Keep Calm and ICD-10 On
“The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d-2(c)) and section 162.1002 of title 45, code of Federal Regulations.” That was the sentence in the Protecting Access to Medicare Act that has caused such a ruckus. Now what?
Coders: If you do not have a clinical background, take an Anatomy and Pathophysiology course. It will assist with understanding the signs/symptoms/manifestations of multiple conditions. This may allow for proper code assignment without as many queries to the providers. Obtaining education on the code set can allow for understanding of how ICD-9-CM differs from ICD-10-CM. This can allow for assessing how much training may be necessary for the practice or facility to get them ready for ICD-10. Coders that have received ICD-10 training can perform readiness assessments on their providers to help them with documentation improvement. They can assist with end-to-end testing with health plans that are moving forward with their ICD-10 preparation. They practice dual coding to keep their skills up. AAPC will offer free refresher webinars to those who have taken their ICD-10 code set training with us prior to October 1 of this year to help keep things fresh.
Physicians/Other Providers: Since ICD-10-CM has a higher level of granularity and coding is based on documentation, working with the physicians and other providers on documentation improvement is one of the best things a practice can do. Assessing the documentation today against ICD-10-CM standards will highlight the areas that need to be worked on to meet them. If you have multiple providers or multiple facilities, this will take time. You cannot expect someone to change their documentation habits of years in a matter of weeks. Just imagine the time to run the reports, pull and copy the records, perform the assessment, put together the reports, and meet with each provider individually. Now imagine that with 5 physicians/providers, 10, 20. Then imagine how many times that will take to work through the top 10 or 20 diagnoses of their patient base. Physicians and providers that perform their own coding will also need code set training on top of this.
Management: There are many things that management will also need to do. The timelines for all ICD-10 implementation steps will need to be reassessed, including, the educational plan and health plan contract reviews and negotiations. The budget will have to be adjusted to meet the new deadline. More in-depth testing of ICD-10 data and generating financial models showing the impact on claims reimbursement can be performed, but only if ICD-10 codes are understood by the practice.
Use your time wisely. Keep moving forward. Keep calm and ICD-10 on.