ICD-10: Keeping on Track
By Doug Arrington, MSN, FNP, CPC, CPC-H, CPMA, CHC, CHRC
The other day I was in the clinic talking with the management staff. They were so relieved that there was another year before ICD-10 was going to be implemented. They all thought that they could put everything on hold for 10 or so months. As an AAPC Certified Coder and Nurse Practitioner this was a good opportunity to remind them of some of the things that still needed to be done to get ready for Oct. 2015. Here are some of the things that I discussed with the management team.
1. EMR templates – All of the history of present illness, physical exam, and medical decision making templates need to be updated to reflect the documentation requirements for ICD-10.
2. Principle diagnosis, and secondary diagnosis screens – Each clinical area has their own diagnosis screens. Each needs to be updated to reflect ICD-10. These have not been validated to make sure that they work for ICD-10. Two clinical teams use coding questions – for evaluation and management, procedure, and HCPCS codes. Create clinical scripts to make sure that these coding questions work correctly.
3. Dual Code each clinical provider – Each clinic needs to be working with their providers to make sure that they are documenting at the level required for ICD-10. I started back in February. Even as a certified coder, when I put on a white lab coat, I went back to the way I have been documenting charts since I graduated from my Master’s program some 25 years ago. I still take my ICD-10 cheat sheet in with me when I see patients. ICD-10 requires a whole new way of thinking for me. I cannot speak for other healthcare providers, but you can teach old dogs new things. It has taken much time and practice for me to get consistent in each clinic. For me, it was like going back to the very beginning and relearning required documentation for the key elements of HPI, PE, and MDM. I would suggest a schedule for each provider with increased frequency and another 6 months from October dual code all encounters. Healthcare providers, coders, billers, and other Revenue Cycle team members need to be comfortable with ICD-10.
4. Revenue Cycle – Look at each stage of the Revenue Cycle. How does ICD-10 impact each step? Has every internal point been validated? Has every external vendor been validated?
5. Dual Testing with External Vendors – Create some test files that can be sent to the external vendors to make sure that you communication links work and that the information comes through correctly. Then set up a date before Oct. 2015 when you will submit two files – one ICD-9 and another ICD-10. Compare each patient side by side to make sure the information matches.
6. Backup plan – What is the plan if the EMR is down? How is the clinic going to function? Consider each step from patient check-in to check out. What is the down time protocol? Even more importantly, what is the practice going to do in the case of a power outage? Patients need to be seen. Have a disaster plan for fire, flood, tornado, or any other type of natural disaster. It is time to take that plan out and update to reflect what the practice is going to do.
After talking to them for about five minutes, they all agreed that there were many things that each clinic site needed to do. They decided to pull in the clinic managers and reexamine the ICD-10 implementation plan. There are still many things on ICD-10 implementation plans that healthcare providers, clinics, and health systems need to do. Each action on your ICD-10 implementation plan needs to be checked, tested, verified (see #5 above), and then tested on a regular basis. Use the extra 12 months to perfect your implementation plan.