Outfitting for the ICD-10 Voyage – Breakaway Thinking

Posted on November 19, 2013 I Written By

The following is a guest blog post by Laura Speek from The Breakaway Group (A Xerox Company) and Honora Roberts from Xerox. Check out all of the blog posts in the Breakaway Thinking series.
ICD-10 Boat
These are challenging times for healthcare providers in every imaginable vessel – and the whitewater ride is not over yet. Just around the bend looms the transition to ICD-10, scheduled for October 1, 2014. Most providers know the wisest course is to start preparing now, yet few have dared to navigate these uncharted waters.

For many, a major problem is not knowing where to start. Others may be suffering from protracted procrastination. And still others may be well on the road to ruin via the path of good intentions.

An effective way to put some wind in your ICD-10 sails is to get real about the serious costs of noncompliance. After October 1, 2014, claims must be submitted using ICD-10 coding to be eligible for reimbursement. In other words, if you don’t bill with ICD-10 codes, you simply won’t get paid. And that’s the cold, hard truth.

The transition to ICD-10 will affect every facet of healthcare, but it begins with understanding the basic differences between ICD-9 and ICD-10. First and foremost, ICD-10 is not just a simple expansion of ICD-9. There is no reliable one-to-one mapping system. Some ICD-9 codes equate to multiple ICD-10 codes, while some do not correspond to any.

ICD-10 codes include much greater specificity; care providers must document etiology, laterality, exact anatomical site, and other information. Patient encounter documentation must include proper detail to enable coders to locate the correct ICD-10 diagnosis and procedure codes. Physicians and mid-level providers should begin to assess their documentation today to identify where ICD-10 coding requirements are already being met and where improvement is needed.

Because clinical documentation is at the core of every patient encounter, it must be complete, precise, and accurately reflect the scope of care and services provided. Assuring depth and consistency of documentation represents a challenge for many organizations.

ICD-10 encompasses a huge increase in accessible codes. The ICD-10-CM diagnostic code set, used in all healthcare settings, increases from roughly 13,000 to 68,000 codes. The ICD-10-PCS procedural code set, used within inpatient settings only, expands from roughly 3,000 to 87,000 codes. It should be noted that ambulatory settings will continue to use CPT (Current Procedural Terminology) procedural codes.

Given this massive growth in coding scope, the importance of detailed clinical documentation becomes even more pronounced. Physicians and other healthcare providers typically are not trained to develop proper documentation skills in medical school or residency; nurse practitioners (NPs) and physician assistants (PAs) generally do not receive such training during graduate school or clinical rotations. Hospitals and healthcare systems need to compensate for this training deficiency by instituting educational programs and tools that align healthcare providers with proper documentation practices to clear the decks for successful transition to ICD-10.

ICD-10 requires physicians, NPs, and PAs to thoroughly document each and every patient encounter to a much greater level of specificity than is needed in ICD-9. Nonspecific or incomplete documentation within ICD-10 will cause delays, claim denials, cash-flow interruptions, and inaccurate quality reporting. Definition and terminology changes inherent in ICD-10, particularly for surgical procedures, will also require focused education and training.

At the end of the day, providers aren’t coders. They are far less concerned with ICD-10 codes than they are with improving quality of care. This is where ICD-10 can be viewed as a welcoming beacon on a rocky shore. It gives healthcare providers an incentive to establish a clinical documentation improvement (CDI) program. In fact, implementing and sustaining an effective CDI initiative should be a top priority for all healthcare organizations preparing for ICD-10. For those with no CDI program in place, the time to begin is now. Consider improved clinical documentation as essential equipment for maneuvering through the twists, turns, and churns that accompany the voyage to ICD-10.

Honora Roberts - Xerox
Honora Roberts is Vice President of Healthcare Provider Services at Xerox.

Laura Speek  - The Breakaway Group
Laura Speek is a Learning and Development Specialist at The Breakaway Group (a Xerox company).

Xerox is a sponsor of the Breakaway Thinking series of blog posts.