July 19, 2015

Ten Principles to Help You Engage Providers Around ICD-10

By Tom Darr, MD

With less than three months until ICD-10 go-live, you may still be having trouble engaging providers around the new code set. If so, that’s not surprising. 

While we know that patient care will ultimately benefit from ICD-10’s increased specificity and data detail, doctors are focused on the here and now. Today and for the near future, ICD-10 seems like more of an administrative headache to them than a boon to the healthcare industry. And frankly, they don’t pay much heed to the “healthcare industry.” They’re concerned about their patients and their practices. 

As a practicing ER physician and an informaticist, I understand both perspectives. So, in the interest of helping both physicians and HIM professionals be successful under ICD-10, I offer the following ten principles to help HIM pros engage physicians:

1.  Stop trying to convince providers that ICD-10 is a good idea. Providers have been taught to hate ICD-10 for 23 years, so getting them excited about ICD-10 now is a lost cause. Any kind of general discussion about ICD-10 is worthless because there’s so much negative energy around this issue. If you know your audience doesn’t believe in something, don’t give them an opportunity to develop momentum in a direction opposite to your purposes. Focus on the real issue, which is, how do we make this work for you and how do we take a practical approach?

2.  Focus on the root cause for the change to ICD-10. Speaking of being practical, let’s remember that, with all of ICD-10’s benefits, we’re replacing ICD-9 because it’s outdated, not because the data will be better or because we need to catch up with the rest of the world. The language of ICD-9 does not match current common parlance and does not account for advancements in technology. Could we have fixed the language of ICD-9? Sure we could have, except for the fact that ICD-9 is out of room. A change was required. 

3.  Talk about specifics that affect providers, not generalities that are irrelevant. ICD-10 will improve the ability to report on risk of mortality, severity of illness, present on admission, patient safety indicators, meaningful use, medical necessity, core measures, and comparative effectiveness research. These are issues that affect, either directly or indirectly, a physician’s reimbursement. 

4.  Focus on the patient and the documentation, not the classification system. I think it’s safe to say that for virtually every doctor in America, their patients won’t change when ICD-10 becomes the law of land. Their disease states haven’t changed and the procedures and services physicians provide for them won’t change. (At least not because of ICD-10; when procedures and services they provide do change, ICD-10 will be able to change with them.)

5.  Change physician perspective to one that makes sense to them. Yes, some of the ICD-10 codes have more information in them than their ICD-9 counterparts, but the amount of information in an ICD-10 code is miniscule in comparison to a good progress note, history and physical, or operative note. ICD-10 is not full of concepts that are foreign to physicians. It is all about classifying and billing for the care they provide for the diseases they see day in and day out.

6.  Bust a few myths. Yes there are 68,000 ICD-10 diagnosis codes, but Optum360’s analysis of our data shows, and providers confirm, that 25 (or fewer) codes constitute a vast majority of a single provider’s work. That means physicians can literally throw out 99.9 percent of the ICD-10 diagnosis codes and the 68 codes they are left with will still be two to three times more disease states than an individual provider will be working with. 

7.  Provide a practical approach to preparing for ICD-10. Here, in a nutshell, is just such an approach:

a.  First, identify the diagnosis codes you work with routinely, likely a list of 25 or less.

b.  Then check and see which of these approximately 25 codes are actually different in ICD-10. Sixty-five percent of all ICD-10 codes are the same as they were in ICD-9. Set aside the ones that are the same. Your documentation will not need to change for these.

c.  Now, for that subset of your original 25 that are actually different, check an ICD-10 reference source to see whether your current documentation already satisfies the requirements for the code. For those that do, set them aside. Again, your documentation for these will not need to change.

d. Finally, for the subset of the subset that you actually need to do something about, likely a number much less than 25, decide how to adjust your documentation. 

e.  Repeat the process for the procedures you perform, which is also likely a very short list, compared to the 72,000 new procedure codes.

8.  Organize your toolbox. Address the tools you have to work with for documentation, once you know where you actually need to adjust, including templates, diagnosis pick lists, super bills, etc.

9.  It’s the documentation, stupid. Understand that the real issue with documentation is poor documentation to begin with, not ICD-10 requiring additional information. So, address your documentation issues. Here are some ideas:

a.  Address the issues around point-and-click fatigue and the counting mechanisms used to define E/M services.

b.  Better explain the complexity of the patient’s problems.

c.  Provide the foundational information for the diagnoses you ultimately list.

d.  Call out important history and present illness reports, past medical history, risk factors, physical exam and lab findings, and your differential diagnoses in your Medical Decision Making documentation.

e.  Physical exam.

f.  Differential diagnosis.

g.  Illustrate the medical necessity of the encounter.

h.  Define treatment provided, how it was monitored and the impact it had on the patient.

i.  Connect the dots of the entire evaluation. Define cause and effect when applicable.  

j.  Assess the severity of the patient’s condition.

k.  Identify the work performed.

10.  Start now

About the Author

Tom Darr, MD, is the chief medical officer for Optum360 Coding Solutions. Dr. Darr brings a patient focus to Optum360 technology solutions and services. He is a practicing emergency medicine physician and certified by the American Board of Emergency Medicine.

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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.

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