February 23, 2015

Proof is in the Process: ICD-10 Success at Gunderson Health System

By Ann M. Bina, MBA CPC, CHC, CPC-I

Gundersen Health System (GHS) is a physician-led, not-for-profit healthcare system of hospitals and clinics headquartered in La Crosse, Wisc.,serving a 19-county region throughout western Wisconsin, northeastern Iowa, and southeastern Minnesota.

GHS approached the transition to ICD-10 in the same manner we do all major initiatives. We established an implementation team, performed a gap analysis, created a plan, identified resources, built, trained, and tested. Had Oct. 1, 2014 remained the go-live date, I am confident we would have been ready!

Our implementation team consisted of physician champions, information systems, revenue cycle, hospital and professional coding, health information management, and utilization review. This diverse team supported the findings of our gap analysis and ensured that all areas in which ICD-9 codes were used were represented.

Our plan was simple, although the work involved was not: get the information to the people who need it. This involved countless hours of system building and testing, research and/or creation of training material, and aligning of training resources. We had an opportunity to offer classroom training, taught by physicians, to all of our providers. In addition to the clinical viewpoint of the instructor, both hospital and professional coding staff were available for questions. Training for coders was done via boot camps or online training sessions offered by industry experts. Dual coding began immediately and continues today to ensure efficiency. 

In fact, dual coding was also used to assist in identifying other issues that may be part of ICD-10, such as changes in DRG (diagnosis related group) codes. We continue to monitor if and when ICD-10 coding changes a DRG, how that affects the overall level of reimbursement, and what financial impact that may have on our organization.

For professional coding, in which providers are responsible for coding their charges and coding specialists review and work edits prior to billing, we performed time studies to see what impact ICD-10 had on staff initially – and we continue to monitor for efficiencies gained over time.

The final testing occurred with our payer clearinghouse in late 2014 with no reported problems. Although this was exciting news, we will certainly continue to test in order to ensure that nothing unexpected occurs prior to Oct. 1, 2015.

Our final review will involve the payer coverage decisions that are being converted to accommodate ICD-10 codes. While we expect that there will be no issues with the crosswalking of ICD-9 to ICD-10 in these policies, we need to be prepared to contact payers should variances be found in order to prevent issues following implementation.

The success at GHS was in the process. Establishing the team, understanding the gaps, creating the plan, identifying the resources, building, training, and testing were all key components in ensuring we are ready for ICD-10 implementation.

About the Author

With over 20 years of experience in the healthcare field, Ann M. Bina has held a variety of positions throughout the revenue cycle.  Ann holds a Masters in Business Administration from Viterbo University and is a Certified Professional Coder (CPC) (COC) as well as certified in healthcare compliance (CHC).  She is also an approved PMCC instructor for the American Academy of Professional Coders (CPC-I).  Ann currently sits on the AAPC National Advisory Board.

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