Transitioning to ICD-10

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<h1>Transitioning to ICD-10</h1><strong> Author: <a href='http://www.articleseen.com/profile_McKesson Consulting.aspx'>McKesson Consulting</a></strong><br /><p>Crossing the great divide: Transitioning to ICD-10 By Bess Ann Bredemeyer, BNS, RN, CHC, CPC, PCS Editor’s note: Bess Ann Bredemeyer is Director of Coding & Compliance Consulting for McKesson Revenue Management Solutions. She is responsible for McKesson’s national consulting services related to physician practice coding and compliance and she serves as McKesson’s lead consultant on ICD-10 planning, transitioning, and implementation with expertise in ICD-9-CM/CPT®/ HCPCS coding and education, and ICD-10-CM/PCS. Ms. Bredemeyer may be contacted by e-mail at BessAnn.Bredemeyer@mckesson.com. Given the abundance of serious issues facing health care today, it’s understandable that many providers may not yet view the 2013 ICD-10 coding transition as a top priority. Yet, physician groups that fail to take advantage of the long lead time for meeting the ICD-10 requirements could experience serious financial and operational disruptions once the deadline arrives. Why is it essential for providers to begin their ICD-10 preparations sooner rather than later? Although ICD-10 may be viewed primarily a coding issue, the scope and magnitude of the transition is such that nearly every aspect of the organization will be affected. That means all personnel—from physicians to the front and back office staff—will be required to modify long-standing practices and procedures in one way or another. To ensure that all pieces of the ICD-10 transition come together ahead of the October 1, 2013 transition date, physician groups should take steps now to identify how each department and team member will be impacted. They can then map out an implementation plan for the training and systems modifications required to accommodate the change. Practices that begin the hard work today of focusing on what each team member must do to accommodate the new system stand the best chance of weathering the transition without significant financial or operational problems. Greater flexibility and accuracy ICD-10 represents one of the most significant transformations ever undertaken on the business side of the US health care system. The new coding nomenclature will replace the 30-year-old ICD-9 system. The number of diagnosis and procedure codes will expand from approximately 20,000 to more than 155,000—a nearly eight-fold increase. The shift is designed to bring the U.S. in line with other western nations, many of which already are using ICD-10, and to provide greater flexibility and accuracy in the assignment of codes for medical diagnoses and treatments. The improved specificity should generate greater efficiency in the care documentation and claims processes, and also allow for more precise quality reporting. Managers leading the way Understanding how ICD-10 will affect each department is the key to effective planning, education, and training. Along with assessing specific departmental needs, managers must identify the resources and steps required to meet those needs. This will likely include setting up training and system upgrades, developing appropriate budgets, and establishing a viable training and transition time line. Another key managerial responsibility are vendor contracts and agreements. The objective is to ensure that key partners, such as outsourced billing companies or IT vendors, are fully prepared to accommodate the intricacies of ICD-10 and meet the needs of the practice in the post-transition environment. Similarly, managers should also be in touch with payer representatives to determine when the payer will be ready to accept ICD-10 coded claims. They should likewise seek information about the extent to which other payer processes will be affected by ICD-10, including medical policies, contracts, and claims adjudication. Because a period of transition between the two coding systems will exist, coding and billing staff must be prepared to code in both ICD-9 and ICD-10 for up to two years after the cut-over date. It is therefore critical that managers confirm that their billing platforms will be able to accommodate both coding systems simultaneously. Documenting the details For physicians, ICD-10-CM’s impact will depend on whether and to what extent the physicians currently do their own coding. Most physicians today leave coding to the office staff, but those who still do code will need to be thoroughly trained in the new nomenclature. The Centers for Medicare and Medicaid Services (CMS) advises that organizations begin formal ICD-10 training six months prior to the compliance date. Whether physicians code or not, all doctors will be required to provide additional details in their clinical documentation. That’s because ICD-10 demands much more anatomic and physiological information than the current ICD-9 system. Here are a few examples: ICD-9-CM has nine codes to describe pressure ulcers. In contrast, ICD-10-CM includes 125 codes that describe both the location and stage of the ulcer. Similarly, ICD-9-CM volume 3 has a single code to describe angioplasty, but ICD-10-PCS has 854 codes that specify body part, approach, and device. Although physicians do not use the ICD system to code procedures, they may be impacted by hospitals’ need for documentation detail. ICD-10’s granularity means that if physicians fail to provide a complete picture of the diagnosis or procedure, they’ll run the risk of not being able to collect for the services rendered. A useful exercise that any physician office can conduct