In my last article on ICD10Watch, I brought up the idea of continuing with the implementation of ICD-10 ready documentation systems now. I touched briefly on some reasons and they were mainly the obvious ones, the ones that may keep physicians awake at night (other than patients calling or an overnight shift).
But what about some of the more subtle reasons it’s a good idea? I these reasons come from taking a proactive rather than reactive approach to clinical documentation and (may I say it?) the revenue cycle.
Unless you came here from a different planet or are simply new to the healthcare business world, you are aware that there are groups who are very vocal in their opposition to ICD-10. The apparent loudest voice in opposing ICD-10 is the American Medical Association (AMA), whose claim is to represent the best interests of its member physicians in its opposition to ICD-10 implementation. As recently as February 2014, the AMA has called not just for the delay of ICD-10 implementation, but a total repeal. The letter cites the following reasons the AMA opposes ICD-10 implementation:
- It is not expected to improve patient care
- It is expected to disrupt efforts to transition to new delivery models (what does this mean?)
- The increase in number of codes
- It places an undue burden on physicians who already have other costly mandates to implement
- It is financially disastrous for physicians (cites report from Nachimson Associates which indicates increase in cost to implement chiefly due to EHR requirements mandated by congress )
- Fewer than half (47 percent) of physicians in an AMA poll state their practice management system vendor plans on delivering them an ICD-10 software upgrade
- Concerns regarding payers requiring a certain level of code detail, and reject or deny claims based upon internal requirements
The recurring litany regarding items one and three as reasons to oppose ICD-10 implementation make less and less sense to me as I use ICD-10-CM to code current documentation. According to the American College of Emergency Physicians (ACEP), ICD-10 can “enable better analysis of patient care through more focused quality measures. This will allow for better monitoring of patients with chronic conditions such as asthma, diabetes, and sickle cell disease. The new system will also permit better tracking of injuries that can lead to improved preventive and safety measures.” ICD-10 can offer through its cause-and-manifestation verbiage the potential to track ways to improve patient outcomes.
However, only through robust documentation and meticulous coding can the resultant data be best used. I have discovered that many conditions that appear on the surface to have expanded greatly in the ICD-10-CM code set are in essence not dissimilar to its ICD-9-CM counterpart. For example, otitis media, frequently described in primary care practices, emergency medicine and otorhinolaryngology specialties, only has the addition of laterality to the code descriptor. However in the past, documentation frequently states only otitis media, missing the terms acute or chronic, serous or suppurative. I spoke to a friend of mine who codes for an ENT practice about this and when she shared this information with the physicians there, they were relieved to find that their documentation already supported ICD-10-CM coding for otitis media. So, here is an example of unfounded fears and anxiety when there exists a lack of information and/or education.
For those situations where a change is in order, physician offices and hospitals should do what they can to implement ICD-10 ready EHR solutions as soon as possible. The advantages are numerous, and here are just a few:
- Allow all practitioners (physicians, non-physician practitioners and nurses alike) to make any adjustments to documentation well ahead of implementation
- Increase comfort level with any documentation changes well ahead of implementation
- More Continuous Documentation Improvement (CDI) can take place prior to implementation
- The improvement in documentation has the possibility of increasing revenue
- Improve patient care “…as documentation is excellent for clinical care it is also excellent for coding.” – Holly Louie, member HBMA
- Could decrease payer inquiries now, thus improving the revenue cycle.
I can fully appreciate concerns physicians have regarding the financial burden of ICD-10 implementation. It is my hope that physicians will also appreciate the return on investment of employing a Certified Professional Coder (CPC), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) as appropriate. These individuals should have the skills and background to efficiently and accurately code encounters, perform periodic documentation audits, conduct clinical documentation improvement sessions with providers and improve the overall business practices anywhere they are employed. If these are all done, the some of the financial burden of ICD-10 implementation might be offset. Investment in one of these individuals should also prevent the situation of having a vendor used by the physician practice or facility who is not ready for ICD-10. If your vendor is not prepared, find one who is.
I have been involved in conversations with payers and colleagues alike regarding statements made by payers about the possibility of pending or denying claims if it is determined that the most specific ICD-10-CM code was not used. I encourage each and every stakeholder to be actively involved in this endeavor to work with private and public payers to reach an understanding of what is commonly possible and not possible for each specialty. Payers should be transparent in their ICD-10-conversions of medical policies so that coders and clinicians can examine the policies in order to achieve a smooth, fair, and equitable transition.
To every challenge, there is a solution. There is no argument from either side stating ICD-10 implementation is not a challenge. It is, and will be. However, the benefit may just outweigh the risk. There are solutions available to overcome these challenges. Arm yourself with information and seek them.