Reduce Administrative Burdens with ICD-10-CM
Target where your practice squanders resources and alleviate the waste, long term.
By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC
There has been much speculation on the potential benefits of implementing ICD-10-CM and whether physicians will see any benefit — or even if patients will. What I’m suggesting will benefit both.
You’ve heard how clinical documentation needs to improve because of ICD-10. But ICD-10 is not the only reason documentation must improve; it simply places a spotlight on any current deficiencies.
Let’s talk about several ways you can improve your diagnostic coding to ensure a more favorable patient experience, all the while benefitting your office.
Be More Specific
A common mistake is to latch onto an unspecified code at the beginning of an encounter and keep reusing it, ignoring that it is causing additional work for your clinicians, patients, and you.
Where coders really fall down is in developing coding tools and “cheat sheets” that only offer the unspecified condition, or in using technology that makes it easy for you or the clinician to select from a pre-populated list, without showing all of the menu options.
You know you’re guilty of these sorts of things if you often receive requests for additional information from a health plan, lab, or other referral source. What do you expect? You sent a claim that said, essentially, “We don’t really know what is going on with our patient.”
Think about it from another angle: After multiple visits, would you continue to pay for service at an auto repair shop if your bills repeatedly said, “unspecified repairs,” or would you find another repair shop?
This is a problem you can and should fix right now. Unspecified codes should only be used when not enough information is available to determine the patient’s actual clinical condition, or when there simply isn’t a more specific code available, and it’s your only choice. When the physician has determined the patient’s clinical condition, make sure to transition to the more specified choice.
In ICD-10-CM, the use of unspecified codes will be closely monitored because there’s little chance of you not being able to find a more appropriate code. Now is the time to move away from using unspecified codes, whenever possible.
Tell It Like It Is
Think about the underlying conditions or reasons the patient is seeking treatment. Is it adequately spelled out in the medical record, or on your claims? How many times have your claims been rejected because there is no indication if something was work related? How often are your claims subrogated?
Approximately 26 million injuries were treated in 2005. Imagine how many of those patients struggled to get their claims paid because of missing information. It took me over two years to resolve a claim for an injury I received. Not only did it consume a lot of my time, but also the time of everyone who paid a claim on my behalf or provided treatment to me.
Outside of injuries, the reporting of chronic conditions can help shape a patient’s future. Many health plans now offer case management or disease management, along with wellness programs. Patients can be identified quickly based on submitted diagnosis codes. This will help patients qualify for benefits that, ultimately, may reduce the cost of healthcare.
To save time, make sure the words found on intake forms, or in the actual clinical documentation, translate to what really happened. This will be much simpler with all the new codes available to us under ICD-10-CM.
Eliminate Administrative Burdens
Here’s a scenario to which many of you can probably relate:
The front desk leaves a field uncompleted in the data entry part of the patient registration. The claim is submitted, but later flagged by a claim scrubber or clearinghouse, resulting in your having to rework the claim. Consequently, your productivity takes a nose dive, as does your practice’s revenue.
Let’s look at this sort of problem from another angle: Your electronic health record interface allows you to request a prior authorization for a patient who needs magnetic resonance imaging to treat his shoulder injury. The documentation does not indicate how the injury occurred or that a comprehensive shoulder examination occurred. Nor does it mention failed treatments or the results of other diagnostic studies. What do you think will happen? More than likely, the claim will remain as “pending” while you gather the required information (physician query), or the physician has to call the health plan. This could take several days, or even a week. In the meantime, the patient sits in pain and waits.
Many physicians view coding as an administrative burden. But if you focus on continuous quality of patient care, all the other initiatives, quality measures, and coding requirements will all fall into place.
Get on Board
The first step to a successful transition to ICD-10 is identifying where your practice is wasting resources. From there, you can strategize ways to alleviate the waste for the long term. For example, approaching physicians with documentation tips that will make their lives easier is a much better approach then talking to them solely about coding. Implementing forms that capture certain information will take some of the burden off physicians, as well. Checklists for staff, retooling of “cheat sheets,” and all-around education will all go a long way in reducing administrative burdens and stabilizing revenue, even after October 1, 2015.
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.
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