Hoping for a deadline extension, many physician practices are behind. Instead they should be highly focused on the transition from ICD-9 to ICD-10 code sets, says one expert.
With so many challenges and changes coming at physician practices, it can be hard to know where to focus attention. Healthcare reform is reshaping the way healthcare is provided and paid for it, and one of the most fundamental changes involves coding.
Physician practices should be highly focused on the transition from ICD-9 to ICD-10 code sets, says Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB, director of audit services with the AAPC in Salt Lake City. Stilley also is part of the AAPC’s ICD-10 Curriculum Training Team, which assists physician practices in switching from the current set of 14,000 codes to over 69,000 codes.
In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date until October 1, 2014, but CMS more recently warned that physicians should not count on any more delays. That means now is the time to get in gear for the transition, Stilley says.
“I’ve seen it all over the board at this point. Some are right on target with where they should be, and we have some practices that have just begun putting their teams together, assessing their policies and procedures to see where the effect of ICD-10 may be for them,” Stilley says.
“You have to start there because there are so many systems in use even by the smaller practices, and all of those systems have to talk to each other with the new ICD-10 codes. When you get to implementation, how will you ensure that all these systems are talking to one another the way they are supposed to?”
That integration of disparate systems is proving to be one of the biggest challenges for physician practices, Stilley says.
Many providers just getting started
Meeting the deadline is creating a lot of pressure for providers, partly because of the significant investment in new technology and consulting services. At least one company—whose survey also confirms that physicians are lagging in their preparations—is trying to allay some of those fears by guaranteeing that physician practices will be ready by the deadline or it will return the money invested.
The number of healthcare providers who may not be ready for implementation of the ICD-10 code sets is alarming, according to a report from the American Health Information Management Association (AHIMA) in Chicago. The survey interviewed more than 300 health information management professionals representing 293 healthcare organizations. The goal of the survey was to identify the themes and best practices that are emerging as the healthcare industry moves closer to ICD-10’s October 1, 2014, deadline.
The report found that more than 50% of survey respondents in fall 2012 still were in the beginning stages of ICD-10 implementation and 25% of respondents’ organizations had not yet formed an ICD-10 steering committee. Thirty percent of surveyed teaching community hospitals and academic medical centers reported that they regularly met with their ICD-10 steering committee and were moving through their project plans at an acceptable speed, and 17% of other types of hospitals reported that their ICD-10 conversion plans were underway.
Physician groups must start by assessing their current situation and soliciting buy-in from key players, Stilley says.
“The physicians and practice leaders need to understand the urgency of transitioning to ICD-10,” she says. “You will not get the financial backing and the other support you need until the people who really control the purse strings have that sense of urgency.”
Documentation may not be good enough
Stilley next encourages practices to look at their clinical documentation to assess whether in its current state it would provide a thorough, credible account of patient care. That might seem like an obvious requirement for documentation, but Stilley says the documentation currently used by some practices will not be detailed enough to support the more expansive coding of ICD-10.
“Look at the most reported ICD-9 codes for each physician, and then code those same records in ICD-10,” she suggests. “Note what is missing, what information you didn’t have to have for ICD-9 but which you will need for ICD-10. Then convey that to the physicians and help them capture that information.”
In some cases the additional information can be built into an electronic medical record so that the system prompts the physician for the additional information. Stilley cautions that an audit may reveal physicians and staff do not know the current ICD-9 codes sufficiently, in which case ICD-10 training will be especially important. ICD-10 expands the number of codes to be used but depends in large part on the user already understanding the general guidelines for coding.
“You’re going to have a hard time transitioning to ICD-10 if you don’t understand the principles behind coding in ICD-9,” she says. “For some practices, training on ICD-10 will be an opportunity to improve your overall coding and reimbursement process.”