Home Health & Hospice Week

It's not too early to get in touch with software vendors.

The OASIS Manual's Attachment D might be giving home health agencies fits over diagnosis coding, but an even bigger coding challenge could soon be upon you -- ICD-10.

With all eyes on the proposed October 2011 deadline for ICD-10 implementation, the Centers for Medicare & Medicaid Services is encouraging providers to prepare now in case that proposed rule becomes final. During a CMS-sponsored ICD-10 National Provider Call in November, presenters reminded listeners to determine where they'll need extra help in transitioning to ICD-10.

Act now: If providers figure they'll cross that bridge when the implementation date is finalized, they may end up behind the eight ball. "Don't wait for the final rule, because you're wasting precious time," said coder Nelly Leon-Chisen, director of coding and classification with the American Hospital Association. "Get started right away if you haven't done so."

Leon-Chisen recommended conducting systems inventories now to determine the databases that use ICD-9-CM. That way, providers can determine which software programs they have and whether they need to work with their vendors to determine the vendors' plans for ICD-10 implementation.

Providers who have homemade software programs should find out whether they have the resources internally to change the system for ICD-10, or whether they'll need outside help to migrate to the new system, Leon-Chisen advised. Vendors probably won't be ICD-10 ready at this point, but it's a good idea for providers to touch base with their vendor representatives to determine their status.

"Vendors are participating in the comment process," explained Pat Brooks, a technical advisor with CMS. "You should initiate a dialogue with your vendor to determine whether they're aware of ICD-10 and are proceeding with ways to incorporate it."

But don't be put out if there aren't a lot of concrete details from vendors yet. "We have not put out a final rule, and until such time as there's a definitive date to move forward, I don't believe it would be possible for many vendors to have a firm timeline yet" for ICD-10 conversion, Brooks advised.

There've been lots of rumors that on-the-ground staff won't be able to effectively use ICD-10 codes unless they've had years of training. But this is wrong, according to the recent CMS call.

Last May, a formal testing process took place to "assess the functionality and utility of applying ICD-10 codes to actual medical records in a variety of health care settings and assess the level of coding training required," according to Sue Bowman, director of coding policy and compliance at the American Health Information Man-agement Association.

Home care bonus: During the testing, credentialed health information management professionals who had no prior ICD-10 experience coded 6,177 medical records. Prior to the test, the participants received two hours of non-interactive training, and their coding accuracy and understanding of how to use ICD-10 were "surprisingly good," Bowman said. Plus, results showed that ICD-10 was found to be a "significant improvement" over ICD-9, and ICD-10 was more applicable to non-hospital settings than ICD-9, Bowman said.

Only 12.3 percent of the reported ICD-10 codes in the project were billed as "unspecified," indicating that documentation required to support ICD-10's specificity was in most of the medical records, Bowman noted.

The participants who coded the records said that ICD-10 "wasn't nearly as hard as they thought it would be," leading AHIMA to conclude that "intensive coder training" should occur three to six months prior to implementation, Bowman said.

A little help: In a statement sure to get coders cheering, Jeffrey Linzer, MD, associate professor of pediatrics and emergency medicine at Emory University School of Medicine, pointed out that physicians should use terminology that helps coders select the right code. "Right now, physicians are not writing down terminology that is helpful to the coders who are helping us do our work, and that's why the coders are coming back to you now asking you to clarify what you've written as a diagnosis, because they need to be able to pick it out of the ICD-9 book," Linzer said in the call. "That's not going to change with ICD-10; it's just going to make it easier for them to take the specific information that you're already writing in the medical record and being able to apply a code to that."