The decisions on a course of action for transitioning to ICD-10 diagnosis codes must start now; not tomorrow, or the day after, but right now. If you are the individual tasked with this responsibility, you must decide how training will be scheduled, who will receive training and to what extent, and how progress will be monitored.
The first consideration is to train people (or the person) who are or will be responsible for training other coders and providers. This training can never start too early, because to educate others the trainer must be well-versed in the complexities of ICD-10 before the actual classes start. Education of coding staff and clinical staff should commence in early January 2013. This hands-on training can be internal or external, but should be budgeted for time and resources. Budget to cover:
- One-time costs
- Training, system modifications/upgrades, outsourced implementation
- Recurring costs
- Employee salaries, benefits, etc.
Being an effective trainer requires not only excellent technical skills, but also interpersonal and management skills to introduce participants to coding with the ICD-10 codes and official guidelines. It is important to have a draft manual(s) of ICD-10 to assist with this goal. The first step is familiarizing oneself with the Index and the tabular lists. The index is referenced in the same manner as ICD-9 but is expanded to accommodate the detail required by ICD-10 alphanumeric codes.
Offer classes during alternative times
To best serve the professional staff, the practice could offer these classes during alternative times such as evenings or weekends. In addition, consider offering different skill level programs (e.g., for beginning and advanced coders/clinical staff). The clinical terms used in ICD-10 code descriptors require a greater understanding of medical terms and anatomy and may require even the advanced coder to upgrade their knowledge base in these areas. Reconciling clinical terminology with coding and classification terminology will take significant effort for many coders.
The trainer must understand the attitudes and abilities of the participants, give proper feedback, and stimulate self-motivation and comprehension of this code classification. ICD-10 coders require training in order to analyze the detailed documentation necessary to assign codes accurately, prepare the protocol and implement documentation guidelines for ICD-10. Superbills will need an upgrade to ICD-10 codes and this may be difficult because many additional digits cannot be assigned until the patient is actually seen. An example is the 7th character requirement for an initial, subsequent or sequel encounter.
All medical records will have to be dual coded on and after October 1, 2013. If the date of service is before October 1, 2013, ICD-9 diagnosis codes will be assigned. If the date of service is October 1, 2013 and after, ICD-10 diagnosis codes will be applied. As you can see, it is important to understand the impact of ICD-10 and its challenges.
Concentrate on frequently submitted diagnosis codes
Provide and prepare solutions for improved physician documentation if a baseline audit reveals deficiencies. Concentrate on the frequently submitted diagnosis codes for your physician/practice. Focus on the changes and coding conventions that impact your practice. Documentation will make or break accuracy in coding patient conditions using ICD-10 alphanumeric diagnosis codes. A comprehensive review of documentation impact by physician is essential and planning the targeted training programs relevant to each functional area should be a priority early on.
It may seem like you have a world of time before you have to worry about ICD-10 implementation, but actually it’s closer than you think; you should get started now on this massive change from ICD-9′s 16,000 codes to the 68,000+ codes included in ICD-10. If you have not already developed awareness programs and assessed planning and implementation strategies, you are behind schedule to successfully transition to ICD-10.
Planning should be a priority this year; form a leadership team to plan timelines and key milestones. Communicate often to avoid last minute crisis situations—prevention, not damage control. Monitor your progress and demand accountability for tasks assigned to team members.
Training timelines will depend on the present skill levels of your coders and clinical staff:
- Coding staff: 2-4 days based on current skill level and number of specialties involved
- Clinical staff: Up to 8 hours
- Administrative staff: Up to 6-8 hours on need to know basis
- Systems staff: Up to 8+ hours
Clinical documentation is right up there on your priority list. Provider organizations will need to train clinicians to improve their documentation practices to provide the details needed to support the higher level of specificity in ICD-10 codes. Physicians have been documenting in a certain way for over 30 years and change will not happen overnight. Look out for “kill the messenger syndrome”! Physicians will see a permanent increase of 3 percent to 4 percent of physician time spent on documentation for ICD-10-CM code compliance, this may ease with daily application.
The move to ICD-10-CM will affect both the practice management system and the electronic health record. In addition to billing, you have to consider patient problem lists, appointment scheduler, local coverage determinations, drop menus or preventive intervention alerts. System interfaces and standard reports will be impacted and must be considered in the impact analysis. In your business process analysis, ask the following questions:
- Where do you use diagnoses currently?
- What are the interfaces that may need to be changed?
- What databases need to be changed?
The government comes out almost daily with new initiatives and as part of these larger initiatives, complete and compliant codes are even more critical. At the same time, federal programs such as the Medicare Recovery Audit Contractors (RACs) are making the documentation process even more complex. The tension headache (G44.209) may not go away but we can prevent a G43.111 (migraine with aura, with status migrainosus) by being proactive.
Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, author of The Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, is a nationally-renowned procedural and diagnostic coding instructor, bootcamp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations. In her expansive career, she has transitioned from nursing, to coding, to practice management, auditing and consulting. Nancy served as Director of Coding and Reimbursement at UTMB in Galveston Texas for four years. She served the first two terms as president of AAPC in the early 1990s.
Hear Nancy speak in a complimentary webinar presented by Kareo medical billing software on “Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding” on June 16, 2011. Register now. (After June 16, the webinar will be available as an archived recording at the same link so you may watch it at your convenience.)
