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The Oct. 1 deadline for implementing ICD-10 is almost here.
Most sizeable healthcare providers have done most of the preparation they need to be ready, including training staff, testing systems and coordinating with vendors.
While Hornberger somewhat focused on long-term care scenarios, her advice -- including making sure physicians are ready to provide adequate documentation -- is applicable across the care continuum.
Hornberger also suggested some providers may find it helpful to staff up when implementation time comes and that in some settings, such as skilled nursing facilities, it may be advisable to put off converting to ICD-10 codes until next month because current residents may be gone by Oct. 1.
What can healthcare providers do now as the final countdown toward implementing ICD-10 begins? We're really getting close now, so what should they be doing, and what could they be doing to prepare better and faster?
Genice Hornberger: Hopefully they started early on developing an implementation plan and timelines on when they were going to begin converting code, looking at their workflow and their processes and seeing how it's going to change [for] ICD-9 versus ICD-10. At this point in time, I think people should be probably [be] beginning to convert codes. It depends on their setting. When you talk about long-term care residents, maybe in long-term care facilities, now would be a good time to begin converting those diagnoses from ICD-9 to ICD-10 because that resident is still going to be there on Oct. 1. Whereas, other facilities that have a shorter length of stay, or even skilled nursing facilities where they get a lot of short-term rehab residents, they might look at converting in September, because a lot of those residents will probably be going home before Oct. 1.
A lot of facilities that are beginning to convert those codes are doing what we call dual coding, which means they are coding in ICD-9, but they also continue to code in ICD-10 for that same diagnosis. So both diagnoses are on the record. You would then have ICD-10 present come Oct. 1 for that resident.
What about the overlap between ICD-9 and ICD-10? Are there a lot of codes that stay the same, and can you save some work by preserving some of the older codes?
Hornberger: The diagnosis is essentially the same, but the codes will be different. People will have to touch every ICD-9 code that's on the resident's chart today and convert it to ICD-10 by Oct. 1, or shortly thereafter in order to process claims. You will only be able to submit claims with ICD-9 up through Sept. 30. If a claim has a service date on Oct. 1 or beyond, then they would have to submit those claims with the ICD-10 code. If they didn't convert, then it's going to impact their reimbursement, and they won't be able to bill for those services come October.
Could you talk a little bit about staff training needs? What should healthcare systems, physician practices, nursing homes, post-acute facilities and long-term care facilities do at this late stage in terms of training? Assuming a lot of training's been done, will clinicians need retraining, or refresher training? Will coders need training support?
Hornberger: Hopefully, training has already been started. The coders are only one part of the training that needs to be done. Other support staff … also needs to have an understanding of ICD-10. People like nurses or medical office staff or physicians, they need to have a basic knowledge of how the new coding structure will be so they can provide that supporting documentation, as well as know what questions to ask. For example, if a nurse gets an order from the physician, and the physician provides a new diagnosis, that nurse needs to know. She might have more specific questions for that physician in order to get the level of specificity that coder is going to need for diagnosis. Otherwise, it's going to take more time to circle back with that physician at a later time to get the additional information so they can code it to the level of specificity needed.
A lot of people have remarked that many providers have underestimated the average time that's needed to code. Is that true, and can you elaborate on the rough estimate that it takes 15% longer than most providers have budgeted for? If it does take longer than most providers have budgeted for, how can they catch up?
Hornberger: With a new process there's always the learning curve, with ICD-10 [there is] a new level of complexity that people need to understand. Providers might need to look at whether their coders are able to keep up. Is the documentation there to support the diagnosis, or do they need to re-evaluate and add additional coding staff for a period of time during this transition period to get caught up? Or until staff begins to better understand what types of questions they need to ask and what type of supporting documentation they need to provide within the record?
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