My cat, Max & ICD-10

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I love my cat, Max and I like to think he loves me too. He likes to rub against my hands to try and get a pet or a good scratch. The other day I noticed that he does the exact same thing with my feet.  Max makes no distinction between the hands or the feet. To him they are the same, good for rubbing and scratching, (almost) equally.

feb_25_13 175What would you think about a healthcare provider that lacked the ability to make the simple distinction between hand and foot? They wouldn’t be in business very long! But that’s exactly what’s at stake for providers when comes to making a successful ICD-10 Transition on October 1, 2014.

Simply put, providers need to write down more stuff during patient encounters in order to capture the new documentation elements, for example; laterality, type of encounter, type of fracture and so on.  They need to make the distinction between right and left, initial encounter or subsequent, mild or moderate, and write it down!

Not doing so, providers face serious loss of revenue; if the code is not specific enough the claim will not get paid!  Not to mention stifled practice productivity brought by the onslaught of queries from coders -billers and referred providers – all needing more documentation to properly support the procedure or order request.


What I learned

I’ve just recently complete a three week intensive training (more like bootcamp!) learning about the pervasive impacts of ICD-10 on physician practices. Our own team of ICD-10 CM experts (having completed over 50 readiness assessments, on paper no less!) found that too many practices have not even started making their transition plan.  Many were hoping there would be another delay; there won’t be, both CMS and now the AMA are fully on board, it’s all systems go!

I also learned, for example, that the fracture of the patella under ICD-9 offers just two code choices, open or closed, that’s it, simple! Any guess on how many code choices there are for the same description under ICD-10 CM? Are you sitting down? Take a breath – 480!

Providers should not be focusing on the tens of thousands of new code choices; rather their focus should be toward capturing the limited elements of documentation required for full, fair and justifiable payment.

Moreover, some practices are deluded into thinking that their EHR or PM software vendor would take care of the transition for them. Nonsense! What exactly will your vendor provide you; a ‘pick list’ with tens of thousands of codes to choose from?  Is that going to cut it?  Ask yourself (better yet ask your vendor), are they going to pay for upgrades to software, provide new hardware or workstations, train staff and so on? Get the picture?!

The good news is that there is plenty of time to get ready. Successful transition to ICD-10 CM will require an ‘all hands on deck approach’.  Everywhere an ICD-9 code currently intersects with your practice process – initial encounter, coding, billing, referrals, lab orders, forms etc., – key stakeholders and practice administrators must have a real understanding of the impact and a comprehensive plan for success. Education, training, time and budget need to be considered.

The other good news is that providers that get started now and embrace the code set change will get fair and proper payment for work done! More thorough documentation leads to more accurate coding, resulting in better (justifiable) reimbursement.

Better documentation also gives providers the ammunition they need (now) in order to reverse medical necessity and other denials from payers.  Over time, more thorough reporting (and accumulated encounter data) can be used to;  demonstrate meaningful use, increase incentives (pay for performance) or provide more fire power when it comes to negotiating (managed care contracts) with payers!

A good place to start

You might want to start by doing some simple chart auditing; pick your top 20 or 30 diagnoses codes, convert them to ICD-10 (using GEMS, books or Transition software), and review several of those charts, identifying documentation shortfalls. Is there sufficient documentation in this chart to support an ICD-10 code choice? If not, help your provider with this information or perhaps even better, flash cards!

So there it is in a nutshell. While my cat doesn’t distinguish between hands and feet, providers and staff can. It’s that simple. You just need the right education, then make a plan and follow through!

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