ICD-10 timetable: Readiness assessments should be complete
Are you ready for the big change?
Most people have trouble planning the next week's dinners or their next vacation, let alone something that is two and a half years away. But experts say that healthcare organizations need to be done with their readiness assessments for the upcoming change from ICD-9 coding to ICD-10 and moving on to the next phase of implementation.
"You should have a team in place and know the big picture for your organization," says Kathy DeVault, RHIA, CCS, CCS-P, manager of professional practice resources with the American Health Information Management Association (AHIMA). A coder with years of hands-on experience in hospitals and other settings, as well as a teacher of prospective coders, DeVault says hospitals need to go look at every department and its personnel, consider whether those staff members enter, trigger, or use ICD codes, how that happens, if they will be affected and what they need to know to succeed with the new code sets, PCS for procedures and CM, or clinical modification codes. "All of those people need to be educated on what ICD-10 is and how it will impact each of them."
For example, coders will need hands-on training for the differences, but for information technology staff, it is more important to look at every single program that will be affected by the change and whether various software vendors are working on new products or upgrades that will make your systems compatible with the new coding.
AHIMA's own checklist includes 13 things that should be completed already in the first phase (to see the full checklist, go to http://ahima.org/downloads/pdfs/resources/checklist.pdf). Second-phase readiness should be starting around now, DeVault says. That involves preparation for implementation, such as ensuring computer systems will have appropriate updates or evaluating new systems. This phase should be complete by the beginning of 2013. The last nine months of the process is preparation for going live on Oct. 1, 2013.
Currently, the Centers for Medicare & Medicaid Services (CMS) says that date is firm, even if some are arguing that it should be delayed. "This will happen," DeVault says. "If you work on the presumption of some sort of delay, you will not be ready."
Among the simple steps you can take now to prepare are:
improving coder skills in anatomy and physiology. DeVault says she was surprised at how much more she needs to know to be an efficient coder using the new sets. "ICD-9 allows us to be just okay in those areas, but with 10, you need a much more in-depth knowledge." She uses the example of a Bill Roth II procedure. In the old PCS code set, you could look up the nick-name. But now, you need to know it is a resection of the stomach with a bypass to the small intestine. "I had to bone up on my cardiothoracic anatomy."
The codes are logical, but knowing how a bypass graft looks and how it happens will help make the transition smoother. CMS acknowledges that productivity is likely to suffer for the first six to nine months. But if you prepare, DeVault says that decline in productivity may be shorter, particularly if you make sure you are caught up by the time the go-live date hits. In the end, she thinks the new codes will have a positive impact on reimbursement through enhanced accuracy and more specificity. This will ensure that every procedure is not down-coded because someone does not know enough about anatomy to make the right choice.
If you are using or planning to use a computer-assisted coding project, now is the time for investigating new programs and beta-testing them, says DeVault. She talks about the benefits for some of the coding procedures that are done over and over again. Think about patients who come to the anticoagulation clinics every month, for instance. DeVault notes that coders working on those cases use the same codes over and over again. "That is just data entry, and computer-assisted coding can eliminate that drudgery."
Introduce coders to the guidelines. The CM set is very similar to the existing set and makes a lot of sense. DeVault likens it to learning Italian if you already speak Spanish. But PCS is like a different language altogether, she says. "It will eventually make sense when you apply it, but at first, it just seems strange." Tell coders about the seven characters of the PCS codes and what each means.
At every monthly department meeting, set aside time to talk about the new coding system. Talk about the concepts, about what the changes will mean. As they get more comfortable, you can take a particular case and go through it using the old and new sets to see the difference. "You have to think about life in the world of ICD-10. Denial is not an option anymore," Devault says.
Pass on your concerns. When you find something that does not make sense, let the people at CMS know. DeVault says that there are things that have been changed because early users have raised concerns. While the nuts and bolts will not change, the codes are changing because it will be better for healthcare. The people in charge are willing to listen to complaints and address them if required.
