ICD-10: Concerns & Preparations

ICD-10—Potpourri:
General State of Readiness- How you can & should be Preparing for the Inevitable, Part 3 of 4

“When healthcare transitioned to ICD-9 on Oct. 1, 1984, there was still great confusion 18 months later on how to submit the codes. There was great deal of frustration both on the provider side as well as the health plan side. There was also a huge lack of training to prepare the doctors for the transition to ICD-9. As a result, for almost a year, there were large drops in revenue.

I am seeing things now, for ICD-10, that I witnessed back then for ICD-9. A great deal of people have not even started their processes.” Ben Michelson, of Hayes Management Consulting ...(1.)

Mr. Michelson says that he has a client that he uses as a standard marker who comes from a health system with 27 hospitals and about 10,000 doctors.  They were one of the first groups to adopt ICD-9 back in the 1980s and he said that they did it well.  This client is concerned about their vendors being prepared, not the primary vendors who are preparing and seem ready, but the secondary vendors - in the lab area, the radiology area, a lot of the ancillary systems.  These secondary vendors are not really stating where they are in the process or how prepared they are.  With a hospital, you can see how the secondary vendors are about as important as the primary vendors. (1.)

 “One of the things that people can do if they have a claims editing tool in place within their organization (on the inpatient side and the ambulatory side), is run their claims through in a profile mode (e.g., don’t stop the claims if there is an error) to be able to see where the coding errors are, and use the opportunities to train providers.”  He also gave the following reality check: “They should anticipate the reimbursement lag during the transition, and have enough reserves ready to make it whole.” (1.)

Again, discussing the concerns of implementing ICD-10 he talks with several consultants and implementers and the end results are documentation, documentation, and documentation.  There are problems with documentation right now, even in ICD-9. Documentation needs to be improved right now, because the current documentation and billing problems are only going to be amplified by the implementation of ICD-10 coding.  Don’t wait to start coding training until ICD-10 is here, implement training, documentation, and coding changes now.  (2.)

Here are some quotes from his experts:

Barbara Aubry, regulatory analyst at 3M Health Information Systems

• "I fear claims will be rife with default codes because the coder can only do so much with vague notes."
• "Obviously education for coders is important, but documentation re-education for providers in I-10 language is critical." (2.)

Terri McCubbin, Director of ICD-10 Services at 3M Consulting

• "Clinical Documentation Improvement programs can play a valuable role today in this process to query physicians for both ICD-9 and ICD-10 missing documentation today.  This way we have 2 1/2 years to change physician documentation behavior before we go live on ICD-10." (2.)

Additional Information:

1. Guest Post: “Lessons learned from ICD-9 implementation” by Ben Michelson, of Hayes Management Consulting at ICD10Watch
2. “Coder Conversation: Improve documentation now” by Carl Natale at ICD10watch
3. ICD-10 Deadline Fast Approaching—Only 28 months away?
4. ICD-10 Coding is Coming- Run Now!