With less than two years before the Oct. 1, 2013 deadline to transition to ICD-10 codes, health care organizations that haven't yet started the process are cutting it close. Preparation for the ICD-10 transition varies among providers -- some are waking up, but some are taking a "wait and see" approach.
At a recent ICD-10 conference
sponsored by the Massachusetts Medical Society, an IT vendor in the audience
asked presenters from auditing firm KPMG LLC how to deal with organizations
that make statements such as the following:
- "We have an outsourced coding vendor, so we don't have to do anything for ICD-10."
- "Medicare said we don't have to start training our coders until six months before it goes live, so we're going to start then."
- "The Centers for Medicare and Medicaid Services (CMS) has been a little generous with the meaningful use and HIPAA version 5010 deadlines, so we don't really think the October 2013 deadline is real."
Some organizations still see ICD-10
as some sort of back-end coding transition and not a major global change, said
the vendor. "If an organization doesn't see [ICD-10] as a global issue,
they'd better wake up," responded Susan Davis, director of health care
advisory services at KPMG.
Luckily, the tide has been shifting.
While excuses might have been common a year ago, they're not so common these
days, said Kirk Kamien, director of regulatory compliance at KPMG.
Indeed, when Kamien polled the
audience at the beginning of his presentation to ask how many people were
either in the midst of a transition ICD-10 -- or at least talking about it --
the majority of hands went up. That's actually pretty impressive, given what
Kamien called the "perfect storm" of health reform and health IT
initiatives whirling about -- meaningful use incentives, accountable care
organizations, HIPAA version 5010 and, of course, the transition from ICD-9 to
ICD-10 codes.
This perfect storm is probably the
most often cited reason for why ICD-10 implementation is falling behind in the U.S. But
organizations that think the transition to ICD-10 codes is just another project
to add to the list had better think again. "ICD-10 will virtually impact
every system, process and transaction that involves a diagnosis and procedure
code," Kamien said. "That means it's affecting a big part of [the]
revenue cycle."
Training physicians to document with
ICD-10 coding is a big challenge
One of the biggest challenges at
Lahey Clinic Hospital Inc. has been preparing physicians for the transition to
ICD-10, said Cynthia Trapp, director of professional coding and coding
education, adding that it can be very difficult to change physician
documentation behavior. ICD-10 codes require much greater specificity, and for
compliance purposes, the information must come from the physician
documentation.
The hardest part about training the
physicians, noted Trapp, is figuring out exactly what physicians will need to
know in order to document properly for ICD-10. For example, a finger wound must
be documented with detail that includes whether it was on the left hand or
right, which digit was affected, whether a foreign body was involved and so on.
Some of that information might be in the EHR system, but some of it might not.
The physicians will need to know what must be included in the documentation to
satisfy ICD-10 coding requirements.
It would be nice, said Trapp, if the
hospital's EHR systems included prompts for physicians at the point of care to
help them figure out the best way to document for ICD-10 coding. Lahey is
working with its EHR vendors to see what can be done in this area.
Even if coding is outsourced, health
care organizations will likely have to make significant changes to workflow and
clinical documentation as part of the transition to ICD-10.
What about this notion of waiting to
train staff until six months before the switchover date? Lahey plans to train
its "heads-down coders" -- the ones who are really just coding and
aren't involved in physician education -- about three to six months before the
transition deadline, said Trapp. However, her team has already begun providing
feedback to physicians during regular audits to help prepare them for
documenting for ICD-10 codes.
While
CMS does recommend conducting intensive daily training for coders about six
months before go-live, it also recommends "educating staff on changes in
documentation requirements from health plans" starting in the summer of
2011. So organizations that have not started to at least promote some basic awareness
of ICD-10 may already be behind.
Getting
senior leadership to buy into the importance and impact of the transition to
ICD-10 is another major challenge, said Trapp, who has been preaching about
ICD-10 for the last decade.
The October 2013 deadline is real,
agreed the folks from KPMG, and it's not likely to move. Ideally, organizations
should have been thinking about ICD-10 back in 2009, said one presenter. The
transition to ICD-10 is big and complicated, and organizations that are taking
the time to educate and prepare now will be better able to weather the storm
when the time comes.
