Updated on: March 16, 2016

Strained Resources, Other Priorities Cited for Physician ICD-10 Delay

Original story posted on: May 10, 2013

Competing priorities and strained resources are just two of the many reasons some physicians are reporting delays in their efforts to prepare for the advent of ICD-10, First Class Solutions Chief Operating Officer Rose Dunn told a national audience on the most recent edition of Talk-Ten-Tuesday.

The former president of the American Health Information Management Association (AHIMA) also cited the American Medical Association’s well-documented reluctance to embrace the new coding sets as a reason for the delays. But by leveraging the help of health information management (HIM) professionals, she added, these setbacks can be overcome.

“The recent WEDI (Workgroup for Electronic Data Interchange) report … indicated (that) more than 40 percent (of respondents) say they don’t know when their assessments will be complete,” Dunn noted.

In addition to the aforementioned factors, there are plenty of other reasons for that, she added, listing the following issues demanding attention from physicians:

  • Privacy and security gap analysis and remediation
  • EHR implementation
  • Meaningful use compliance and demonstration
  • Healthcare reform initiatives
  • Practice-specific initiatives

To get the most out of HIM staff, providers should consider having them seek answers to the following questions, Dunn said:

  • Will edits permit an alphanumeric code with alphabetical characters in fields other than the first field?
  • Will the billing scrubber catch a diagnosis that starts with a numeric character before the bill goes to the payor?
  • Can we ensure that the billing application doesn’t auto-fill a code that is fewer than seven characters?
  • If the diagnosis code starts with a “U,” is it rejected before it goes to the payor?

“Explaining why the physician will receive more queries from both the practice and hospital coders is an essential part of your consultation as well,” Dunn said, noting that efforts taken to reduce queries could include:

  • Utilizing dropdowns to assist in capturing required specificity
  • Using structured data fields
  • Modifying templates or data collection forms to:
    • Add laterality
    • Check boxes for the encounter (initial, subsequent, sequela)
    • Note related conditions

But that’s not all that can be done, Dunn added, further recommending the following:

  • Instituting keyboard training for staff members who perform data entry due to the alphanumeric code format
  • Increasing the automatic log-off time to allow staff to review physician notes to find the additional documentation elements required for coding
  • Preparing for medical necessity denials due to the increased detail in ICD-10 codes
  • Monitoring the physician profiles due to the expanded Y62-y84 section of the coding book (comprised of what Dunn labeled “oops” codes)

“Also, we should remind them to confirm with their system vendor when the upgrade will be available for their practice management system,” Dunn said. “This is not an ‘if’ it will be ready for ICD-10 question, but a more forceful ‘when.’”

Dunn also shared with listeners a variety of ways in which to find more information on these topics, such as:

  • Reading published articles online
  • Visiting the Canadian Health Information Management Association website and the websites of the AHIMA, AAPC, AMA and MGMA
  • Looking at the World Health Organization website, which features ICD-10 education
  • Checking out YouTube for short ICD-10 snippets
  • Tuning in to Talk-Ten-Tuesday!

There are also plenty of sources of low-cost education available from state HIM associations, local AAPC chapters, audio conferences and phone apps, Dunn noted, concluding by recommending the following measures:

  • Revising encounter forms or charge tickets
  • Setting aside a reserve for increases in medical necessity denials and lost or delayed claims
  • Recognizing that quality of care and severity of conditions treated will be assessed and compared to others by payors and other transparency advocates
  • Understanding that reimbursement changes may occur as a result of refined profiling capabilities with ICD-10, which should incentivize physicians to enhance their documentation


Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years.