3 tips for ICD-10 transition after initial implementation
The health care industry has been in the process of making the transition to the ICD-10 codes for over a month now and some practices are having more success than others. Although Oct. 1 has come and gone, physicians still need to use guidance from industry experts and the federal government to prevent any setbacks from occurring during the first few months of ICD-10 implementation.
While recent reports from the Coalition for ICD-10 suggest that the larger a practice is, the easier the switch from ICD-9 to ICD-10, there are certain steps that providers can take to ensure a smoother transition regardless of their practice size. Here are three tips that providers should use to help their practices get back on track or continue their success during the next few months of implementation.
1. Adapt to increased specificity during documentation
One of the biggest changes that providers are adapting to with the new coding set is increased specificity for most diseases. For example, a couple of common clinical scenarios include documenting hypertension and diabetes. For hypertension, ICD-10 calls for the condition to be defined as essential, meaning that hypertension can no longer be documented as benign or malignant. With the ICD-10 codes, there are two factors that physicians must include when documenting hypertension: the type and causal relationship.
The American Medical Association explained that alterations to the process of documenting diabetes is another important change that physicians and their staff need to become familiar with to avoid obstacles. When documenting the diabetes mellitus codes, providers now have to include the type, complications and treatment to adhere to ICD-10 standards. The Centers for Medicare and Medicaid Services used the example of code E08.65, for which providers should document something along the lines of "E08.665: Diabetes mellitus caused by underlying condition with hyperglycemia." Understanding these changes to the documentation process of these prevalent diseases is crucial to the success of the transition in months to come. In fact, Jim Daley, director, of the Workgroup for Electronic Data Interchange past-chair and WEDI ICD-10 Workgroup co-chair of BlueCross BlueShield of South Carolina, told ICD Watch that he expects most successful providers have cheat sheets set up for common diseases.
2. An efficient EHR is key
It has never been more important for practices to implement updated electronic health records. Certain features like mobile applications and software interfaces designed to enhance the transition from ICD-9 to ICD-10 will make becoming familiar with the new codes less daunting for providers – any added convenience can go a long way during such a major transition.
"Using the electronic health record is going to be more important than ever, because that's where the documentation will be," Mary Reeves, assistant vice president of Health Information Management Operations at Regional HealthCare Partners, told HealthIT Analytics. "Some of the most important information for coding is in the daily progress note, and providers have to be sure that we are capturing the complete clinical picture of the patient."
EHRs that can be customized to fit the specific needs of physicians and their staff will eliminate a lot of the unnecessary workflow processes that tend to be required for general EHR systems. This is true for specialty practices in particular. As they continue to switch over from the old codes to the ICD-10 codes, having a system designed for their specific needs will make familiarizing themselves with the new documentation processes simpler.
3. Do not focus too much on the flexibility rule
To ease the worries and concerns of providers as the ICD-10 implementation date approached, the CMS released an announcement that there would be a period of flexibility after Oct. 1. However, too many providers have been taking this rule to be more of a grace period than it actually is. In fact, stakeholders have argued that the rule, although a necessary compromise from a political standpoint, has only given health professionals across the industry an excuse to not fully learn the new codes and document them as they should be.
Physicians still have to correctly code the first three figures of the ICD-10 codes if they want to ensure their claims are not going to be denied. Another factor to consider is that private payers are not forced to honor this agreement with the CMS. With this in mind, most experts suggest that providers act as though the flexibility rule does not exist. Working toward a goal of getting all of the ICD-10 codes and processes right will keep them on the path to success. After all, if providers have to learn the first three digits of each code, stopping there and putting themselves at risk of penalties come reporting time is not practical.
These are just three of the many tips that health professionals should consider as they continue to adapt to the new coding system. For more guidance, especially for small practices, providers should refer to the Road to ICD-10 released by the CMS.
