October 31, 2011

Where Are You in the Transition to ICD-10-CM/PCS?

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At this point in time providers’ preparation efforts for ICD-10 should be well under way, with most providers having completed all of the Phase 1 tasks outlined in “ Impact Assessment” and approximately half of the Phase 2 tasks outlined in “Overall Implementation” from AHIMA’s June 2007 “ICD-10 Preparation Checklist.” As suggested by AHIMA, preparation and implementation planning for ICD-10 should be accomplished in a phased approach (see Figure 1).

As such, Phase 1 for the implementation plan development and impact assessment should have been completed during the second quarter of 2011, and work on Phase 2 should be going on now. The key tasks associated with the transition are included here for your review, along with our suggestions for adequately preparing your physicians, clinical documentation specialists and coding professionals.

At this point the following tasks from the Phase 1 Impact Assessment should be crossed off your to-do list:

  • Establish cross-functional team;
  • Create communication plan;
  • Ensure that health information management has assessed education needs;
  • Develop budgets for ICD-10;
  • Evaluate data, workflows and operational processes for improvement opportunities;
  • Determine extent of changes required for systems, processes, policies and procedures;
  • Perform a comprehensive systems audit for ICD-10 compatibility;
  • Determine vendor readiness and timelines for upgrading software;
  • Perform (with IT vendors) a comprehensive system audit for necessary HIPAA transaction changes; and
  • Implement a documentation improvement program to target deficiencies.

Again, in addition to completing all Phase 1 tasks, organizations should have completed half of the Phase 2 tasks.

Here are the Phase 2 tasks that should be completed:

  • Contact payers, business associates, other HIPAA trading partners and vendors for ongoing updates, preparations and testing for HIPAA transaction standards and ICD-10 changes;
  • Develop strategies to minimize problems during transition;
  • Determine impact of the coding system change on longitudinal data analysis;
  • Develop a schedule leading up to the “go live” date, incorporating key stakeholders’ roles and responsibilities; and
  • Modify reports and redesign forms identified in Phase 1.

 


 

Here are the tasks from Phase 2 that should begin soon or continue:

  • Continue to assess and improve medical record documentation practices engaging clinical staff in the process;
  • Provide updates to senior management and affected staff;
  • Revise processes, policies and procedures as appropriate;
  • Follow up with system developers or suppliers regarding their readiness;
  • Implement and test systems changes, including in-house and proprietary systems changes; and
  • Maintain testing schedules with vendors and ICD-10 trading partners.

Awareness Training

Phase 2 will involve continued efforts in providing awareness training. This training is important in that it provides the foundation for the next two phases of training for your CDI team: developmental and role-specific training.

ICD-10 awareness training specifically provides:

  • An introduction to ICD-10-CM/PCS;
  • Tips for preparing for the transition;
  • Understanding of the impact; and
  • The dispelling of myths.

Developmental Training

Developmental training involves assessing and acquiring core skills, more commonly referred to as biomedical skills. Biomedical training generally involves medical terminology, anatomy and physiology, pathophysiology, and pharmacology. Proficiency in these areas is critical to learning and working successfully with ICD-10-CM/PCS. While it is argued that both the CDS and coder already have advanced knowledge of biomedical subjects, there are many reasons why an assessment of this knowledge and additional training are of great value in preparing for ICD-10-CM/PCS.

First of all, most of us in CDS and coding roles received our biomedical training decades ago. This is concerning, because research indicates that when we are exposed to an idea at a certain point in time, at the end of 30 days most of us will have retained less than 10 percent of the material. Much of the education acquired in biomedical courses during those early college years was not utilized while working with ICD-9-CM due to its lack of specificity. The same lack of specificity is not found in ICD-10-CM or ICD-10-PCS. In fact, ICD-10-CM/PCS has tens of thousands more terms than ICD-9-CM.

To use ICD-10-CM/PCS effectively, coders and CDS must know:

  • Greek and Latin prefixes, suffixes, roots and combining forms used as the basis of most medical terms;
  • Commonly accepted and approved medical abbreviations;
  • Eponyms and names of syndromes;
  • Alternative names and descriptions of diseases;

 


 

  • Adjectives used to describe and define diseases and disorders (“purulent,” “necrotic,” etc.)’
  • Verbs and terms used to describe surgical approaches and techniques (“resect,” “dissect,” “incise,” “excise,” “aspirate,” “-scopic,” “-otomy,” “-ectomy,” etc.); and
  • Technology-driven and manufacturer-given names for tests, devices and procedures.

I suggest that developmental training begin either in late 2012 or early 2013, prior to the start of the next phase of training, referred to as “role-specific training.”

Role-Specific Training

Role-specific training involves training to prepare the CDI team to perform key functions associated with individual positions. For physicians, this will include developing thorough knowledge of the clinical documentation requirements of ICD-10-CM/PCS; for the CDS it will include developing thorough knowledge of the clinical specificity necessary to capture severity of illness, risk of mortality and appropriate reimbursement adequately.

Role-specific training for the coder will include developing thorough knowledge of how to assign and sequence ICD-10-CM/PCS codes according to the official coding guidelines. At minimum the following role-specific training would be required:

Physicians

Clinical documentation requirements of ICD-10-CM/PCS by specialty. I recommend utilizing a physician ICD-10-CM/PCS expert to provide both physician awareness and role-specific training.)

CDS

Clinical documentation requirements unique to ICD-10-CM/PCS’

Official coding guideline changes; and

CDI software training.

Coder

Clinical documentation requirements unique to ICD-10-CM/PCS;

Official coding guideline changes;

Coding training (basic, intermediate and advanced); and

Encoder software enhancements.

In the end, there are no shortcuts to preparing your CDI team for ICD-10. To stay on track with your preparedness efforts we advise making 2011 the “year of awareness,” 2012 the ”year of development” and 2013 the “year of role-specific training.”

 


 

In an effort to ensure that your organization is on track for success with ICD-10, remain aware of those tasks that have yet to be accomplished and make the necessary preparations for their timely completion.

About the Author

Angela Carmichael, MBA, RHIA, CCS, CCS-P, is the HIM Product Development Specialist specializing in clinical documentation improvement, coding education and reimbursement methodologies for J.A. Thomas & Associates. Angela earned a Bachelor of Science degree in Health Services Administration from Barry University and a MBA from Nova Southeastern University. She is a Registered Health Information Administrator and also has achieved the designations of Certified Coding Specialist, and Certified Coding Specialist-Physician and AHIMA Approved ICD-10-CM/PCS Instructor.

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References:

Kasey, John, Naugle, Andrew, Zenner, Patricia. “ICD-10: Industry Perceptions and Readiness”. milliman.com

Bowman, Sue, and Ann Zeisset. "ICD-10 Preparation Checklist" (Updated June 2007)

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