October 19, 2015

Out with the Old, in with the New: Tackling ICD-10 Challenges During Week 1

By Cassie Milligan, RHIT, CCS

The healthcare industry may have finally flipped the switch to ICD-10, but many of us know that the hard work has only just begun. 

For example, during the first week following implementation, H.I.M. ON CALL has spent considerable time gathering feedback from its coders, monitoring productivity, and keeping lines of communication open with clients. 

Our next step will be to dig more deeply into the data. Is it accurate? Are payers processing it correctly? Why do denials occur? These are the questions that every provider will be asking in the months to come. 

Following is a summary of what we’ve seen to date during this first week of ICD-10 implementation. How does your own organization compare?

  1. Drops in coder productivity. As expected, many organizations and coding vendors experienced at least a 50-percent decrease in coding productivity during the first week following implementation. Although we expect the productivity to increase slowly over time, it’s also important to take proactive steps to mitigate the losses. H.I.M. ON CALL has been working directly with its coders to better understand any decreases in productivity. For example, we’ve asked these questions: Is the decrease due to an ICD-10-related issue, such as insufficient documentation or the inability to find PCS information easily? Or is it because of something else, such as basic electronic medical record (EMR) navigation, problems with connectivity, or frequent system logouts? Might it be a combination of all of the above?
  2. Rises in unspecified codes. Just in the short time that our coders have been using ICD-10, we’ve noticed an uptick in unspecified codes due to a lack of sufficient documentation. It will be important to monitor these codes and provide physician education when necessary. H.I.M. ON CALL plans to compile coder feedback and provide this data directly to our clients so they can work with their clinical documentation improvement (CDI) teams on-site to improve documentation. 
  3. Staffing fluctuations. During the first week following implementation, we’ve been monitoring staffing needs very closely. In many cases, we’ve doubled resources for clients, and we are prepared to continue to do so indefinitely.
  4. Increased focus on quality. Coding quality has always been important. However, in ICD-10, a system that is still new for everyone, there is more room for error. That’s why providers must value quality over quantity. At H.I.M. ON CALL, our QA managers oversee nearly 250 coders, performing concurrent QA functions for high-risk DRGs. We’ve also assigned an entire on-site QA team to our India-based coding staff. This team reviews coder questions concurrently to mitigate compliance and productivity issues.

For now, ICD-10 challenges are only beginning to emerge. It’s too soon to know exactly how providers will fare, both operationally and financially, in the long run.

Looking Ahead

Now that the healthcare industry has moved past the ICD-10 implementation hurdle, the next step is to ensure data quality and mitigate denials.

Ask yourself these questions as you move forward during the next few weeks: 

  • How accurate is your coded data?
  • How can CDI professionals specifically mitigate unspecified codes?
  • Is your coder productivity improving? If not, do you have sufficient coding assistance?
  • Does your vendor provide regular feedback regarding ICD-10 documentation insufficiencies, particularly regarding your top 25 diagnoses and/or procedures?
  • How are payers processing your claims? Pay close attention to denials for medical necessity.

It has been a relatively smooth transition thus far, but we’re definitely not out of the woods yet. Keep your eyes and ears open for challenges and developments as they occur. And remember that ICD-10 is a journey, not a destination. 

About the Author

Cassie Milligan, RHIT, CCS, is an expert in coding and data quality, is the manager of quality improvement at H.I.M. ON CALL. With over 30 years of experience and thorough understanding of HIM technology systems, including many encoders and EMR systems, Ms. Milligan is a talented asset for H.I.M. ON CALL and its clients. Prior to joining the H.I.M. ON CALL team she worked as a QA specialist in Meridian Health Systems, Jersey Shore University Medical Center division. Over the past 30 years.

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