now—assuming they have office personnel with at least one ICD-10 book—is to take the medical notes of several common patient encounters from the physicians and code them in both the ICD-9 and ICD-10 formats. For coders and physicians alike, this demonstration should illustrate the differences between the systems and the level of specificity ICD-10 will require. Revising the encounter form In all physician offices, both doctors and billing staff likely will need to re-think their use of the encounter form or super bill. Typically one page long, the paper encounter form provides a list of commonly used diagnoses and codes. Once the patient encounter is complete, the physician checks off the specific diagnosis. The form is then taken to the Billing office, usually by the patient, to expedite coding and billing. But, because ICD-10 will require much more information to code an encounter, it is impractical for most practices to assume that a single-page encounter form will be able to accommodate frequently used diagnoses. Groups therefore will need to develop an alternative system that can be used to convey information about the encounter in lieu of the current checklist encounter form. One option is to create a new paper form that essentially allows the physician to write out the diagnoses, although this approach will be cumbersome and likely more time-consuming for the physician and coder. Perhaps the best, long-term solution is for physicians to utilize their electronic medical record, practice management system, or billing software to capture the patient encounter data electronically. To that end, managers and/or information technology specialists should contact the group’s IT vendors to discuss what options may exist for replacing the paper encounter form with an electronic version. Assessing the needs of nurses and front-desk staff As is the case with physicians, the extent to which nurses will be affected by ICD-10 will depend on how much, if any, coding they’re currently asked to do. In Emergency Departments, for instance, nurses frequently assist with facility coding. Like physicians who code, nurses who code will need full, formal ICD-10 training ahead of the deadline. Scheduling and registration personnel at the front desk will need to be appraised of the new procedures relating to the encounter form. In addition, any policies and procedures that reference ICD-9 should be updated to reflect the change to ICD-10. Finally, if front desk personnel make referrals or get approvals for surgeries, they’ll need to understand ICD-10. Coders face steep learning curve For coders, ICD-10 will require detailed knowledge in a broad range of areas, including anatomy, physiology, pathophysiology, medical terms, surgical procedures, medical science, and pharmacology. A comprehensive training program must therefore be developed that can deliver the right knowledge to the right personnel at the right time. Training of between 25 and 50 hours per coder, depending on their level of knowledge and experience, typically will be required to achieve proficiency with ICD-10, according to CMS and the American Health Information Management Association (AHIMA). Managers should begin by assessing each coder’s strengths and weaknesses, and then develop individualized plans that can address areas of deficiency. A wide range of outsourced training options are available, from online e-learning to onsite consulting and classroom sessions. Managers should consult with trade organizations to determine the best training fit for their organization. Along with anatomical and clinical education, training will include an overview of the ICD-10 coding conventions, guidelines, and definitions. In addition to the greater level of clinical and anatomical specificity, other key differences between ICD-10 and ICD-9 include the use of seven-digit alphanumeric codes, as opposed to the five-digit codes used with ICD-9; an increased number of code combinations and more descriptive codes; and the restructuring of conditions (for example, injuries are grouped by anatomic site, as opposed to injury type). In the Billing department, a key task in preparing for ICD-10 will be to ensure that the clearinghouse used by the group has upgraded its claims software to handle the alphanumeric, sevendigit codes required by ICD-10. One step at a time The ICD-10 transition represents a monumental undertaking. Virtually every aspect of the physician office practice must be considered and potentially modified in light of the new documentation and coding requirements, yet the task is not insurmountable. By starting early in the identification of specific department requirements, developing an overall plan for training and transition, reaching out to key vendors to ensure compatibility and compliance, and moving ahead in small but steady steps, groups should be well-positioned when that now distant but fast-approaching deadline finally arrives. </p><strong>About the Author:</strong><br /><a rel="nofollow" href="http://sites.mckesson.com/practiceconsulting/practice_leaders.htm">Learn more about McKesson Practice Consultants</a> <a rel="nofollow" href="http://sites.mckesson.com/practiceconsulting/home.htm">Read about Physician Consulting Services</a> <a rel="nofollow" href="http://sites.mckesson.com/practiceconsulting/ICD-10.htm">Visit the ICD-10 Information Portal</a> <p> Article Source: <a href='http://www.articleseen.com/Article_Transitioning-to-ICD-10_113011.aspx'> http://www.articleseen.com/Article_Transitioning to ICD-10_113011.aspx</a></p>

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Keywords : IDC-10, coding and compliance, ,

Category : Business : Management