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Don't delay transition to ICD-10, experts warn

Even if training doctors is hard, coding has been outsourced and the C-suite remains unconvinced, health care organizations should not delay their ICD-10 preparations any longer.

With less than two years before the Oct. 1, 2013 deadline to transition to ICD-10 codes, health care organizations that haven't yet started the process are cutting it close. Preparation for the ICD-10 transition varies among providers -- some are waking up, but some are taking a "wait and see" approach.

At a recent ICD-10 conference sponsored by the Massachusetts Medical Society, an IT vendor in the audience asked presenters from auditing firm KPMG LLC how to deal with organizations that make statements such as the following:

  • "We have an outsourced coding vendor, so we don't have to do anything for ICD-10."
  • "Medicare said we don't have to start training our coders until six months before it goes live, so we're going to start then."
  • "The Centers for Medicare and Medicaid Services (CMS) has been a little generous with the meaningful use and HIPAA version 5010 deadlines, so we don't really think the October 2013 deadline is real."

Some organizations still see ICD-10 as some sort of back-end coding transition and not a major global change, said the vendor. "If an organization doesn't see [ICD-10] as a global issue, they'd better wake up," responded Susan Davis, director of health care advisory services at KPMG.

Luckily, the tide has been shifting. While excuses might have been common a year ago, they're not so common these days, said Kirk Kamien, director of regulatory compliance at KPMG.

Indeed, when Kamien polled the audience at the beginning of his presentation to ask how many people were either in the midst of a transition ICD-10 -- or at least talking about it -- the majority of hands went up. That's actually pretty impressive, given what Kamien called the "perfect storm" of health reform and health IT initiatives whirling about -- meaningful use incentives, accountable care organizations, HIPAA version 5010 and, of course, the transition from ICD-9 to ICD-10 codes.

This perfect storm is probably the most often cited reason for why ICD-10 implementation is falling behind in the U.S. But organizations that think the transition to ICD-10 codes is just another project to add to the list had better think again. "ICD-10 will virtually impact every system, process and transaction that involves a diagnosis and procedure code," Kamien said. "That means it's affecting a big part of [the] revenue cycle."

Even if coding is outsourced, health care organizations will likely have to make significant changes to workflow and clinical documentation as part of the transition to ICD-10.

Training physicians to document with ICD-10 coding is a big challenge

One of the biggest challenges at Lahey Clinic Hospital Inc. has been preparing physicians for the transition to ICD-10, said Cynthia Trapp, director of professional coding and coding education, adding that it can be very difficult to change physician documentation behavior. ICD-10 codes require much greater specificity, and for compliance purposes, the information must come from the physician documentation.

The hardest part about training the physicians, noted Trapp, is figuring out exactly what physicians will need to know in order to document properly for ICD-10. For example, a finger wound must be documented with detail that includes whether it was on the left hand or right, which digit was affected, whether a foreign body was involved and so on. Some of that information might be in the EHR system, but some of it might not. The physicians will need to know what must be included in the documentation to satisfy ICD-10 coding requirements.

It would be nice, said Trapp, if the hospital's EHR systems included prompts for physicians at the point of care to help them figure out the best way to document for ICD-10 coding. Lahey is working with its EHR vendors to see what can be done in this area.

Even if coding is outsourced, health care organizations will likely have to make significant changes to workflow and clinical documentation as part of the transition to ICD-10.

What about this notion of waiting to train staff until six months before the switchover date? Lahey plans to train its "heads-down coders" -- the ones who are really just coding and aren't involved in physician education -- about three to six months before the transition deadline, said Trapp. However, her team has already begun providing feedback to physicians during regular audits to help prepare them for documenting for ICD-10 codes.

While CMS does recommend conducting intensive daily training for coders about six months before go-live, it also recommends "educating staff on changes in documentation requirements from health plans" starting in the summer of 2011. So organizations that have not started to at least promote some basic awareness of ICD-10 may already be behind.

Getting senior leadership to buy into the importance and impact of the transition to ICD-10 is another major challenge, said Trapp, who has been preaching about ICD-10 for the last decade.

The October 2013 deadline is real, agreed the folks from KPMG, and it's not likely to move. Ideally, organizations should have been thinking about ICD-10 back in 2009, said one presenter. The transition to ICD-10 is big and complicated, and organizations that are taking the time to educate and prepare now will be better able to weather the storm when the time comes.

Let us know what you think about the story; email Anne Steciw, Associate Editor.

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