Updated on: August 12, 2014

The ICD-10 Delay: Making Hay While the Sun Shines

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Original story posted on: July 13, 2014

Several months have passed since we got the news about the latest postponement of implementation of the ICD-10 code set. For a large part of the industry, after the shock wore off, the next emotion was relief. Many welcomed the delay, which eroded the fears and anxiety that had been building as the October 2014 deadline approached.

In some ways, the delay was viewed as a reprieve, allowing for another 12 months of preparation for the daunting challenge of implementing the code set change. It is understandable that teams poised for the transition would throttle back a bit in their preparations now. However, those who have turned off the engine altogether will likely regret that decision as the new deadline approaches.

For practices that merely shift gears and utilize this additional time to enhance their ICD-10 readiness, this delay is a gift-wrapped present. To make the most of the opportunity the delay affords, let’s look at a few ways you can use it to your advantage.

Provider Workflow

One significant weakness that many practice managers and employees suffer from is the lack of real insight into the provider’s workflow. It is critical to have an understanding of how your organization creates documentation and the role that code selection plays in that process. To really understand the challenges providers will face, it is important to step into their shoes and try your hand at documenting an encounter – completing orders for services such as lab work, diagnostic testing, and durable medical equipment – and filling out drug preauthorization requests. These are some of the most common areas in which providers will encounter the need to access the new codes. Depending on your specific specialty or specialties, there may be several other scenarios in which coders will have to grapple with the new code set. Support staff who are very familiar with the nuances of the workflow  will do a much better job of educating others and preparing them to effectively deal with the coming changes.

Most electronic medical record (EMR) systems have a test environment or test patients that can be used for practice. To step into the shoes of those on the front lines, spend some time in this test environment to document a fictional encounter. For example, try to document an annual physical exam for a patient with common problems such as hypertension or diabetes. As part of this encounter, order a chemistry panel, electrocardiogram, and chest X-ray, using appropriate disease diagnosis codes matched to the selected tests. This sort of exercise is invaluable in anticipating the hurdles your physicians and coders will face in 2015.

Provider Audits

Many of my clients have balked at the idea of provider readiness audits, primarily citing lack of time to undertake this task. However, with the additional time we have been afforded, there is no longer a good reason to avoid them. Even for practices with limited resources, it should be within their grasp to evaluate four or five encounters per provider to audit over the next six months. Use your EMR software to identify the most common diagnoses submitted, then select one encounter from each of the top four or five diagnosis codes to audit. If there are sufficient resources, two encounters for each of these diagnoses would be a better sample size upon which to base recommendations. Of course, the purpose of this audit is to determine if there is adequate documentation in the record to accurately attach a specific ICD-10 diagnosis to the services provided.

Vendor Preparedness

After the delay was announced, many institutions were surprised to learn that their EHR vendor subsequently issued a revised preparation schedule for implementation. The concern is that those vendors may not have been as ready for implementation as they had been proclaiming as the earlier deadline approached.

If they truly were ready, why not proceed on schedule with testing and software upgrades? If your vendor has remained on track for ICD-10, you should be encouraged. Be sure, however, to hold their feet to the fire to meet deadlines and take full advantage of their testing offerings.

Testing will be crucial to successful implementation, and entities that test extensively will undoubtedly fare better. Talk to your vendor about available test environments and testing scenarios. Coders and physicians should take advantage of testing platforms, and testing should be available for both groups.

Now is the time to have a lengthy discussion with your EHR vendor about testing plans and implementation so that you can coordinate your staff and provider schedules with the available testing opportunities.

Cheat Sheets

I have long been advocating office staff to begin creating ICD-10 cheat sheets specific to their clinic and practice specialty. Begin by identifying the top 20 ICD-9 diagnosis codes used (your EHR application should make this easy for you).

Then investigate these diagnoses in ICD-10 to gain an understanding of their places in the new code set. Once you know the potential code range in ICD-10, it is time to meet with your providers to obtain their help in narrowing down the selection choices. In this process, they will explain to you which of these new codes are most likely to applicable to their practice(s) and which ones are not likely to be useful to them.

Once you have this information, you can develop a cheat sheet that provides shortcuts to ICD-10 codes for the most frequent diagnoses used by your providers. There are many applications outside the EHR realm in which staffers will find having this information at their fingertips to be invaluable. Ancillary lab and diagnostic orders, durable medical equipment orders, home health orders, and preauthorization requests mark just a few of the instances in which a provider will need to have ready access to this information. The staffer that successfully spearheads and implements the cheat sheet initiative will be the rock star of the organization after October 2015!

Make Hay While the Sun Shines

Again, the new implementation delay came as a shock to many, but savvy practice managers will quickly recover and strategically position their practices as they shift gears to capitalize on the delay. I have outlined several ways this extra preparation time can be exploited to minimize implementation headaches. The months are flying by, and before long, this advantage of extra time is going to evaporate!

The sun is shining…so are you ready to make hay?

About the Author

Stephen C. Spain, MD, CPC, is a family physician with more than 30 years of patient care experience.  He currently serves as Physician Advisor to Career Step and, as such, informs their ICD-10 provider documentation education and presents the introduction to the Career Step online overview module, ICD-10: Understanding its Purpose and Value.  In 1998, Dr. Spain founded Doc-U-Chart, a consulting firm that helps medical professionals improve their understanding and application of documentation and coding principles. 

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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.
Dr. Stephen Spain, MD, CPC

Stephen C. Spain, MD, CPC, is a family physician with more than 30 years of patient care experience.  He currently serves as Physician Advisor to Career Step and, as such, informs their ICD-10 provider documentation education and presents the introduction to the Career Step online overview module, ICD-10: Understanding its Purpose and Value.  In 1998, Dr. Spain founded Doc-U-Chart, a consulting firm that helps medical professionals improve their understanding and application of documentation and coding principles.

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