Put Your ICD-10 Transition in Fast-Forward

With the deadline for ICD-10 compliance now set for Oct. 1, 2014, it's good to reflect back on why we as an industry are transitioning to ICD-10 in the first place. The greater specificity levels within clinical documentation will provide an improved understanding of health conditions and impact patient outcomes. ICD-10 will also provide more granular data for disease management worldwide and reduce additional documentation that is needed at the time of reimbursement. At the end of the day though, this change links directly back to patient care.  

Because the ICD-10 deadline has been pushed back, some may think that they can devote time to other pressing projects. However, now is not the time to backburner efforts to streamline the transition to ICD-10. There are three main areas that healthcare provider organizations should be focused on over the next two years in order to ensure that this transition is a successful one. 

Education and training

The first step, according to a checklist developed by the American Health Information Management Association, is to educate the executive team on the reimbursement impact of ICD-10. It is critical to have strong leadership that will support the initiative and facilitate the creation of the necessary committees needed to tackle this transition head on. The committee will need to be multidisciplinary based on your goals and objectives, since it will impact the clinicians, coders, revenue and reimbursement staff — as well as your bottom line. For the clinicians, the key will be to look at the level of specificity in their documentation. It will be prudent to evaluate the specialties that will be most affected and to look at the most utilized Diagnosis-related Groups that you have based on volume and revenue. You should also evaluate how other regulatory mandates, such as meaningful use, will impact the capture of clinical documentation. 

If you have a clinical documentation improvement program or are looking into one, this will be the bridge to assist your clinicians in starting to document at the specificity that will be required under ICD-10. As you are implementing this CDI process, understanding the impact across the board will give organizations the opportunity to account for all necessary changes, instead of addressing them incrementally. For the coding staff, they will need to brush up on proficiency in the anatomy, physiology and medical terminology required for the transition. There are many ICD-10 certified trainers and vendors in the industry that have created assessment plans and transition programs to assist with the education process.

Technology

Evaluating tools that are available to assist with this transition can be monumental in ensuring accuracy, productivity and reimbursement levels remain at an appropriate level. The coding complexity is going from seventeen thousand diagnostic and procedure codes to over one hundred fifty five thousand. The advent of computer assisted coding with clinical language understanding as the backbone will provide a true advantage. These technologies provide real-time CDI queries as the physician is documenting or signing their documentation. This will enforce the training of the physicians to ensure they are capturing the level of specificity at the front-end, without additional duties to their workload. Coders also benefit from this technology as they are able to easily review the suggested codes from the CAC, and they can focus on reviewing and validating the codes, which opens up more time for them to focus on complex issues. The ability to turn text into actionable data will further increase the quality of documentation, minimize impact to clinician workflow and give you the advantage of structured and codified data to meet your regulatory, quality and reimbursement needs.

Testing

Once you have a handle on the most utilized DRGs and the target physician populations that you want to focus on, it's important to create testing scenarios. This will allow your organization to run through the entire process from capturing the documentation through the eventual testing with your payors. It will also assist with troubleshooting internally as the documentation improvement program will be able to identify up front the queries that need to be addressed by the physician. This type of testing and troubleshooting, along with CLU and CAC, will assist with the accuracy of coding, creating a continuous cycle of improvement so that your organization will be able to identify the problem areas and resolve them before the Oct. 1, 2014 deadline.

While 2014 may seem a long way off today, it's actually not when you consider the complexity and planning needed to make the ICD-10 transition seamless. When it comes to tackling ICD-10, it's best to live by this motto:

"A wise person does at once, what a fool does at last. Both do the same thing; only at different times." — Lord Acton, British Historian

Patricia Trumm is a senior marketing manager for the healthcare division at Nuance Communications, responsible for driving the marketing of Nuance’s clinical language understanding-based solutions as well as serving as a resource to those working on EHR integration efforts.  Her focus is on driving positive outcomes by utilizing technology and best practices for clinical documentation improvement.

More Articles on ICD-10:

5 Steps for a Smooth ICD-10 Transition From CMS
Tackling ICD-10: Why Physicians Play the Largest Role in Adoption