With so many delays, it’s hard to trust that October 1, 2015, will be the magical date we finally see ICD-10 become our new standard. The crystal ball seems a little murky on the subject of another delay, but I believe that 2015 is the year. Health systems are prepared, AHIMA is pushing full steam ahead and the Centers for Medicare Services (CMS) estimated that the March 2014 delay will cost the health care industry over 6 billion dollars in extended planning, testing and rework.
The ongoing delays of ICD-10 have created a marked physician resistance regarding what has come to be viewed as a seemingly mythical change, especially in light of so many competing health initiatives requiring your full attention and adoption. While I won’t guarantee this short list will provide a 100% painless transition, I can assure you that implementing these steps over the next 5 months will greatly diminish your frustrations in October.
1. Analyze your Current Data
Sure, there are 68,000 diagnosis codes in ICD-10, but there are 13,900 codes in ICD-9. Are you using all of those now? Of course not. It comes down to basic probability. Your patient population will not dramatically shift come October, so utilize your current ICD-9 data for the previous year to really dig down and see the changes that will affect you and your practice. There are many levels of planning you can do with this data; the most basic being a simple summary of diagnoses you have used. The results may surprise you. Identify your top 50 diagnoses, or it may be more fitting in your practice to just include any diagnosis assigned to more than 10 patients the previous year.
Knowing which diagnostic codes you frequently used allows you to focus your energy. The next level would be to take your top 10-20 diagnoses and see exactly what documentation changes these new codes require. Talk to your coders, your practice manager or the hospital’s HIM department. More than likely, they will be bursting at the seams to show you the changes for your top 10 diagnoses. If not, a simple internet search of “diabetes coding changes for ICD10” will provide a plethora of information. (We have been planning this for a few years now, there are a lot of experts out there willing to share their knowledge.)
Lastly, ascertain your revenue impact analysis. This can get complicated and there are companies with dedicated software programs and algorithms that can give you a true impact assessment. Use the information you have readily available to have a general idea of your trouble areas for coding and reimbursement.
If feasible, take 20 random charts and have them coded in ICD-10 per physician, if in a practice. See which charts cannot be final coded with current documentation and review what additional information is required for accurate coding. Could the codes listed as “unspecified” have been further clarified to allow for a more specific code? Don’t get too comfortable using “unspecified” codes. Your retrospective severity and risk scores won’t reflect the level of care being provided or the severity of illness of your patients without the proper documentation. Going forward, the key to good clinical documentation is consciously documenting the type of verbal hand off you would give to another physician during transition of care. Document details, laterality, causation, acute versus chronic, and complicated conditions.