Don’t Forget to Budget for ICD-10 in 2011

Yes, we have until 2013.  However, the more I take part in ICD-10 planning committees, the more I realize that this is going to take a huge amount of preparation time.

It’s time to get started now.

Obviously, since we’re still in the process of training the trainers on ICD-10, I’m not referring to training your team on the actual ICD-10 codes.  But, since ICD-10 will place a significant emphasis on specificity and anatomy, I do believe that it is time to start training your providers and coders on:

1. Documenting every detail  (providers)
2. Understanding what they will be reading (coders)

This means some form of Clinical Documentation Improvement (CDI) program across your organization.  It also means training or retraining your coders on Anatomy.

These things take tremendous amounts of time, and the time to train on the actual codes is quickly approaching.  The best way to avoid a training logjam at the end is to begin soon.  (Logjams in coding tend to be a major financial problem)

The time is now.  Don’t forget to budget for it.

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About the Author:

Aaron is one of the leaders of the HIM Circle movement and former HIM Director at multiple hospitals.  Join the free HIM Circle for further discussion about ICD-10 on these various forums:

• http://facebook.com/HIMCircle
• http://LinkedHIM.com
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Motivation for Clinical Documentation Improvement (CDI)?

As we continue to build our Clinical Documentation Improvement (CDI) program in preparation for ICD-10 and a continued increase in audits (RAC, MIC, and Commercial Insurance), we’ve been doing a lot of discussing and research related to what objectives a CDI program might have.

• Is it to increase reimbursement through assignment of CC’s and MCC’s?
• Is it to improve coding productivity?
• Is it to reduce the potential risk from recovery audits?
• Is it to improve patient care?

Or, should it be a combination of the above?  Glenn Kraus, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS had some interesting thoughts on why we shouldn’t only focus on the reimbursement. 

There is almost always an opportunity to improve clinical documentation in any medical record chart from both a resource intensive reimbursement standpoint and quality of care and clinical outcomes standpoint. 

But just as the profession is gaining momentum and increased recognition in the business facet of healthcare, we have reached a crossroads and may be going down the wrong path.

The crossroads

For those of us who have been in the clinical documentation improvement arena for a long time, it is eye-opening to view the advertisements and promotional materials for clinical documentation improvement projects readily available at trade shows and appearing in prominent trade journals. The common promotional theme is increased reimbursement for the hospital, which is not surprising given the fact these clinical documentation improvement programs are marketed strictly on the basis of “reimbursement enhancement.”

Let’s not kid ourselves, every healthcare expenditure that is not direct patient care related must provide for a reasonable chance of return on investment, contributing to the organization’s financial performance in some form or fashion, whether it be additional revenue or at least cost avoidance.  But there has been some talk in the industry that some firms have worked into their CDIP contracts a guarantee of specified amount of increased reimbursement for the hospital with the implementation of their programs. 

The aftermath

Clinical documentation improvement programs can be structured to meet the documentation requirements required in the health record to financially sustain the hospital from a financial accounting and quality of care reporting perspective.  How the program is structured can dictate success or failure in the rollout and acceptance of the program by physicians and other ancillary service providers.

In speaking with a fellow colleague recently, I heard a valid concern that is worth mentioning regarding where the CDIS profession is now, and where it may be going. Once again it may be going down the wrong route. My colleague pointed out that in some instances, the clinical documentation improvement specialists appear to be focusing on reviewing the record solely for identification and documentation of “missed CCs and MCCs,” almost as if they were “CC/MCC scroungers.”

The very idea of CDIPs being promoted primarily as reimbursement mechanisms perpetuates and drives the ever-increasing viewpoint of CDIS as CC/MCC identifiers. In order to be directed down the right path, we need to stay attuned to the mission of the profession, which is to affect positive change in physician’s patterns of clinical documentation over the long term through provisions and actions of continued physician education. This relentless pursuit of physician clinical documentation education embraces a holistic approach with an emphasis upon the direct correlation between clinical documentation and the continued business financial viability of the both the hospital as well as the physician. A primary focus upon “getting that CC/MCC” documented in the record represents a very small cross sectional piece of what the CDIS can fundamentally contribute to a successful program.

 

Which way do you think it should go?

We are at the crossroads for CDI.  The direction we as an industry decide to take will guide the future.  Decisions made today will impact all of us in HIM and finance both tomorrow and well into the future.

An Abridged Guide to ICD-10

As you probably have heard by now, on October 1, 2013, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.  We’ve compiled information directly from the CMS website to help provide a basic introduction and some steps to help prepare for ICD-10. 

In the future, we’ll be posting more updates.  If you’d like to have those updates sent to you, simply subscribe on the right side of blog’s home page (Click the word “Clear” above to get there).

ICD-10

ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

1. ICD-10-CM for diagnosis coding
2. ICD-10-PCS for inpatient procedure coding

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

 

Why?  The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. 

 

Steps to Prepare for Version ICD-10

• Begin preparing now for the ICD-10 transition to make sure you are ready by the October 13, 2013, compliance deadline. The following quick checklist will assist you with preliminary planning steps.
• Identify your current systems and work processes that use ICD-9 codes. This could include clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.
• Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.
• Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, the HIM Circle, online courses, webinars, and onsite training. If you have a small practice, think about teaming up with other local providers. You might be able, for example, to provide training for a staff person from one practice, who can in turn train staff members in other practices.
• Coding professionals recommend that training take place approximately 6 months prior to the October 1, 2013 compliance date.
• Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, training and related expenses.
• Conduct test transactions using ICD-10 codes with your payers and clearinghouses. Testing is critical. Check to see when they will begin testing, and the test days they have scheduled.

See the “Compliance Timeline” below for important stages of implementation for ICD-10 and the Version 5010 that goes with it.

 

DECEMBER 31, 2010

• Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance

JANUARY 1, 2011

• CMS begins accepting Version 5010 claims
• Version 4010 claims continue to be accepted

DECEMBER 31, 2011

• External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance

JANUARY 1, 2012

• All electronic claims must use Version 5010
• Version 4010 claims are no longer accepted

OCTOBER 1, 2013

• Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures

  

To discuss ICD-10 with your peers, visit http://www.HIMfacebook.com