June 25, 2013

Transitioning to ICD-10: Impacting Forces

By Mario A. Perez III, RHIA, CDIP, CCS, CCS-P

Beyond ensuring mere awareness of ICD-10, currently all healthcare entities should be on the pathway to transitional preparedness in anticipation of the ICD-10-CM/PCS implementation date of Oct. 1, 2014. Health information management (HIM) coding professionals certainly should be in the process of skill set enhancement regarding the new diagnoses and procedural classification systems. However, there are several impacting forces that should be considered from an operational infrastructure perspective during this transitional phase. The following factors are imperative to assess and adjust for, both leading up to the implementation date and beyond.

Health Information Management Workforce

Healthcare entities must ensure that they identify a process to ensure attainment and retention of qualified HIM coding professionals.

There is currently a shortage of qualified HIM professionals to meet the demands of a growing healthcare industry dependent on individuals with skills in informatics and clinical technology. In 2002 the U.S. Department of Labor’s Bureau of Labor Statistics projected a 49 percent growth in the number of HIM professionals by 2010. Health information management is one of the fastest-growing occupations in the field, yet only about 2,000 HIM graduates emerge annually – and 6,000 a year are needed to fulfill the projected demand.1

Healthcare infrastructure is critically dependent upon having a workforce to administer it. The American Health Information Management Association (AHMIA) has launched several initiatives to address and provide solutions through workforce studies and raising awareness and the profile of the HIM professional, promoting higher levels of education and specialized advanced certificates while building on the strength of diversified areas of employment.

AHIMA continues this initiative to “fill the estimated 50,000 new positions that will be needed to implement a national transition to electronic heath records,” in the words of association president Bonnie Cassidy.2

Electronic Health Records (EHRs)

The ICD-10 classification system will offer greater coding specificity. However, application of these codes is dependent upon accurate documentation. The evolvement of the electronic health record (EHR) continues to bring new challenges to the HIM professional, in particular regarding transitional phases between paper-based records, computerized scanned records, and entirely electronic records.

The EHR also brings new challenges to coding professionals as it pertains to source documents used for coding, as they may present interpretation subjectivity from the coder – particularly when information is being “cloned” (copied and pasted).

Health information data is the basis for publicly available reporting outcomes due to the dependence on coding. Establishment of a collaborative process among HIM and clinical professionals to ensure capturing accurate and meaningful information that renders significant and valid reportable outcomes is essential.

A few additional steps to consider:

  • Ensure effective training and monitoring for all healthcare providers regarding compliant EHR documentation practices;
  • Ensure documented, collaborative clinical communication between providers, particularly within hospitalist groups;
  • Establish policy and procedure protocols on prohibiting “cloning” of documentation, and educate regarding its negative ramifications; and
  • Establish and ensure timely documentation (in ICD-10-PCS, it will be imperative to have a detailed, documented operative/procedural note).

Computer-Assisted Coding (CAC)

Analogous to when “encoder grouping” software first was introduced decades ago, the advent of computer-assisted coding (CAC) certainly offers new technology to assist with the coding process. But like the encoder, it will not replace the critical thinking skills of the HIM coding professional, and its functionality is totally dependent on complete and specific documentation. Ensuring this is a process that only is accomplished with a robust and effective documentation improvement program.

When implementing CAC, facilities must ensure that appropriate source documents are being referenced for diagnoses/procedural documentation for coding assistance. As an example, an EMR in which its “problem list” is not effectively managed by the providers is useless from a clinical and coding perspective. Healthcare facilities must ensure the establishment of policies and procedures to mandate active and consistent management of the problem list.

Audit Industry

As with any transitional initiative, there will be a learning curve to assess, design, implement and monitor processes as part of continuous quality improvement. Undoubtedly, the audit industry will have a major impact on providers, post-ICD-10 implementation. It is imperative that healthcare entities assess their current internal auditing processes and stakeholders and that they create an effective, multidisciplinary team composed at minimum of team members representing administration, medical staff, case management, utilization review, coding professionals and business offices.

Conclusion

The four forces addressed here certainly do not represent an all-inclusive list, but they should provide a basis for consideration by healthcare entities. Such entities should assess not only these factors, but also others within their enterprises that would impact infrastructure, present concern, e or have a direct or indirect operational influence on effective ICD-10 transition.

About the Author

Mario Pérez, Director of Clinical Consulting for J.A. Thomas & Associates, a Nuance Company, brings 20+ years of experience in health information management within acute care enterprises. He administratively oversees project management in assessments, implementation and continuing education programs in regard to addressing compliant regulatory documentation and coding requirements within healthcare enterprises. Mario is an AHIMA Approved ICD-10 CM/PCS Trainer.

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AHIMA Statement on Health Information Management Workforce 1

Healthcare IT News, AHIMA touts HIT Pro exams as a way to increase workforce, June 6, 2011 2

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.