The ICD-10 (International Classification of Diseases, Revision 10) mandate presents the U.S. healthcare industry with the most complex shift in diagnostics and procedural coding. As the industry awaits the final announcement from HHS to address the delay timeline, this has created indecision throughout the healthcare industry. However, many are moving ahead as if they still have an Oct. 1, 2013, deadline to meet.
Timing
During the AHIMA ICD-10 Summit, the key slogan was “Stay on Course”. Given the potential for financial and clinical impact of ICDâ10 and the system information changes, healthcare organizations are encouraged to take steps now to understand how to successfully prepare for ICD-10 implementation. The ICD-10 Implementation consists of 3 main phases:
• Phase 1: Impact Assessment:
Involves assessing the impact of the transition to ICD-10 CM/PCS coding systems and identifying key tasks and objectives
• Phase 2: Overall Implementation
Involves three key steps: implementation of required IS changes, follow-up assessment of documentation practices, and increasing education of all pertinent associates.
• Phase 3: Go-Live Preparation
Involves finalizing system changes, testing systems, intensive education of associates, monitoring coding/grouping and reimbursement accuracy
Diagnosis and procedural codes, currently represented by the ICDâ9 code set, are used in virtually every aspect of healthcare organizations operations (both clinical and administrative). The impact of this change will therefore reach into the business processes and systems supporting these operations as well as the relationships between and among providers and health plans.
Healthcare organizations should have the following completed by the third quarter of 2012:
• Defined project management structure
• Identified all people processes and systems impacted by 5010 and ICD-10
• Aligned 5010 and ICD-10 with other strategic initiatives
• Completed organization risk management
• Conducted vendor/payer readiness assessment
• Developed business roadmap
The key objectives of Phase 1 are:
• Assess readiness (business processes, technology and people) via gap analysis in applicable functional areas;
• Inventory and assess ICD-10 impact for systems, applications, education and training;
• Conduct a medical record documentation assessment for recommendations to implement a documentation improvement program that targets deficiencies;
• Develop an actionable plan that is designed around IT, business processes, physicians, coders, education and training, and other key constituents
Timing is everything and the time is now!
Training
Training and education will be the most critical factor to successfully implementing the new coding system. Clinical and administrative staff will require significant time to learn ICD-10. As the new coding version is not a simple substitution of one code set for another, the learning curve is expected to be quite steep for clinicians, coders, and administrative staff, particularly for smallâ and mediumâsized organizations that do not employ certified coders.
Coders will need to master aspects of anatomy and physiology, pharmacology, and medical terminology that is not required by the current classification schemes, ICD-9; training must evaluate coding personnel’s baseline knowledge in skills to identify knowledge gaps in medical terminology, anatomy and physiology, pathophysiology, and pharmacology. Measuring coding staff baseline knowledge will shorten the learning curve, improve coding accuracy and productivity, prepare for educational needs, and accelerate the realization of the benefits of the new coding systems.
Healthcare practices must consider “Role Base Training” as opposed to a one size fits all solution. Education should only be role or job-specific. Healthcare practices will need to work with a vendor that will classify the roles into different subgroups. There must be consensus as to the extent of training that needs to be done, who (what roles) needs to be trained, what level of training is needed, and how training will be delivered. Different levels of training will need to be based on the impact of ICD-10 on roles and functions.
Technology
ICD-10 will drive every hospital’s reimbursement and financial future. Many organizations are looking at ways to help capitalize on ICD-10 opportunities. Many are turning to CAC, Computerized Assisted Coding. CAC is defined by the American Health Information Management Association (AHIMA) as the: “… use of computer software that automatically generates a set of medical codes for review, validation and use, based upon clinical documentation provided by healthcare practitioners."
Coding productivity is expected to decrease as much as 50% for the nine months following the ICD-10 implementation with a permanent decrease of 10%. The adoption of computer assisted coding (CAC) is anticipated to provide productivity gains of up to 30%, which will offset the expected productivity decline to 20%.
The use of CAC solutions will elevate the role of the coder to a reviewer or auditor, increasing the overall productivity and accuracy of the coding process. Providers will need to closely evaluate CAC systems with an understanding that coding accuracy and consistency can vary widely based on the natural language processing (NLP) technology. Natural Language Processing (NLP) allows the system to “annotate” the information and assign codes based on the provider’s documentation.
Even though the future of the ICD-10 implementation “date” is uncertain, continue to move forward, especially with clinical documentation improvement, physician education, and technology needs.
In conclusion, in the famous words of Mark Twain, “The secret to getting ahead is getting started.”
