ICD-10 presents itself with many challenges and complexities while the deadline of October 2013 is quickly approaching. For most organizations, this type of implementation and change is hospital-wide. To put it simply, ICD-10 migration will affect nearly every department in the hospital to some extent. A wise decision for any hospital would be to have a steering committee with representation from IT, Rev Cycle, HIM, and Clinicians to ensure the smoothest transition possible. The way to attack the transition will differ depending on your unique hospital; no two transitions will be alike. However, according to Healthcare Informatics Magazine, the technical issues of ICD-10 are not too bad – it’s the training of clinicians and coders that represent the biggest obstacle.
The key to ICD-10 transition is the training of clinicians and coders as early as possible. The suggested training time of these clinicians and coders is 3 to 6 months before go-live. Do not train too early, or else you risk those individuals forgetting the training they received. Because there is such a large difference in ICD-9 and ICD-10 codes, physicians and clinicians will need to be trained in proper documentation and coders themselves will need training in the new process and code list. For physicians, an average of only 4 hours in medical school is dedicated to proper documentation for coding. Without properly identifying the diagnoses, some coding is entered incorrectly. Insurance companies can then be billed improperly or incorrectly. If this is the case, it could lead to denied claims from the payor and then more effort to recode, resubmit, and appeal the denied claim – all adding additional cost to get the claim paid. So, proper coding the first time will help get the claim paid quicker. Educating those clinicians or physicians so they can write the correct diagnosis for the coders is extremely important.
As far as the system itself, it’s not just about adding the field by a few digits; it is literally a new coding methodology. There are thousands of new codes being introduced to the new system. Not only are the codes becoming more detailed per specific diagnosis, but the number is increasing dramatically. In a way, when do we know when something is too detailed, or there are too many codes? For example, there is code for being bitten by a turtle, and there is also a separate code for being “charged” by a turtle. Where is the line drawn for complexity of codes? How do we know if it is too much?
Many organizations are targeting their training and education processes differently. Ensuring a creative way to train in the new processes may assist in a smoother coding transition. Investing in products that show a crisscross methodology can show coders how ICD-9 codes would show in the ICD-10 system. Other organizations are researching their top diagnoses to see how much they will change from the 9 system to the 10 system. They’ll then use that research to guide and strategically educate their coders and clinicians. It is all about finding which process would be best for your specific hospital and employees.
What about the complexity of Meaningful Use (MU) and ICD-10 together? There is growing testimony that ICD-10 and MU complexities are “clashing.” According to Dr. Peter Muir, one of the first to receive federal reimbursements of MU, MU is making ICD-10 more complicated. Dr. Muir noted that because his practice is being compliant with MU, he cannot modify the coding templates as much when trying to crosslink ICD-9 and ICD-10. Instead, he advises future migrators to do the ICD-10 transition first. To be able to run a parallel in ICD-9 and ICD-10 rather than trying to modify each template in short order would make the transitions much easier. That way, many codes would automatically transfer to the ICD-10 system. But with the extreme detailing of diagnoses in ICD-10, how do we know each code would transfer properly, anyway? Transferring codes from a less detailed system (ICD-9) to a more detailed system (ICD-10) could present problems. Dr. Muir doesn’t believe the new ICD-10 system will help physicians in the practice of patient care. In fact, he thinks it will have a negative impact on healthcare in this critical time – it will cost a lot of money and not really improve care. Many doctors will be retiring earlier rather than later, he says.
What do you think about the complexity of ICD-10 and Meaningful Use? Do you think Meaningful Use and ICD-10 transitions will cause complexity issues?
Need guidance or assistance on an ICD-10 assessment or implementation? VCS can help! Email vcs@getvitalized.com, or call 610.444.1233.
