Get ahead of the ICD-10 curve

Carl Natale
by Carl Natale

ICD-10 will impact more than how patients are documented or how charts are coded. It will change how data is collected and processed, touching nearly every area of business and clinical operations.

The costs associated with the changeover are significant. The American Health Information Management Association (AHIMA) predicts that ICD-10 could cost hospitals as much as $20 million each. While much of that can be attributed to cash flow disruption, another large chunk of the budget will go to IT investments and testing, since almost every system in the enterprise will need to be upgraded for the conversion.

The Department of Health and Human Services (HHS) has mandated the adoption of the more complex ICD-10 codes by all HIPAA-covered entities by October 1, 2014. Although a year may seem like a long time, the ICD-10 deadline is right around the corner. A readiness survey published earlier this year by the Workgroup for Electronic Data Interchange (WEDI) reports that many hospitals lag behind on their implementation plans due to competing internal projects, compliance date changes and other regulatory mandates such as Meaningful Use Stage 2, HIPAA 5010 and e-prescribing. The announcement comes as both a warning and a reminder that provider organizations need to prepare now to be assured of a seamless transition to the new code set without impacting cash flow. Fortunately, a planned approach to ICD-10, one that involves investing in the right technology, can help mitigate both the cost and the stress associated with such a significant event.

Plan for Training

The scope of the ICD-10 changes are enormous with an estimated eightfold increase in the number of codes. Undoubtedly, the greater volume and specificity of the new code set increases the risk of error and frustration on the part of billing staff. For these reasons, training is essential for a successful implementation and should include stakeholders, physicians, coders and anyone else who touches the medical record. Department teams and stakeholders need to be prepared for the rollout and its potential impacts with time to create training plans and crisis workflows. This takes time. A good rule of thumb is to prepare six months to one year before go-live, and AHIMA recommends at least 60 hours of training for coding staff.

Secure the Right Technology

In addition to training, having the right solutions at hand will ensure a smooth transition and help staff do their work more quickly and accurately. An integrated, enterprise-wide technology solution that supports the following can offset productivity losses during the changeover:

  • Online education
  • Computer-assisted coding (CAC)
  • Clinical documentation improvement (CDI)
  • Abstracting with automated processes and workflows.

Implementing technology solutions in advance will allow providers to incorporate them into their training programs, enhancing coding and clinical staff’s familiarity with the new code set and the applications that will contribute to a smoother transition.

Computer Assisted Coding

CAC is an essential solution for enhancing staff productivity and improving documentation as providers transition to ICD-10. In Canada, provider organizations reported a 50 percent loss in productivity during the adoption period. Based on those findings, American industry experts advise that hospitals plan for a similar experience here with a corresponding reduction in reimbursement.  CAC systems use computer software and Natural Language Processing (NLP) to read and interpret clinical documentation (from patient charts, scanned images or dictation) and provide both ICD-9 and 10 codes for validation. Using CAC has been shown to increase the number of codes used by 36 percent and significantly increase a facility’s case mix index. CAC systems can perform a majority of the coding, especially on routine procedures, allowing coders to address more complex scenarios while reviewing output. This system offers numerous advantages over manual coding, including increased productivity and efficiency in documentation as well as consistent application of coding rules. CAC products enable faster, more accurate coding that leads to reduced costs (overtime, contract support, transcription costs), better reimbursements and improved clinical data quality.

Clinical Documentation Improvement

CDI is a process typically used in hospitals that employs specialists who review clinical documents and provide feedback to physicians. The feedback is designed to fill gaps in documentation such as questions about coding, quality measures and overall care management of a patient. Because the process is manual, the specialist has to compare the chart to the patient’s needs to identify documentation issues, which takes time. As a result, the process frequently takes place after the patient has left the hospital. A web-based CDI solution streamlines workflows by automating concurrent documentation review processes. It eliminates the need to manually create work lists from hard copy census reports, saving both time and money. It allows the documentation specialist the ability to track and manage daily work assignments and produce reports to measure the effectiveness of the CDI process. Through automation, an electronic physician query capability helps users effectively communicate with physicians who can respond quickly and easily. A documentation specialist can initiate a query from within the usual workflow process. Given the increased number of ICD-10 codes, automating CDI will enable specialists to make sure the medical records are detailed and accurate.

Dual Coding

While some in the world of health information management argue against dual coding, saying that using both ICD-9 and ICD-10 codes in the same health record is resource-intensive and hampers productivity prior to the transition, there are many good reasons to invest in the practice. How best to dual code depends on each facility’s ICD-10 implementation plan and may be affected by availability and usage of certain technologies such as encoders and computer assisted coding. Dual coding reduces the costs of overall training by allowing staff to practice and become familiar with the new code structure and methodology in advance of deadline, before revenue is impacted, and it also provides ongoing assessment of physician documentation for targeted training. The method also assists with financial modeling and forecasting since the two code sets will provide data that can be classified into payment groups to determine potential reimbursement pitfalls. It will enable hospitals to test internal systems as well as external testing with payers and clearinghouses.

The benefits of dual coding even extend beyond the October 1, 2014, ICD-10 deadline. According to the Centers for Medicare and Medicaid Services (CMS), providers must be able to process claims using both ICD-9 and ICD-10 codes until all transactions for services performed prior to the transition are complete. Additionally, claims are subject to RAC audits up to three years after the date the claim was paid, making transactions processed in ICD-9 susceptible to review as late as September 30, 2017. A system that enables users to work in both code sets will give providers a head start as the transition nears and during the time that follows immediately after.


In order to understand how the migration to ICD-10 will impact reimbursements and cash flows, hospitals need to be able to collect medical data and code diagnoses and procedures.  Implementing a web-based abstracting solution enables the health information management (HIM) department to achieve maximum efficiency and accountability by automating and streamlining how data is collected, aggregated and reported from patient medical records. Programs with a built-in workflow engine let HIM managers create electronic work queues for coding staff while automating manual handoffs. HIM managers can also reassign cases to adjust workload as needed. Coding and abstracting functions increase productivity, improve data entry and reduce billing delays.

Putting it All Together

The move to ICD-10 is one the biggest changes to hit the U.S. healthcare system. Hospitals that carefully prepare for the change by planning six months to a year in advance, establishing training programs for coding and clinical staff, and implementing solutions that will simplify coding, enable machine-readable documentation and facilitate data collection will not only experience a smoother transition but also see a greater return on their investment.

Daphnee Fuentevilla, RHIA, is Solutions Manager, Coding and CDI Solutions for Streamline Health.