Updated on: September 23, 2013

Procrastination Won’t Pay – Use This Time Wisely! A Cautionary Tale …

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Original story posted on: April 23, 2012

Three physicians, two nonphysician practitioners, a chief financial officer, a compliance officer, two practice managers, and me: These were the attendees of a very recent meeting. The purpose: an exit conference to talk about audit findings. I had recently conducted an audit of medical record (MR) documentation in comparison-and-contrast to how the services were coded and reported. One of the “bucket” findings, of course, was ICD-9-CM diagnosis coding. And, of course, the conversation quickly turned to the recent year-long stay proposed by the Department of Health & Human Services (HHS) for the migration of ICD-9-CM to ICD-10-CM. The new proposed timeframe: October 2014. A year longer—but a year to procrastinate?

One of the physicians sheepishly boasted, “Well, we weren’t going to be moving towards any serious kind of conversion until early 2013 anyway, so now we’ll simply postpone that effort until early 2014. I mean, maybe this coding system change isn’t going to happen anyway! Thoughts Michael?”

My thoughts and reaction? “Doctor, let me say a few words about some very important things you must consider and get into place to successfully make the change from ICD-9 to ICD-10, and how you should look at this new allowance of time. First, the ‘train has left the station.’ This coding system conversion is going to occur, there’s no question. Second, think of this year-long stay as a gift by starting with two easy but commonsense areas that need to be considered to get moving, gain some ground, and build some momentum. If you use this time wisely, I guarantee you’ll find yourself ahead of the curve, with all systems go.”

Take a Small but Significant First Step—Superbill Translation

One of the simplest things physician practices can do to convert from ICD-9-CM to ICD-10-CM is to translate their current encounter form (superbill) into ICD-10. That’s it. Quick. Simple. Painless. But this small endeavor provides, or may provide, a wealth of information. A few physician practices that are more mature in the electronic medical record (eMR) process, who no longer rely on superbills, can generate a listing of their top 25 to 50 ICD-9-CM diagnosis codes. Ascertain that list of commonly accessed ICD-9-CM codes and find out their ICD-10-CM equivalents. This small step can give you a window into how the conversion will affect your practice, considering your clinical specialty or specialties. Some ICD-9-CM codes may be compounded into fewer ICD-10-CM codes, and vice versa. Some ICD-9-CM codes have been expanded enormously into a multitude of ICD-10-CM codes. This expansion and/or constriction of codes can significantly impact your superbill design, layout and application, and/or the eMR code “libraries” in which the current ICD-9-CM codes are now housed. Here’s another important question to ask: Are there also new guidelines and coding principles wrapped around those new codes that must be learned?

For instance, what if you manage an orthopedic practice and must not only convert the codes from ICD-9-CM to ICD-10-CM but also must incorporate new code-assignment considerations (e.g., right or left side, initial or subsequent visit, type of fracture, aftercare, external cause of morbidity, place of occurrence and type of activity, etc.)? That’s only scratching the surface of one clinical specialty; there are many more direct coding principles and guidelines contained within the migration from ICD-9-CM to ICD-10-CM that must be considered, learned, assimilated and applied.

Identify, and Train, Key Staff

ICD-9-CM diagnosis coding—as the primary vehicle for communicating conditions, illnesses, signs, symptoms and confirmed diagnoses to outside entities—now affects and touches the job functions of numerous personnel within the physician practice (see my ICD10 Monitor article ( “Touchpoints in the Physician Practice: Operational Impact,” January 23, 2012). Making the leap from ICD-9-CM to ICD-10-CM will affect numerous staff. Considering the various staff and systems now leveraged for ICD-9-CM, performing a coding system conversion won’t be as simple as asking your eMR vendor to “handle it.” Key personnel must be identified and trained in a first wave (tier one) of staff newly educated in ICD-10-CM; a subsequent wave of personnel (tier two) will next need to be trained, and so forth. Also, providers must be trained. Ancillary clinical and administrative staff need to be trained. This includes nurses, laboratory technicians, radiology technicians, physical therapists, even check-out receptionists—whomever the practice relies upon in terms of accessing, assigning, inputting, transcribing, and ultimately reporting ICD-9-CM codes to accurately represent your services.

With an additional year to get some of these very basic processes underway, every physician practice should be, at the very least, in the planning stages for ICD-10-CM conversion. Stages of conversion should be identified, timelines assigned to those stages, and some sort of basic implementation plan should be sketched out. Providers should be made aware of these plans during practice meetings. Budgets for outreach, education and training, system conversion, and revision of internal tools and materials should be outlined.

And, as I told the attendees of this particular meeting, do not be afraid to reach out and ask for help. Don’t simply rely on pulling information and data from the internet. There are highly skilled, seasoned professionals well-versed in ICD-10-CM that can be of enormous assistance, even if informally, in providing guidance, advice and know-how.

And finally, procrastination is not the answer; use this time wisely!

About the Author

Michael G. Calahan, PA, MBA, is the director of physician services at KForce Healthcare, Inc. Michael has more than 25 years of experience in health care, beginning as a physician assistant with the USN. He has served as an administrator for several physician practices and has enjoyed a varied career in healthcare consulting, being affiliated with Ingenix, CGI, Navigant, PWC and Parente-Randolph. He has authored numerous industry publications and articles in physician, IP/OP/ASC, DMEPOS, ESRD, HHA, ambulance, HIPAA and in Medicare Parts C & D for Medicare Advantage.

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Michael Calahan, PA, MBA

Michael G. Calahan, PA, MBA, is the vice president of hospital and physician compliance for HealthCare Consulting Solutions (HCS). Michael lives and works in the Washington, D.C. metro area, specializing in compliance, revenue cycle management, CDI, and coding/billing in the facility inpatient/outpatient and physician arenas.