Preparing for ICD-10 Lift Off
Although it looked as if there would be no reprieve this time, Congress passed a delay of ‘at least one year’ for ICD-10 conversion as part of a package enacting another temporary patch to the flawed sustainable growth rate formula on Monday evening, March 31.
In addressing members of the Healthcare Information and Management Systems Society (HIMSS) in late February, Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said, "There are no more delays, and the system will go live on Oct. 1.” She then added, "It's time to move on."
Evidently it isn’t quite time, yet. However, the American Hospital Association, IT professionals, coding experts, and a number of consultants across the health continuum share Tavenner’s sentiments. Those in favor … or at least acceptance … of the move find that ICD-10 coding better mirrors what we now know about disease states, improves the ability to research and trace diseases on a global scale, and is laid out in a logical, orderly manner.
Kraft Healthcare Consulting experts Heather Greene, MBA, RHIA, CPC, CPMA, and Scott Mertie, CHFP, FHFMA, recently sat down with Nashville Medical News to discuss ICD-10 and its implications and implementation. Greene, a member of the 2014 Women to Watch Class (see insert), is vice president of Compliance Services and Mertie is president of Kraft’s healthcare industry team.
ICD-10 has been in use by some countries since 1994. While World Health Organization rules call for all member states to adopt the latest version of ICD, there really is no way to mandate or enforce when that might occur. However, more than 100 nations have adopted the system, which can be clinically modified for use within a country. The United States is among the last industrialized nations to make the switch.
“The reason we’re so far behind is because we were so far ahead,” Greene said. She went on to explain that when ICD-9 was adopted in 1979, the United States heavily invested in technology, equipment and training. “Those advances have made it expensive to change.”
Despite ICD-9 modifications and tweaks over the years, the U.S. is using a system crafted 35 years ago. As the Kraft team pointed out, it is inconceivable that any other type of business system would have been in place that long with no major update.
“We’re three decades behind,” Greene said. “We’re using a nomenclature that is no longer relevant to a lot of our disease processes and understanding.”
Greene added the previous implementation delay didn’t necessarily pan out as envisioned. “We’re further behind now than we were a year ago,” she stated. “Before it was delayed, we were all moving forward. There was momentum.”
Once the delay from 2013 to 2014 was announced, many people put ICD-10 on the back burner. The concern is that rather than using this extra time to prepare, the same thing will happen again with this latest extension.
“We have some clients who have been very proactive,” Mertie noted. “Others are not ready to worry about it yet.” However, he added, “You can’t avoid the inevitable. The time is now.”
Eating the Elephant
As the old saying goes … “How do you eat an elephant? One bite at a time.”
Greene said some of the trepidation over ICD-10 understandably comes from the magnitude of the switchover and vast increase in codes. Thinking about ICD-10 in toto is understandably overwhelming. However, most everyone will have parts of the ‘elephant’ left untouched.
Providers, Greene pointed out, have a good idea about their general patient population and should pay particularly close attention to codes used in frequent rotation … and recognize that a significant number of the codes might never be used. For example, codes pertaining to being bit and/or hit by a sea turtle might possibly come into play in Hawaii and coastal states, but Tennessee coders are probably safe to chuckle over those and then promptly forget them.
Mertie added Kraft recently completed a boot camp for a large national skilled nursing provider. When honing in on necessary codes for their senior population, Mertie pointed out, “A lot of sections were just gone … like OB/GYN, pediatric codes, etc.”
Both agreed orthopaedic practices cross many populations and would, therefore, have a steeper learning curve than some specialties. “Orthopaedics is going to be hit hard,” Greene said. “They need to be prepared.” However, she continued, “If they documented well in ICD-9, it should only be tweaking for ICD-10. I’m not a proponent of massive documentation, but I believe in clear, concise documentation … it’s key words.”
She added that coding, whether in ICD-9 or ICD-10, is a challenge every day. In conducting trainings, she said, “I ask my coders, ‘When did a challenge stop you?’ … ‘Not often’ is the usual response.”
Finding the Good
A major plus, Greene and Mertie agreed, is that ICD-10 coding does follow a logical sequence. “Think about how many diseases have been discovered in just the last three decades,” Mertie said. He added that in trying to ‘squeeze’ new information into the existing ICD-9 structure, any pattern that existed got lost over time.
