For health care providers, testing technology systems' ability to cope with the upcoming International Classification of Diseases, Tenth Edition (ICD-10) is no doubt an important step. However, there are more critical internal workflow concerns associated with the ICD-10 changes.
Physicians and nurses will have to provide more specific documentation of patient diagnoses and treatments to support the use of the ICD-10 codes in claims. The degree of success for your ICD-10 transition hinges on their level of compliance with new documentation requirements, as well as your hospital's ability to get claims paid quickly. Senior leadership needs to understand this to support your ICD-10 preparation efforts, according to Cynthia Trapp, American Health Information Management Association (AHIMA) member and director of coding for the Lahey Clinic.
The 83rd AHIMA Convention & Exhibit, which commences this weekend, should provide plenty of insight for health IT professionals who need help overcoming the many obstacles the ICD-10 changes.
IT leaders can ease this transition with speech recognition software and other tools that can enable faster documentation. They can also ensure that applications storing procedural and diagnosis data -- including EHR, RIS and PACS -- have ample space and free-text fields to provide documentation.
Linda Howrey, principal compliance consultant for Hayes Management Consulting, has worked with many facilities preparing for ICD-10. She's found that physician education can be effective during regularly scheduled one-on-one audits between physicians and coders.
Behavioral health gets DSM, ICD double whammy
Here's a little-discussed coding and technology transition that could affect a portion of the users on the hospital network. Behavioral health professionals will get a new version of the Diagnostic and Statistical Manual of Mental Disorders -- the current version of which is better known as DSM-IV -- six months before the coding world fully implements the ICD-10 changes.
According to an audience member at the HCCA New England Regional Conference who performed a preliminary review, DSM-IV diagnoses and ICD-9 codes "match perfectly," while preliminary reviews of the new DSM-V and ICD-10 "don't match any more."
Speakers at the conference said they've heard very little about what could be an intensive training period for behavioral health clinicians. They advised attendees to keep up with what their professional associations are advising to ease the transition -- and do it.
"I have heard no one talking about the DSM-IV/DSM-V and how it relates to ICD," said Linda Howrey, principal compliance consultant for Hayes Management Consulting, who added that the double transition could potentially catch some providers unaware and result in rejected and delayed claims payment.
IT could play a role in solving this problem, she continued. "You need to look at what your vendors are doing. Hopefully there will be a way to crosswalk within the system so if your providers are used to using the DSM and they're not going to use ICD-10, your systems are going to have to crosswalk for you."
Do it now, Howrey concluded, because vendors might not yet be aware of the issue.
In these sessions, Howrey explained, coders show physicians how claims look using ICD-9 codes compared to how they will look using ICD-10 codes, highlighting issues such as where more documentation will be needed. It's a low-pressure situation that's conducive to learning, she continued; physicians aren't being punished for inadequate documentation, since the switch to ICD-10 hasn't yet occurred. Furthermore, physicians respond better in one-on-one situations where their lack of ICD-10 knowledge isn't put in display before a group.
CMS has help, but it's not be-all, end-all guidance for ICD-10 changes
ICD-9 features five-digit numerical codes, while ICD-10 codes are seven-digit alphanumerics. Who publishes the official crosswalk from one to the other? Nobody, said Patrice Devoe, Tufts Health Plan director of ICD-10 implementation and infrastructure initiatives. CMS offers its best guess in what it calls "general equivalency mappings," commonly referred to as GEMS, on its ICD-10 guidance pages.
These aren't foolproof, Devoe said. Many ICD-9 codes have direct equivalents in ICD-10. But with the ICD-10 changes, some ICD-9 codes have no new equivalent, and a few are errantly mapped in the GEMS. What’s the biggest problem? There are approximately 10% of ICD-9 codes that could map to many different ICD-10 codes.
Organizations need to customize their own maps -- especially the one-to-many scenarios from ICD-9 to ICD-10. This means examining the intent behind each ICD-9 code it uses and understanding which ICD-10 codes will need to replace them in which situations.
They also need to map ICD-9 to ICD-10 and then backward-map it to ICD-9, as both maps will be used during and after the transition. Such mapping will be crucial to help coders for both providers and payers sort things out during the months immediately following the switchover.
Devoe predicted the U.S. health care system will appreciate "real value" from the ICD-10 changes by 2015, but from the changeover to that point, it will be "chaos."
Tufts, for its part, is making the transition to ICD-10 codes with a four-part process:
- Gathering data on all processes and policies that involve ICD codes, so it has an inventory of all the items that will require change.
- Mapping ICD-9 to ICD-10.
- Changing over to ICD-10, which includes pilot testing with providers and vendors before go-live.
- Implementing a monitoring and maintenance process, based on new guidance and real-world experience using ICD-10 codes.
Devoe recommended that organizations confronting ICD-10 changes begin by designing a governance process for the transition. This should include input from senior leadership.
Let us know what you think about the story; email Don Fluckinger, Features Writer.
More advice from AHIMA on confronting ICD-10 changes
- Proper ICD-10 preparation combines technology, testing
- Have questions about the ICD-10 changes (or advice to share)? Visit the Health IT Exchange!