September 29, 2015
ICD-10: Don't Stumble Out of the Gate

With two days to go, the conversion to ICD-10 is on everyone’s minds. Beginning on October 1, there will now be tens of thousands of new codes to contend with, most of which require a much deeper level of detail if you want to get paid. Here are some ideas for running a last-minute ICD-10 boot camp, to help your practice, department or facility start strong.

1. Answer any last-minute questions for physicians, physician assistants and advanced practice nurses

Staff who can diagnose, prescribe or otherwise provide billable care are the front line. Their notes will determine everything that follows, so it’s important that it be right from the start. With 54,000 more codes to contend with, the ICD-10 code set is, by nature, more specific than that of ICD-9 — meaning that documentation, too, will need to be more extensive, to differentiate between nuances in the codes. The good news is that 78% of ICD-9 codes correspond directly or closely to an ICD-10 code, and a large chunk of ICD-10 codes are related to accuracy in anatomical location (i.e. left, right and bilateral). Therefore, whether your physicians or scribes trained specifically in creating patient records that ease ICD-10 coding, you should have patient record templates that accommodate the more detailed notes that will be required. These templates should also make it easy to provide information for codes that will be frequently used, particularly those that will be subject to “external cause of reporting” justification or recorded as part of a linked condition (e.g., hypertension and heart disease, or diabetes lower-limb neuropathy). Go over these templates before conversion and answer any last-minute questions — now is the time, not October 1.

2. Perform final checks with your practice management software and/or EHR vendor

Those templates? They need to work. Practice management and EHR vendors have updated their software to work with ICD-10, and you’ve had the option to input your own, bespoke templates or adopt those provided by the vendor. However, the templates may be “more related to coding than to documentation,” and prompts for various pathways may be missing. Walk through mock patient encounters at the physician Q&A, to flag up issues that may happen in practice. ICD-10-trained scribes can also help you note documentation-flow issues. Insert prompts as necessary in the template, or work with your practice management software or EHR vendor to add them as soon as possible to the date of implementation.

3. Do a run-through with your coding and billing staff or vendor

Use the mock patient encounters and the documentation they generate to determine the corresponding ICD-10 codes. These codes can then be checked for accuracy and completeness according to each payer’s requirements, and whether they would result in payment in full. Using scribes connected to coders in real-time is one approach for ensuring that there are minimal gaps in time between patient care and final billing — critically important when undertaking such a huge transition. ScribeAmerica offers a real-time coding solution that reduces the latency in feedback and improves overall efficacy of the revenue cycle by connecting the clinician, in the room with the patient, with back-office coding personnel, so that documentation contains all the information necessary for these more-detailed codes.

4. Double-check, and triple-check, with your payers

Although payers will have sent their specific requirements in advance of October 1, don’t be afraid to ask questions about the codes you generate. Show that you’re holding up your end of the bargain by closely tracking the types of claims that are frequently sent back for revision, and those that are rejected outright — you can never be armed with too much data when communicating with your payers. Payers want to collaborate, as it makes their jobs easier, too.

5. Breathe deep, and dive in

Physicians now have a 1-year grace period until full implementation, but hospitals and other facilities must be fully ready on October 1. ICD-10 represents the global standard for medical coding and record-keeping, and it’s high time the United States caught up. The sooner you take the plunge, the sooner it’ll all become second nature.