“In ICD-10, there is a rhyme and a reason for placement,” Greene said of codes. “Even though it’s huge, it’s structured; and it’s logical; and it makes sense.”
She added, as an example, injury codes run from head to toe. ICD-10 also has much more emphasis on laterality and has a specificity that is missing in the current system. The hope is that the ability to more fully explain a patient’s situation through coding will result in the need for less verbiage in documentation and fewer claims heading to appeals since payers will have a clearer picture on the front end.
Although she understands why providers might be frustrated with the level of specificity, Greene said there is a bigger picture that impacts research and patient care.
“If I’m being attacked by a crocodile or an alligator, I don’t care which it is. But, if I’m researching the overpopulation of these animals in the Everglades, I’d want to know which animal is more aggressive and where it is attacking. From a research standpoint that information is huge,” she said.
Circling back to a more common injury … falls … she pointed to how details that might initially be thought of as extraneous could actually impact patient care and prevention by statistically showing patterns to providers and payers. “If you know what room it’s in (the fall), that might make a huge difference with an aging population,” Greene said. “For example, if I find most seniors are falling in bathroom tubs, it might make more sense to pay for a $50 handrail instead of $50,000 in hip surgery and rehab.”
Mertie added, “My hope is that as a population, it will help us find solutions that we couldn’t before. We would have been stretching the correlation in ICD-9 … it’s a much more direct correlation in ICD-10.”
Coming Out the Other Side
Like most things in life, preparation is half the battle.
Greene and Mertie said they readily recognize the concerns of providers and coders worried about denials as a result of inadvertent mistakes. However, Mertie noted, “The more time they can spend preparing for it, that’s going to make the hit on their revenue cycle much less.”
Greene favors a ‘ripping the bandage off’ approach. At some point, providers and coders simply have to dive into the new process. In some ways, the U.S. has debated ICD-10 for so long that it has become healthcare’s version of the bogeyman.
After training sessions are finished, Greene noted she inevitably hears comments from participants that ICD-10 wasn’t as bad as imagined. “Part of what I do is help them get rid of the fear, which hinders learning,” she explained.
Still, Greene added, the new nomenclature represents a major shift and will be a bit like starting over even for experienced coders. “Be prepared for some glitches,” she counseled, adding those are to be expected no matter how long individuals have to prepare for the conversion. “One thing I advise is to make sure you have a financial plan in place to weather the (cash flow) disruption.”
Greene concluded, “Any change is difficult … and this is going to be difficult. I wouldn’t want to ever say it’s all going to be rainbows and roses. It’s going to be hard work.” But, she continued, “I think when we get to the other side, we’ll find ourselves in a better situation.”
ICD-10 Boot Camps
There are a number of opportunities to attend an ICD-10 training seminar in Nashville over the next few months. Below are a few upcoming options. For additional ideas, check with your local, state and national professional organizations and your technology and management consultants.
June 11-13 • AHIMA Academy for ICD-10-CM/PCS
Pre-requisite for the in-person training is completion of two self-paced online courses. In Nashville, the three-day course builds upon the basic online training and focuses on in-class coding exercise while modeling training techniques. For more info, go online to ahima.org/events.
July 24-25 • AAPC Boot Camp for Coders
Developed by a team of nationally renowned experts, AAPC’s ICD-10 training for coders incorporates comprehensive curriculum with actionable steps for all those involved with their organization's transition to ICD-10. For information, go to aapc.com/ICD-10/training.aspx and select boot camps.
A Few More Options
The Tennessee Medical Association has teamed up with the Tennessee Health Information Management Association to create coding camps slated for early fall. For information, go to tnmed.org/professional-development/icd-10.
The American Congress of Obstetricians and Gynecologists have a workshop scheduled in Nashville May 22-25.
ZHealth Publishing is hosting a coding seminar covering the codes for reporting Interventional Radiology, Interventional Cardiology, and Vascular/Endovascular Surgery procedures May 12-16 at the Omni Nashville and Sept. 8-12 at Gaylord Opryland.