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ICD-10 Impact on Productivity
The implementation of ICD-10 brings an exciting challenge. Some see it as an obstacle but it really is an opportunity to enhance our skills and knowledge in our careers. There will be a learning curve that comes with ICD-10; the codes are very different, the guidelines have changed in some areas, and we are going to be communicating with physicians more closely to make sure all the necessary information is available. Initially, we will have to learn all the new guidelines and coding processes. Today, the codes are still considered "unstable" and are subject to change prior to implementation.
ICD-10 implementation will impact productivity on many levels. Documentation is the most obvious and largest area that will be affected, which will have a direct impact on productivity. If the documentation lacks specific elements required for accurate and precise code selection, the physician or provider will need to be queried for additional information. If they are not immediately available, the service can not be entered or billed until the information is obtained. Charge tickets (superbills) may become a thing of the past because of the increased amount of code choices in some areas. Physicians can not be expected to document appropriately if they do not understand what is required in the first place.
The education process for coders and physicians should begin early to have the least impact on productivity throughout implementation. Those who do not embrace the changes, and wait until the last minute, will be at a disadvantage and may have to take extensive training classes (time away from work) to quickly learn all the changes. A coder should expect to devote around forty to sixty hours towards ICD-10 education prior to implementation.
Productivity will not return to normal upon implementation. There will be a delay as we assess how the payers interpret the new coding system. Payments and remittance advices will need to be closely scrutinized to ensure that claims have been processed appropriately and when additional information is required, it must be sent in a timely manner. Staff must be prepared to focus on assessing payer responses throughout the first few months of implementation to identify deficiencies immediately.
Today, diagnosis codes are mostly numeric (with the exception of V and E codes), but with ICD-10 the codes are alphanumeric. The process of entering the new codes alone will slow productivity because we will no longer be able to rely solely on a number keypad to enter all the codes. Also, it will be very important to distinguish between letters and numbers when a diagnosis code is written as opposed to a narrative description. For instance, depending on penmanship, it may be easy to mistake a number two for the letter Z, or the number zero for the letter O.
The key to minimizing the impact on productivity is to begin raising the awareness of each individual physician/provider regarding how documentation will specifically be affected by the changes, and encouraging them to become familiar with the terms and specificity of their specialty. This will allow plenty of time to become familiar with the requirements and will not feel like such a significant change all at once. It is very important to keep in mind though, that ICD-10-CM codes have not yet been officially finalized and are subject to change.
When preparation is done early, we should expect that productivity will return to normal about four to six months after the official implementation date. The bottom line of an office will be only minimally impacted if the office has anticipated, learned, and prepared for the changes as well as for the potential setbacks.
An office that waits until the last minute to prepare for the changes or which relies too much on outside sources (EMR, billing company, etc.) will be consistently striving to catch up with the changes. Such an office may even experience an increase in claim denials and not be able to make corrections because of a lack of understanding the guidelines. Timing and awareness are crucial in making a smooth transition to ICD-10.
IN THE NEWS
The last meeting to address ICD-9-CM and ICD-10 code updates before the partial code freeze is being held on March 9th and 10th. March 10th will focus on the diagnostic codes and proposed changes to both ICD-9-CM and ICD-10-CM.
The following agendas have been posted and are available for download:
Procedures topics – Wednesday, March 9 – Agenda is in the "Downloads" section
Diagnosis topics – Thursday, March 10 – Agenda is under "Upcoming Meeting, March 9-10, 2011"
Chief complaint: hyperglycemia
Subjective: Patient feeling "pretty good" this morning. Describing pain in the left foot s/p surgery. Did have a true AM fasting blood sugar this morning before juice was given.
Diabetes history: 12-year history of diabetes with hyperglycemia per chart, denies retinopathy or nephropathy. At home patient is on 220 units of PM glargine administered to the belly, 90 units aspart with meals administered to arms, and Metformin 1000 BID. No intraoperative steroids were given to affect glucose.
Exam: Sitting up in bed eating breakfast, no distress wearing nasal 02. Poor dentition, small café-o-le spot on right side of forehead. Non-enlarged thyroid, without nodularity, arms without evidence of bruising from insulin injections. Left metatarsal bandaged post surgery. Appropriate affect.
Labs reviewed, CT angiogram pending
Impression: 55-year-old s/p left metatarsal excision with wound cultures pending (surgeon following) now with seemingly well controlled blood sugars with decreased, but split lantus dosing to arms and decreased mealtime insulin. Patient has hyperglycemic episodes; however, at this point, current dosing, correctly given, seems appropriate. Continue current lantus and aspart dosing. Insulin dependent, type two diabetes management is stable at this time, will sign off.
Rationale: The diabetes mellitus codes are combination codes which include the manifestation of the disease process, the type of diabetes mellitus, the body system affected, and the complications affecting that body system.
The age of a patient is not the sole determining factor, though most Type 1 diabetics develop the condition before reaching puberty.
If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11, Type 2 diabetes mellitus, should be assigned. Code Z79.4, Long-term (current) use of insulin, should also be assigned to indicate that the patient uses insulin. Code Z79.4 should not be assigned if insulin is given temporarily to bring a Type 2 patient's blood sugar under control during an encounter.
There are five (5) Diabetes Mellitus categories in the ICD-10-CM. They are:
- E08: Diabetes Mellitus due to an underlying condition
- E09: Drug or chemical induced diabetes mellitus
- E10: Type 1 diabetes mellitus
- E11: Type 2 diabetes mellitus
- E13: Other specified diabetes mellitus
In ICD-9-CM users were instructed to code by type and hyperglycemia was not included in the choice selection. In ICD-10-CM we have a combination code available. Also, controlled and uncontrolled are not part of the code choices in ICD-10-CM.
Index lookup: Diabetes, Type 2 with hyperglycemia= E11.65, and long term (current) use of insulin= Z79.4
We will be sharing a number of steps to help your practice successfully implement ICD-10-CM. They are also found in your ICD-10 Implementation Tracker on AAPC's website.
Step 9: Implementation planning
Break implementation into stages. Identify who implements what, and when each piece is implemented. Review opportunities that could affect reimbursement, such as value-based purchasing and pay for performance. Take this opportunity to revise or change your current procedures. Map out your implementation plan, which can be completed in a simple Excel file or project-planning software. This is a good time to develop a post-implementation problem-resolution process that will address how to report, track, prioritize, and correct identified issues.
We have developed several tools and resources to help with preparing for ICD-10 and have organized them all in our ICD-10 resource site. These resources include conversion and mapping diagrams, ICD-10 naming conventions and FAQs, ICD-9 to ICD-10 reference sheets and translator, ICD-10 myths and facts, videos, articles, an updated ICD-10 training timeline and tracker, and a countdown widget to place on your own website. Here is an example of one of these new and improved tools:
With this implementation benchmark tracker tool (requires AAPC membership) you will be able to keep track of your staff's progress toward the implementation of ICD-10.