the benefits of the change and sustain that positive messaging over and over again. For ICD-10, this means being able to articulate the beneficial aspects of the new coding set in a factual manner will be key.

Focusing on the positive, ICD-10 provides greater flexibility in terms of quickly incorporating emerging diagnoses and procedures. It also provides characteristics that allow for the recording of details to identify diagnoses and procedures precisely, while ICD-9-CM does not. In addition, maybe most importantly among the positive aspects of ICD-10, it will allow for a greater understanding of the quality of care being provided, which aids in improvement in overall care – and it will provide data for healthcare reimbursement more accurately and equitably. We all want this to occur, and the sooner the better. The best change programs reinforce core messages through regular, timely communications that are practical, factual and even sometimes inspirational. Thus, your planning needs to ensure that there is communication about the positive aspects of the ICD-10 change.

The ICD-9 code set has been used in the United States for more than 30 years, and it has become outdated. It is no longer considered usable for today’s treatment, reporting and payment processes. It does not reflect advances in medical technology and knowledge. In addition, the format limits the ability to expand the code set and add new codes. ICD-10 incorporates much greater specificity and clinical information, resulting in:

  • Improved ability to measure healthcare services;
  • Increased sensitivity when refining grouping and reimbursement methodologies;
  • Enhanced ability to conduct public health surveillance; and
  • Decreased need to include supporting documentation with claims.

As with ICD-9-CM, we still will need to assign multiple codes with ICD-10-CM to describe certain diagnoses or conditions. In ICD-10-CM there are some similarities with ICD-9, and one such similarity is the “use additional code” instruction. During the change process, ensure that your training focuses on the similarities, not just the differences. Remember that many experts say it’s best to over-train, whenever possible, prior to start-up (using the new technology and work processes in simulations). Training early allows employees to build skills and confidence, which in turn reduces stress and resistance. With ICD-10 we need repetition as well to help absorb the changes, so allow for this – and don’t wait for the last year to provide it, or the change will be more difficult.

Sometimes when we’re dealing with change, we need to do some research and gain additional information on a given subject to help. Often it’s said that providers did not have input in the ICD-10 development, but in fact there is a long list of groups that reviewed ICD-10. Here is a partial list of reviewers, many of which are providers:

  • American Academy of Dermatology
  • American Academy of Neurology
  • American Academy of Oral and Maxillofacial Surgeons
  • American Academy of Orthopedic Surgeons
  • American Academy of Pediatrics
  • American College of Obstetricians and Gynecologists
  • American Burn Association
  • American Diabetes Association
  • American Nursing Association
  • American Psychiatric Association
  • American Urological Association
  • ANSI Z16.2 Workgroup (Worker’s Comp)
  • National Association of Children’s Hospitals and Related Institutions

The sheer volume of new codes can come across as overwhelming and challenging.  However, when looking at ICD-10 diagnosis codes more closely, you can see that many of the code increases are due to “laterality,” or the right/left designation. In addition, many codes are within the musculoskeletal system (34,000 codes), and these codes focus on the specifics of fracture site and type (17,000 codes). This alone counts for a large share of the overall increase. Breaking down the volume of codes helps with the change and removes the misunderstanding about the code increase that has been mentioned negatively in many publications across healthcare.

Physician engagement is not only a good thing to have, but it is important in all healthcare settings and initiatives – and it is essential in an organization's successful transition to ICD-10. Being able to articulate the benefits of ICD-10 to physicians is a critical factor in obtaining their engagement. To help, HIM, coding and/or CDI (clinical documentation improvement) professionals can offer to conduct a documentation assessment and provide the findings to physicians as a beneficial gesture. Include the physician office staff in your educational efforts and share the knowledge. This is a great opportunity to bring awareness to physicians (as well as their staffs) and shepherd them through the process of ICD-10 conversion. Working together can and will decrease the negativity associated with the pending change.

Some ICD-10 healthcare solutions may reside in the emerging technologies of computer-assisted coding and documentation assistance programs. These can help solve the resource issues raised by ICD-10 and are seen as very positive ICD-10 connectors. Take the opportunity to reach out to other healthcare leaders in your organization, practice and/or business as well, and discuss these solutions now. This effort can be the vehicle through which you can develop new relationships with stakeholders and ultimately make the change easier.

Also, look at your implementation plan. Besides fostering awareness among the low-, medium- and high-impact stakeholders and staff (which should have been completed more than a year and a half ago), look at the change management aspects of your plan. With strong executive support, thorough communication, and organized project management, assessments and education/training, you will be successful in executing ICD-10 implementation – and the results can be positive and rewarding.

We all know that there often is resistance to change and that this is a natural reaction when employees are asked to change. Change is uncomfortable and requires new ways of thinking and doing – like with ICD-10. Ask yourself, then, if you or your organization has included “change management” in your ICD-10 readiness planning. If not, please consider this and take steps to address it as a means to implementation success. As you can see from the above information, there are many positive components to switching to ICD-10, so let’s work on focusing on these and embracing the change – and let’s do it together!

About the Author

Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, is a 30+ years HIM professional and leader. She has a RHIA (Registered Health Information Administrator), a RHIT (Registered Health Information Technician), Certified Coding Specialist (CCS), a Certified Clinical Documentation Specialist (CCDS), Clinical Documentation Improvement Practitioner (CDIP) and an AHIMA Approved ICD-10-CM/PCS Trainer.

Ms. Bryant has conducted numerous ICD-9-CM, ICD-10 and CPT coding, DRGs, MS-DRG, APR-DRGs and APC (OPPS) workshops for hospital based coders and others. She received the AHIMA Triumph Award in the category of HIM “Champion” in the fall of 2007. Gloryanne is a sought-after national speaker and author on healthcare compliance, reimbursement, clinical documentation improvement, coding regulations (ICD-9-CM, ICD-10 and CPT) and serves as a catalyst for change and improvement in HIM and healthcare.

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Resources: https://www.cms.gov/Medicare/Medicare-Contracting/ContractorLearningResources/downloads/ICD-10_Overview_Presentation.pdfhttps://www.cms.gov/Medicare/Coding/ICD10/downloads/Jan122011_ICD10_Call.pdf; Engaging Physicians in Icd-10 Planning: The Documentation Link, AHIMA Journal, May 2012; Leading Your Organization Through Change: A Management Plan – 5 Rules for Success, Colleen Mills, Ph.D., FASTLANE Coaching, July 2008; http://thinksimplenow.com/clarity/embracing-change/