How staff can prepare for ICD-10

By now you have heard and read a lot regarding ICD-10 changes coming in October. This is the most significant coding change in health care in more than 30 years, and the impact on healthcare practices cannot be overstated. Let’s discuss some of the changes in the new diagnosis coding system and how you can prepare for the transition.

ICD-10 vs. ICD-9

The ICD-9 coding system is 30 years old and felt to be outdated. Some codes are outdated or obsolete. The additional specificity in ICD-10 provides codes for more accurate payment for new procedures, and the hope is that they will lead to fewer rejected and improper claims as well as better understanding of new procedures and improved disease management.¹ Not only are there many more codes (about 69,000 ICD-10 codes compared to about 14,000 ICD-9 codes), the format of the codes and some of the rules and conventions for assigning the codes have changed.

The biggest concern in most practices is that the conversion to ICD-10 will disrupt the claims process and, by extension, cash flow. So, it goes without saying that this change will affect the coding and billing staff.  But it goes beyond the claims process and affects more than the billers.

Medical Economics: ICD-10 documentation: The key to getting paid 

Here’s a quick look at how moving to ICD-10 will affect different roles within the office.

• Doctors. They need to better document in order to select and support the correct codes. Some doctors assume that the office’s EHR program will take care of this for them. While the EHR should be loaded with the full selection of ICD-10 codes-and it may even be able to map over from previously reported ICD-9 codes to narrow down the code choices-it should not be relied on as the final answer.

• Administrators and managers. They will oversee implementation and education and managing the report for CMS bonus programs (such as PQRS).

• Technicians and scribes. They will need to rethink how they interview patients and document in charts.

• Reception and front desk staff. They will face new forms, changes to payer policies, and requirements for precertification.

• IT staff. They must handle updates to the computer.

• Outside billing companies. They must insure that they are they compliant. 

Next: Techs-all about documentation

Techs: all about documentation

Often technicians ignore the details of coding, presuming someone in the practice is responsible for coding and billing. However, both the procedure and diagnosis codes are based on what is documented in the record. With the dramatic increase in the number of code options, it is obvious that the objective is to be more specific in your code selection, not less. The use of vague, non-specific codes is discouraged, and the code selection is very detailed.

Related: ICD-10 transition costs lower than previously reported

Detailed coding begins with thorough, correct charting, so documentation is a good place to focus your ICD-10 preparation. Consider common ophthalmic diagnoses and how they are reported in the medical records. It is not unusual see the impression listed as “cataract,” “glaucoma,” “diabetes,” or “corneal abrasion.”

The use of very specific ICD-10 codes requires more detailed information regarding the condition, such as which eye(s) are affected, severity, and other factors such as insulin or prior care for that condition.

To properly select an ICD-10 code, the impression it the chart should look more like:

• Nuclear sclerotic cataract, both eyes (ICD-10 code H25.13)

• Primary open angle glaucoma, both eyes, mild stage (ICD-10 code H40.11x2)

• Type II diabetes with mild NPDR w/o macular edema (ICD-10 code E11.329), patient on insulin (ICD-10 code Z79.4)

• Injury of the conjunctival and corneal abrasion without foreign body right eye, initial encounter (ICD-10 code S05.01xA)

Many technicians see this level of detail and wonder, “What made you think to ask if the patient was on insulin or if the abrasion had been evaluated previously?” and a slight panic may set in. Let’s not go there.

In preparing for ICD-10, doctors and technicians need to change their history-taking and documentation habits so the pertinent information is available when the time comes to select a code.

Next: Getting started

Getting started

Get your hands on the ICD-10 book and attend training. The rules and conventions are spelled out in the introduction of the ICD-10 manual. The book contains language intended to direct you to the correct code, such as “see” and “see also,” “code also” or “code first,” “excludes.”

Look for new coding concepts, such as laterality required in some codes, combination codes, required fifth or seventh digits, and “placeholders” prior to the seventh digit in some codes. Review the neoplasm table and the table of drugs as they apply to your practice.

Although Chapter 7 focuses on conditions affecting the eye and adnexa, familiarize yourself with the other chapters of the book that contain codes pertinent to eye care, such as neoplasms (Chapter 2), endocrine and nutrition conditions (Chapter 4) and injuries (Chapter 19).

Related: Many ODs unprepared for ICD-10

There are many sources of training available, including online training, recorded or live webinars, conferences and seminars, and in-office training. Ophthalmic-specific courses are preferred. 

Following your introduction to the book and initial training, review a sample of medical records. Consider running a report from the practice management system to find the top 20 or 25 diagnoses used by each doctor. Focus your attention on charts containing those conditions.

Determine if there is enough detail, as documented, to assign an ICD-10 code. If charting is insufficient, follow up with training for the technicians on history taking and knowing what questions to ask. Include scribes in this training. As the physician continues the conversation with the patient, it up to the scribes to ensure that portion of the history is recorded. In reviewing your charts, begin assigning ICD-10 codes where possible. Work in a small group and double check each other’s answers.

Use this exercise to both improve your understanding of coding and improve the way you think about charting. As you gain accuracy and confidence in coding, expand the chart sample from the most common diagnoses to some of the less common conditions your practice treats, such as infections and injuries. 

Arm yourself with resources. Often an electronic code search yields information more quickly than searching through ICD-10 book. For your smartphone or tablet, app stores have a number of options (make sure you are getting the most current version). There are useful tools on the CMS website, including the CMS GEM files. The websites for coding organizations such as AHIMA and AAPC also contain useful tools.

Next: Planning for implementation

Planning for implementation

October sounds like a long way off but the best time to begin is now. 

Here’s a checklist to prepare for ICD-10 implementation.

• Rally the troops. If the practice does not already have a team in place, now is the time to rally the go-to people. A lead technician or technician supervisor should be part of that team.

• Schedule first-level training. The sooner, the better if you haven’t already had training.

• Put that training to work.

• Review small samples of charts with all the resources available to you to assess current documentation and where improvements may be needed.

• If forms or templates need revising to improve documentation, take the necessary steps to do so now.

• As documentation improves, begin coding a small sample of charts each day using the ICD-10 system.

• Practice, practice, practice.

• Check your progress. CMS has announced three week-long testing periods during which physicians and other providers and suppliers can submit ICD-10 codes on claims and receive acknowledgment of where the claim was received and accepted vs. received and rejected. No remittance advice will be generated. The first two took place in November and early March. Plan to take advantage of the third testing period June 1-5, 2015.²

Related: Specificity key for smooth transition to ICD-10

Looking ahead

Remember, while moving into ICD-10 coding may seem daunting, it is doable. Education and preparation are key-they will help minimize the panic and help ensure a smooth transition. Technicians and staff have a number of resources at their fingertips. The limiting factor, like always, is finding the time in a busy practice to dedicate to planning and training. Start soon, start small, and build on your efforts as you progress.

Click here to see the latest advice for techs

References

1.   Federal Register. Vol. 74, No. 11 1/16/09. http://www.gpo.gov/fdsys/pkg/FR-2009-01-16/pdf/E9-743.pdf. Accessed 12/18/14

2.   MedLearnMatters, MM 8858, 8/22/14. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8858.pdf. Accessed 12/18/14