October 5, 2015

The Initial Weeks and Months of the ICD-10 Transition

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It now has been a few days since ICD-10-CM/PCS was implemented, and these first weeks and months certainly are bringing some excitement and intrigue. 

 

The enthusiasm on the part of providers during the final weeks leading up to implementation was so strong and contagious that an atmosphere of celebration and jubilation was seen across the industry. We are now “transitioning,” which is the process of changing from one state or condition to another. Let’s take a look at this initial part of the transition into the new code set. Reviewing these initial components will help us better understand some of the considerations and actions to take within the next few weeks and months for coding and health information management (HIM) professionals.

Having your ICD-10 command center up and running is one of the key activities to engage in during the first 2-3 weeks of October (and maybe longer if needed). You also may have daily status calls within your practice, organization, or hospital. Status calls allow for different areas/departments to call in and report on how the implementation is going. This allows for the sharing of information about f others’ issues and problems, but also resolutions and the outcomes of these situations. Gather the reporting issues and resolutions, track them, and summarize them. From a coding perspective, there may be questions coming into the command center that will suggest a need for education as well. 

The formation of transition plans should be well underway, as should some coding quality reviews or assessments to occur initially. It is critical to have some samplings of encounters to validate the quality of coding in a very timely manner. Some organizations are taking a daily sampling of coded encounters and reviewing them while offering feedback to the coding staff. Others are taking a weekly sample, and still others are conducting a monthly review of the coding quality. All are good models, but certainly one does not want to wait until 2016 to conduct a review of ICD-10 coding.

The coding quality review/assessment (some refer to this as an “audit”) can be either random or focused. Since the code set is new to all of us, we should start out with a random structure for the sampling of encounters or discharges to review. Gather some data from the review findings and trend this over a period of time, such as one, two, or even three months. This will allow for close monitoring of patterns and/or trends that may be occurring. Once you have this information, you’ll be able to develop a more focused quality review/assessment format and put that in place for a few months further into 2016. Constant checking is very important, and the sooner this is done, the better. The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has stated that ongoing auditing and monitoring is necessary for healthcare entities, so don’t be afraid to begin these reviews earlier rather than later. 

You may have internal review/audit resources or internal resources, but outside of your department/area, there may be staff within the compliance department that is qualified to review the coding quality. Another step to consider is having an external resource in place to conduct coding quality review, representing a separate set of eyes that are truly impartial and nonbiased. You also could utilize a combination of internal and external reviews.

Your coding command center will be the first place to look for areas that need re-enforcement, clarification, and/or education. For clarification on a particular coding guideline or scenario, you’ll want to be sure to put this in writing and distribute guidance broadly enough to reach all coding professionals within your practice or organization. There may be a need for a policy and procedure to be developed as well. More formal education may include a brief 30-minute review of guidelines or how to locate particular ICD-10-CM/PCS codes. Education also may be more formal and lengthier, such as a two-hour in-service program on a particular guidelines chapter or body system. A more formal educational program will take some time to research and develop, so this may carry into November and December.

Monitoring and tracking coding productivity  has been a hot topic over the past five years with the implementation of ICD-10. Be sure to have daily, weekly, and monthly productivity statistics available. Review and analyze the figures and results. Discuss with your management leaders and your staff. Being as this is a transition, we know there will be some reduced productivity for a few months initially and then things should improve. This is an area you’ll want to address often. 

Contract coding services from vendors/suppliers should be in place with the appropriate contract and BAA (business associate agreement). Work very closely with your coding vendors. Have calls every few days; follow up on questions and shift staff to areas that need greater attention. Monitor productivity and quality, and be sure to have reports to summarize these areas. Of course, you’ll also want to be sure to get your ICD-9-CM coding caught up and sent to billing so any backlog is eliminated.

Communication is another area on which we should continue to focus. With change comes the need for information, and thus lines of communication should be open and transparent. Plan for and conduct daily or weekly meetings with your staff. Also summarize issues, problems, and solutions on a weekly basis at a minimum and share across your organization. 

Also, during these initial weeks and months be sure to collect information and access resources. Obtain the American Hospital Association (AHA) Coding Clinic on ICD-10-CM/PCS. This is a must-have for any coding professional. Read through this publication and have all your coding staff read it as well. Watch for Centers for Medicare & Medicaid Services (CMS) communication and notices for guidance and direction, and also look for notices from your Medicare Administrative Contractors (MACs) on ICD-10 as well.

We are all learning together, bringing forth improved healthcare data that will benefit the entire industry. Being organized and having checks and balances in place initially will make things better in the long run. 

Remember to work together, be strong, and transition on! 

 

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Gloryanne is a coding and HIM professional with 35 years of experience. She is the past president of the California Health Information Association. Gloryanne is a member of the ICD10monitor editor board and is a popular guest on Talk Ten Tuesdays.

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