Readiness for ICD-10 depends on the type and size of an organization. While the majority of hospitals have trained their staff, less than half of physicians practices have completed their training. Learn about what still needs to be done before the October deadline.
How ready you are for ICD-10 transition might depend on the type and size of your organization. It’s reported that 85% of hospitals have trained their staff on ICD-10, while only about 40% of physician practices have completed that training. Practices also are less likely to offer additional training for coders to maintain their skills.
That’s not surprising given the fact that practices are still reeling from the costs of electronic health records (EHR) and other updates to get to this point of finally transitioning to ICD-10.
That doesn’t mean it’s too late for your office to prepare. The Centers for Medicare and Medicaid Services (CMS) just released a guide for organizations to get on track to implementation no matter where they are in the process.
Here are some additional tips to help focus your physician training and support so that the transition is successful.
Do not try to teach your physicians the ICD-10 code. Instead, talk to them about what information they need to document so that coders can build the ICD-10 code.
Most providers utilizing an EHR have developed templates for their most common chart entries.
Find out what information is not included in the template and work with the providers and your IT staff to update the template to capture all of the information needed for an ICD-10 code. Ask your providers to explain what they’re doing. Ask what they mean by certain terms. Many of them will be happy to share their expertise.
This information is commonly the reason for the office visit or procedure. For instance, a pediatrician typically has a template for otitis media since this is a diagnosis that he/she sees on a daily basis.
Make sure that the template includes the information that will be needed to support the higher specificity of the ICD-10 code.
The otitis media template should be updated to include:
This information can be captured anywhere in the note, (i.e., History of Present Illness, Review of Systems, Exam and/or Medical Decision Making, reason for surgery), so make sure you review and update all the templates that the provider uses.
Incorrect or unspecified laterality is a simple mistake, probably caused by lack of familiarity with the codes or a lack of documentation. The payment isn’t going to change, so you may think of it as “no harm, no foul.” And you would be right, to a point. A problem could arise when the patient comes in for a follow-up visit and checked the wrong ear. The patient may or may not remember and correct the physician.
But keep in mind, not all errors or mistakes are so minor.
Updating templates is a win-win situation, and the best way to ensure that the provider will capture the required specificity. This will not only minimize the risk that comes from documentation mistakes, but alleviates the chore of querying the provider later, assigning a less specific code (and risking a denial from the payer), or spending time and manpower resubmitting a corrected claim.
So it’s important to allow your providers as much time as possible to practice these new documentation habits. This will help overcome one of the top challenges facing all organizations: maintaining clinical workflow and productivity.
For both practices and small hospitals, another major challenge relates to vendor and partner readiness.
Even at this late date, some vendors are scrambling to ensure that their systems are updated and working properly. If you haven’t already, make sure your vendor provides you with an ICD-10 timeline.
Also, you need to consider addressing the following with your vendor:
If your EHR includes an ICD-10 converter, check that the ICD-9 codes are crosswalking correctly to the ICD-10 code(s).
Only above 33% of the ICD-9 codes crosswalk to a specific ICD-10 code, so converting or crosswalking codes is definitely challenging.
Related:ICD-10: Fact vs. myth
Additionally, vendors typically purchase the mapping/crosswalking software from another company, so it is an issue that even large vendors are still struggling with. Simply put, the ICD-9 codes are crosswalking to wrong ICD-10 codes-and vice versa.
If these issues aren’t addressed, they could not only cause significant cost and workflow issues, they will confuse your providers, who could become overwhelmed by the amount of analysis and challenges that the ICD-10 conversion poses.
Pull charts-standard recommendation is 10-and the associated billing claims.
Review the diagnostic statement from the chart and select the appropriate ICD-9 code. Do not infer anything that is not written. Review the diagnostic statement and choose the ICD-10 code. Is there any documentation that would allow a higher level of specificity? Use an assessment tool and list out the missing elements. Educate the providers on what is lacking so they can continue to improve.
Related:20 bizarre new ICD-10 codes
Also, tracking your denials will be critically important after October 1, 2015. Classify the denials and get to the root cause.
Renee Dowling is a billing and coding consultant with VEI Consulting in Indianapolis, Indiana. Send your billing and coding questions to email@example.com.