With approximately seven months to go, and after nearly three years of preparation, is your organization ready for ICD-10? On Oct. 1, hospitals must begin to report claims using the new ICD-10 coding system for all payers. It's likely that a lot of progress already has been made, including software changes. With the time left this year, hospital leaders must prioritize and monitor progress on the conversion across the entire organization with the focus being on coder education, improving physician documentation and testing software changes.
This is the biggest change in the coding field in the last 30 years and hospitals can expect a slowdown in coder productivity that may result in cash-flow delays. ICD-10 consists of both diagnosis codes (ICD-10-CM) and procedure codes (ICD-10-PCS) with a significant increase in the number of codes and increased specificity. Current ICD-9-CM expert coders will find many similarities with ICD-10-CM and will quickly adapt to the change. However, the transition to ICD-10-PCS is much more dramatic because the systems bear little resemblance in structure, format and complexity. Only hospital inpatient reporting will transition to ICD-10-PCS. This is important as the diagnosis and procedure codes are the DNA of DRG payments.
While physicians will not be responsible for knowing the actual codes, they need to understand the conceptual changes to the subset of codes in their clinical areas. It's not about increasing the volume of physician documentation, but about targeted improvements in a few specific areas. For example, operative reports should specify the surgical approach, the organ or part of the body operated on, and whether any devices were implanted. Hospital leaders will need to communicate with physicians to address the value of the increased information that the more specific codes can provide in existing initiatives such as improving care, quality reporting, value-based purchasing and preventing readmissions.
Many hospital preparation plans include dually coding (coding the same claim using ICD-9-CM and ICD-10-CM/PCS) for a subset of claims. This is important to provide coders the opportunity to practice after training, identify gaps in physician documentation and have sufficient information to conduct financial impact analyses using the hospital's own patient claims data. Any problems identified should be resolved prior to the go-live date for an easier transition and to avoid delays in billing. For example, if operative reports routinely do not specify the vein used as a coronary artery bypass graft, the hospital may work with the surgeon(s) to determine the physician's preference (e.g,. greater or lesser saphenous vein) and either create an internal coding policy or obtain the surgeon's collaboration in providing this information in future reports. Failure to correct this problem will result in the claim being held back while the coder seeks clarification from the surgeon on every CABG because the procedure cannot be coded without identification of the vein graft.
The dually coded data also are useful to test with major payers to ensure that claims can be transmitted and processed consistent with payer and provider expectations. Mistakes could lead to unexpected and potentially adverse changes in payment, as well as delays if large numbers of claims are denied.
Time flies, and hospitals have a lot of work ahead for the remaining seven months to ensure a successful transition to ICD-10.
Nelly Leon-Chisen, RHIA, is the director of coding and classification at the American Hospital Association.
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