With the ICD-10 October 1^st, 2015 deadline fast-approaching, is your organization ready?  Below is a quick readiness assessment to benchmark where you are and where you should consider being.

Readiness checklist

1. Have both your Practice Management and EHR been updated to be ICD-10 compliant?
2. If you are using the Charge module in Allscripts TouchWorks^TM, have you tested submitting ICD-10 codes to your Practice Management system?
3. If you are not using the Charge module in TouchWorks^TM, have you considered implementing it to increase revenue cycle turn-around or considered updating your existing Encounter Forms to include ICD-10 codes with more specificity and using laterally to meet the ICD-10 requirements?
4. Have you contacted all your vendors to ensure they are ICD-10 compliant, such as payers, clearinghouses, and any lab or radiology vendors?
5. If necessary, have you loaded the ICD-10 dictionaries in both your Practice Management and EHR applications?
6. Have you tested submitting codes from your Practice Management system to your payers and clearinghouses?
7. Have you tested submitting orders (labs/diagnostics/imaging studies) from your EHR to appropriate vendors with ICD-10 codes?
8. Have you identified the top 25-50 diagnoses for each specialty (based on volume and/or high revenue) and trained appropriate staff on ICD-10 criteria for coding, billing, and clinical documentation?
9. Have you optimized all preferences and enhancements within TouchWorks^TM to assist in the ICD-10 transition such as Billable Indicators and Clinical Qualifiers?
10. Have you reviewed current clinical documentation and identified gaps for ICD-10 requirements?

What else do you need to know and consider?

The preceding is just a short list of items to consider to ensure your organization doesn’t experience challenges starting October 1^st, such as payment denials, increased A/R days, and workforce overload. I’d like to focus on the clinical documentation that will need to go along with the actual transition. Many organizations have completed the initial items on the readiness checklist, and some were even ready a year ago prior to the delay. Still, the ICD-10 implementation can present a significant challenge to your providers’ documentation workflows.  Each claim will not only need to have the appropriate codes, but will also require the clinical documentation from the patient visit to support the submitted ICD-10 codes. This is not any different than how ICD-9 codes work other than the obvious… ICD-10 requires more detail!

Specialties that will primarily be affected the most with the ICD-10 transition include Orthopedics, Family Medicine, Pediatrics, OB/GYN, Cardiology, and Behavioral Health. ICD-10 coding and clinical documentation will require more detail than we experienced with ICD-9. Some examples of the increased documentation include:

• Laterality
• Episode of Care (initial encounter, subsequent encounter, sequela)
• Anatomical detail
• Type of injury
• Severity
• Approach

Many believe this is only related to ICD-10, however, the increased documentation requirement stretches across many other healthcare initiatives, such as Meaningful Use, value-based purchasing, and hospital admission/re-admission reporting. A clinical documentation improvement program can offer several benefits for organizations which extend to a variety of healthcare initiatives.

I’d like to take a quick look at a common ICD-9 diagnosis and focus on three areas to consider that can streamline your ICD-10 transition and assist your clinical providers in meeting the ICD-10 requirements for coding and documentation.

Otitis Media: Using the Clinical Qualifier

By turning on the Clinical Qualifier preference, it can help your providers dive into the required detail by narrowing the search for problems.

As a provider highlights certain details, the search window pares down the list, allowing the provider to select the appropriate diagnosis.

Another area to consider is how a patient visit occurs today and what that actually should look like in ICD-10 if we apply the level of detailed required.

Overall Patient Visit for Otitis Media: The patient is being seen for acute ear pain. Examination reveals bilateral acute serous otitis media with a total perforated tympanic membrane of the right ear. Mother admits she and the father smoke in the home.

Considering updating the current note templates to assist the providers by presenting all the documentation required in order to ensure no rejections of any claims. Notice the note template below is simple, straightforward, and has all the necessary supporting elements for ICD-10. AHIMA recommends that organizations utilize their templates as much as possible to assist providers in the clinical documentation for ICD-10.

With ICD-9 coding, it was relatively simple to document a common diagnosis seen in Pediatrics, Urgent Care, or Primary Care. Moving forward, the increased specificity, laterality, and other causes become more important.

ICD‐9‐CM:

381.01 – Acute serous otitis media

ICD‐10‐CM:  

H65.03 – Acute serous otitis media, bilateral
H72.821 – Total perforations of the tympanic membrane, right ear
Z77.22 – Exposure to environmental tobacco smoke

Lastly, consider developing a Quick Assessment noteform for the top 25-50 diagnoses to ease the selection for providers.

These suggestions along with the readiness checklist will ensure you are indeed ready for the ICD-10 implementation date and do not impact any revenue flows to your organization. This is a brief article to be used as a guide and is not all-inclusive.

If there are further questions, please don’t hesitate to contact us or visit our website to ensure you are ready for October 1^st, 2015!

References:

http://www.cms.gov/Medicare/coding/ICD10/index.html

http://www.ahima.org/~/media/AHIMA/Files/HIM-Trends/CMS%20and%20AHIMA%20ICD-10%20Clinical%20Documentation%20Webinar%202014-12-10.ashx