May 12, 2014

Uncertainty is Hard: Four Steps to Take While Waiting for ICD-10 News

By Cathie Wilde, RHIA, CCS

According to the online survey conducted during ICD10monitor’s Talk-Ten-Tuesday broadcast on April 8, the majority of healthcare respondents (59 percent) plan to revise their ICD-10 timelines in response to the latest implementation delay. Others are staying the course (23 percent) or waiting to determine next steps until a new deadline is announced (15 percent).

While a well-known best practice is to begin with the end in mind, the new “end” for ICD-10 isn’t even known — at least not yet. Deadline uncertainty is wreaking havoc on every ICD-10 stakeholder, including about 75,000 American Health Information Management Association (AHIMA) members. A group of industry titans called the Coalition for ICD-10 strictly opposed the additional delay and is working to prevent any further delay past Oct. 1, 2015.

While we wait for more ICD-10 news, I recommend making the most of the delay by focusing on these four areas:

  • Maintaining training momentum
  • Continuing dual coding
  • Continuing to improve clinical documentation integrity
  • Reviewing, updating, and adjusting plans.

Keep Training Programs on Track

Performing correct coding has a direct impact on improving revenue integrity, reducing denials, and minimizing auditor takebacks. Investments in ICD-10 training already are being parlayed into revenue improvements under ICD-9 as coders refresh their knowledge of basic coding guidelines, anatomy and physiology, and medical terminology. Most coding and clinical documentation improvement (CDI) professionals (and many physicians) already are participating in ICD-10 training.

I advise organizations to maintain momentum and keep a steady pace with their training efforts. Regular hands-on practice and ICD-10 refreshers should be continued. Make plans to once again ramp up training six to nine months prior to the new implementation deadline once it is announced.

ICD-10 training is extremely resource-intensive. A key best practice is to distribute training aspects evenly and to use additional time to dig deeper into known problem areas. The next year (or more) also should be used to assess training obstacles faced so far and to fine-tune programs to conduct more specific and detailed education in trouble areas.

Continue Dual Coding

Many early adopters of ICD-10 have been dual coding for 12 months or more now. Some of these hospitals have indicated that they will continue to code in ICD-10 and map back to ICD-9 for billing purposes. Beyond these early adopters, most organizations have implemented some level of dual coding.

Dual coding delivers tremendous advantages in coder accuracy, payor testing, and financial impact assessments. More time for dual coding with ICD-10, even if it only involves a few cases per week, can offer a benefit windfall for health information management (HIM).

Dual coding reinforces training by giving coders hands-on practice. It also helps HIM leadership benchmark productivity and accuracy for future staffing purposes. Consider cross-training staff during the next year, and use dual coding as a platform for strengthening coder knowledge and experience with ICD-10. Apply the lessons you’ve learned with dual coding to refocus education and CDI initiatives in the year ahead.

Focus on CDI

Improving clinical documentation strengthens coding and reimbursement in all code sets: ICD-10, ICD-9, and CPT. Therefore, a continued investment in CDI is highly recommended.

Most provider organizations already have a CDI program in place. ICD-10’s requirements for greater documentation specificity drove additional executive interest, operational investments, and human resource focus. Continue this momentum by funding CDI programs and focusing on physician documentation integrity in 2014.

Review charts of your top 10 to 15 diagnoses, procedures, and DRGs. Recode under ICD-10 to evaluate impacts. Based on these results, make adjustments for documentation improvement, education, and form or template redesign.

Also ensure that your physicians’ thought processes (regarding diagnoses, evaluations, and treatment plans) are accurately documented. They are the key to capturing severity of illness, supporting medical necessity, and ensuring quality and continuity of patient care.

Review, Update and Adjust

The latest delay is certainly disruptive, and it puts ICD-10 investments at risk. Plans must be reviewed, updated, and adjusted. However, there are positive consequences as well.

More time for ICD-10 preparation ultimately will ensure a smoother transition to the new code set and minimize the anticipated financial hit. The delay gives every stakeholder in the ICD-10 journey greater transparency into implementation “gotchas” while helping them avoid costly surprises and setbacks.

Take advantage of an extra year, apply the lessons you’ve learned, and keep moving forward!

About the Author

Cathie Wilde, RHIA, CCS, is the Director of Coding Services for MRA. Ms. Wilde has been active in the healthcare industry for more than 25 years. Her previous positions have included assistant director of HIM and DRG coordinator at the Massachusetts Hospital Association and DRG validator at Blue Cross Blue Shield. She has extensive experience in ICD-9-CM and CPT coding, auditing, data analysis, development and testing of coding products, specialized reporting, and in-service training. As director she is responsible for overseeing the coding division providing the strategic direction of MRA as a local industry leader of quality coding and case mix services. A graduate of Boston College, she received her HIM certificate from Northeastern University and is a Registered Health Information Administrator (RHIA) as well as a Certified Coding Specialist (CCS). In addition to being a member of both the American and Massachusetts Health Information Management associations, Ms. Wilde is an AHIMA-approved ICD-10-CM/PCS trainer.

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