November 14, 2011

Turning ICD-10 into a Strategic Advantage

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It is pretty safe to say that by this point, most organizations understand that the magnitude of the change to ICD-10 is huge and the impact on an organization is enterprise-wide.

This conversion impacts a broad spectrum of processes, from patient scheduling through claims processing to payment and beyond. The scope of the change requires a well-constructed ICD-10 conversion project plan. Furthermore, this challenge is not the only one being faced by organizations.

Meaningful use, 5010 and EHR implementations represent an extra layer of complexity and risk. The healthcare industry is overwhelmed by multiple initiatives, and focusing on ICD-10 initiatives has strained resources both in terms of manpower and subject matter expertise. However, with every challenge presents opportunity.

Organizations can leverage this opportunity into a strategic advantage that will result in a positive impact on key areas of patient care, revenue cycle and compliance.

Complementary or Conflicting Initiatives?

Meaningful use and ICD-10: are they complementary or conflicting initiatives? I think it depends on how you are asking the question. If you are managing these initiatives separately from a tactical perspective, they are conflicting being as they are separate initiatives managed in a parallel fashion by different work teams. If you are managing these initiatives strategically as one, meaningful use and ICD-10 are complementary initiatives. Synergies will be gained by the evaluation and implementation of these changes. Meaningful use measures have CMS-defined coding requirements that will be impacted by ICD-10 changes, particularly related to measurement reporting during the transition from ICD-9 to ICD-10.

Making ICD-10 a strategic advantage by gaining synergies with meaningful use and ICD-10 documentation requirements requires multi-disciplinary expertise to integrate the two. Integration of these documentation requirements into the EHR to optimize the return on technology investments is the key to turning these initiatives from a matter of merely “complying” into a strategic advantage.

As with any physician documentation initiative, physicians will need education and guidance, plus assistance navigating the myriad documentation requirements for both meaningful use and ICD-10.

Integrating these requirements into the EHR to facilitate the capture of documentation at the point of entry by the physician will be required to manage future data-capture requirements effectively. It is this integrated focus that will provide organizations with the optimal efficiencies, representing a cost-effective solution for achieving compliance and value from investment in the EHR.

Strategic Alignment of Requirements

Start by performing an impact assessment to establish the current meaningful use and ICD-10 requirements, including the following steps:

  • Assess clinical documentation data capture of all data elements required for meaningful use, core, menu, clinical quality measures and ICD-10;
  • Assess any documentation gaps in data required for outcome severity adjustment;
  • Determine comprehensiveness of capture of structured, unique data requirement; and
  • Discover any “hidden” data required.

Once these requirements are identified, align them with the clinical documentation focus areas of your organization. Keeping in mind the clinical documentation management program structure of your organization, align the focus areas for ICD-9 documentation improvement outcomes with ICD-10 documentation requirements.




Strategic decisions will need to be made for the EHR documentation optimization design to achieve desired outcomes. At the conclusion of this evaluation, the EHR documentation template design will require IT resources that can translate data requirements into EHR templates. A key success factor will be gaining physician input as it pertains to the design of the EHR templates. These templates, if designed for optimal effectiveness, will complement your organization’s clinical documentation improvement program, enhancing your meaningful use and medical necessity documentation requirements.

Using the EHR to optimize the capture of clinical documentation will facilitate the capture of documentation requirements for both meaningful use and ICD-10, creating a strategic advantage for your organization.

About the Author

John Pitsikoulis, RHIA, is a Strategic Advisory Services Client Executive and ICD-10 Practice leader at CTG Health Solutions (CTGHS). John is responsible for the strategic advisory services such as ICD-10, EMR clinical documentation integration program, and Computer Assisted Documentation Services. John has over 25 years of Health Information Management (HIM), coding, and compliance consulting experience working with clients on ICD-10 services, RAC, coding, and clinical documentation improvement engagements.

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John Pitsikoulis, RHIA, is the ICD-10 practice leader and an AHIMA ICD-10-Approved Trainer for Nuance Communications. John has more than 28 years of revenue cycle, health information management, coding, and compliance consulting experience. John has developed and led several corporate and client strategic engagements for managing the conversion to ICD-10, including ICD-10 assessments, implementation planning, integrated testing, education plan management and revenue preservation strategies.