Alleviating ICD-10 concerns

Carl Natale
by Carl Natale

In my last article on ICD10 Watch, I discussed the idea of continuing the implementation of ICD-10-ready documentation systems.

I touched briefly on reasons to continue with ICD-10 implementation — mainly the ones keeping many physicians awake at night (other than patients calling or an overnight shift).

But what about some of the more subtle reasons that come from taking a proactive rather than reactive approach to clinical documentation and (may I say it?) the revenue cycle.

Unless you’re from a different planet, you’re most likely aware of the groups who are very vocal in their opposition to ICD-10. The loudest voice is the American Medical Association (AMA), whose claim is to represent the best interests of its member physicians. As recently as February 2014, the AMA called for the delay of ICD-10 implementation and a total repeal. I have felt strongly that the opposition arises from a simple lack of education regarding the actual codeset.

The following are the concerns outlined by the AMA, and my responses:

Concern: It is not expected to improve patient care.

Response: It can improve patient care. According to the American College of Emergency Physicians (ACEP), ICD-10 can “enable better analysis of patient care through more focused quality measures.  This will allow for better monitoring of patients with chronic conditions such as asthma, diabetes and sickle cell disease.  The new system will also permit better tracking of injuries that can lead to improved preventive and safety measures.”  Through its cause-and-manifestation design, ICD-10 can offer the potential to track ways to improve overall patient outcomes.

Concern: The increase in number of codes.

Response: While it’s true that there is a big increase in the number of codes, just looking at the increase in numbers doesn’t tell the whole story.  In general what’s going to be required of physicians is better communication of what they already know.  An example is otitis media.  The changes in terms of ICD-10 are around laterality and whether the OM is recurrent, both of which the physician would know based on history and physical exam.  As my colleague Hank Hikspoors discussed in another recent article, there are certain features and functionality to look for in EHRs that can facilitate the necessary level of communication without burdening the physician.  Integrated clinical content that readily provides options such as laterality and reoccurrence as well as feedback mechanisms that remind physicians what information is important to document will significantly decrease the burden on physicians.    

Concern: It places an undue burden on physicians who already have other costly mandates to implement, and is potentially financially disastrous for physicians.

Response:  Meticulous coding coupled with robust documentation may make a difference in revenue resulting in faster reimbursement, fewer physician inquiries and supporting documentation for procedures.  I recommend investing in a Certified Professional Coder (CPC), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).  These individuals have the skills and background to efficiently code encounters, perform periodic documentation audits and conduct CDI sessions with providers.  They are also skilled at improving overall business practices, and in many instances can find ways to offset some of the financial burden of ICD-10-CM implementation.

Some final advice

Every challenge has a solution. There’s no argument from either side that ICD-10 implementation is not a challenge. It is, and it will be. However, along with the challenges of ICD-10 are the advantages, and the benefits may just outweigh the risk. I encourage each and every stakeholder to be actively involved in this endeavor and work together to achieve this common goal.  These stakeholders include HIM professionals, providers, payers and vendors alike. Continue with ICD-10 implementation and as you do, arm yourself with knowledge and seek available solutions to overcome the challenges.

Elizabeth Morgenroth, CPC, Revenue Cycle Business Analyst at T-System, Inc., has 16 years of healthcare experience in the payer, provider and vendor areas of service. While with Blue Cross and Blue Shield of Kansas, she provided coding assistance to all professional specialties statewide. Morgenroth was responsible and integral to the entire revenue cycle process for a family practice in Lawrence, Kansas with four physicians and five physician assistants. While working for Clinical Coding Solutions, she performed professional and facility coding for nearly all specialties. In her current position, she is responsible for encoder tool development and ICD-10 readiness for T-System revenue cycle solutions. Morgenroth attended the American Health Information Management Association (AHIMA) Academy for ICD-10-CM and ICD-10-PCS and is an AHIMA Approved ICD-10-CM and ICD-10-PCS Trainer.