George Argus, senior director, health data management for the American Hospital Association (AHA), says that most hospitals are happier about the changes than other stakeholders. For example, the Medical Group Management Association (MGMA) has complained about the cost for solo and small practices in particular.
"I'm sympathetic to those who do not like the idea of the changes, but ICD-9 has outlived its usefulness, especially on the procedure (PCS) side," he says of the 30+ year old codes. "There are areas that can no longer enumerate procedures and services anymore, so codes are manipulated or things just are not classified correctly."
The work can be frustrating, but greater precision is needed, says Argus. "We want a system where people can report exactly what is taking place according to disease, illness, and procedure and can then develop comparative data which will let researchers and others refine protocols, reimbursement rates, and individual and facility performance."
Hospitals not where they need to be
Argus thinks that hospitals are not, as a whole, where they need to be. And it is not just smaller or rural facilities that are lagging. There are some bigger hospitals that have yet to complete their assessments and move on to subsequent phases. Often, they have many different computer systems that have to be evaluated, which can slow them down. Meanwhile, there are small facilities that are already all over the change.
One thing that the AHA is working on is getting the national coordinator of health information technology and CMS to push back some of the Stage II requirements for meaningful use so that those requirements do not collide with ICD-10 implementation. "We'd like the former pushed back past the Oct. 1, 2013, date," says Argus.
For now, hospitals need to define which computer systems are mission critical for Oct. 1, 2013, and ensure they are ready. "Develop a billing instrument for ICD-10 by then or you risk not getting paid," he says.
Then identify all the systems that have to be changed and begin prioritizing, Argus recommends. If they are your own house-built systems, get to work on them now. If they are from vendors, start asking questions about upgrades and new programs. You'll want to test them well before October 2013.
While AHIMA talks a lot about coders getting ready, Argus mentions the importance of talking to physicians and making sure they are aware of the changes. "Find materials appropriate for physicians and develop a training program process." Physicians need to understand how this will impact them, he continues. "Physicians need to know that their task is to provide really good documentation. They need to be very specific on the procedure side." For example, PCS changes include specifying laterality of body what you do on the right side will code differently from the same procedure on the left. "This is not complex," he notes, "but it is something that will have to become habit." Argus thinks that with practice, everyone will learn to love the new code sets. "The greater specificity should mean better reimbursement," he says. "The more complex the case, the better pay you'll get. And it should not have a great impact time with patients because there are tools out there that should help you to zero in on the most appropriate coding."
Like Argus, DeVault believes in the new system and its potential. "After two years with my hands in it, I think it is great," she says. "I get bothered when people say they will retire before the implementation, because we will lose so much leadership and experience. That experience will translate. They will get used to it, and while I do not expect a whole bunch of cheerleaders, they should understand that we can get through the change."
ICD-10 conversion resources
Here are some helpful resources for ICD-10 conversion information, including courses, seminars, webinars, and updated documentation:
- Centers for Medicare & Medicaid Services: www.cms.gov/ICD10
- American Hospital Association: http://www.ahacentraloffice.com/ahacentraloffice/index.shtml
- Centers for Disease Control and Prevention: http://www.cdc.gov/nchs/icd/icd10cm.htm
- Medical Group Management Association: http://www.mgma.com/policy/default.aspx?id=28420
- American Health Management Information Association: http://www.ahima.org/icd10/default.aspx
For more information contact:
Joe Kuchler, spokesman, Centers for Medicare & Medicaid Services. Washington, DC. Telephone: (202) 690-8230.
George Argus, Senior Director of Health Data Management, American Hospital Association, Chicago, IL. Telephone: (312) 442-2820.
Kathy DeVault, RHIA, CCS, CCS-P, Manager of Professional Practice Resources, American Health Information Management Association, Chicago, IL. Telephone: (312) 233-1520. Email: [email protected].
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