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Five steps to avoid a ‘Code Blue’ situation when making the switch to ICD-10

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john Squire
John Squire, President, Amazing Charts

The impact of ICD-10 will vary enormously depending on how and where you practice medicine. It won’t be a big deal if you are directly employed by a hospital or health system. Likewise, if you work for a hospital-owned practice, or a large practice, your risks also will be minimal. Your organization probably has a team of IT and finance administrators who will sweat the details. Coding will likely be managed by a team of specialists who have been preparing for ICD 10 for a while now.

The situation is very different for the small, independent medical practice where a doctor and reduced support staff likely manage their own coding and, as such, will have to learn those guidelines and Clinical Documentation improvements. If you have staff to help with coding, then their productivity may be impacted by the learning curve for ICD-10 and the possible increase in rejected claims.

Here are five essential steps for small practices to take today to start mitigating the risks of implementing ICD-10, avoiding a ‘Code Blue’ situation and increasing the odds of success:

1. Target your most frequently used ICD-9 codes

Just like most things in life, the 80/20 rule probably applies to your current ICD-9 coding. In other words, 20 percent of medical codes cover 80 percent of your office visits. For Primary Care Providers, the ratio might be closer to 90/10.  Some examples of the most frequently used diagnoses codes at primary care practices are:

  • Abdominal pain
  • Depression
  • Diabetes
  • Gastroesophageal reflux (Acid reflux)
  • Headache
  • Health status and services
  • Hypercholesterolemia
  • Hypertension
  • Otitis media

Identify your most frequent occurring or high-value diagnoses or diagnosis codes – maybe start with the top 10 to 20. Map these to what you identify as the most appropriate corresponding ICD-10 code, and use the increased granularity to your advantage. Then, save whatever you learned by focusing in on these codes on a “cheat sheet.” By actively practicing with codes, you can focus your time on making documentation improvements exactly where they can have the greatest impact. The goal is to get comfortable with the elements of coding when ICD-10 goes live to maintain productivity. 

There are many ICD-10 conversion tools available online to help you with this step; however, mapping tools can sometimes fall short in providing definitive code since there are inconsistencies when mapping between ICD-9 and ICD-10. Additionally, some codes are new and some require much more specificity.

2. Refine your clinical documentation

Accurate and correct code assignment is dependent on clinical documentation and directly impacts reimbursement. Is your current documentation sufficient for the transition? Will “cheat sheets,” along with ICD-10 education, help you become more proficient?

Take this opportunity to “audit your charts.” Look at the previously identified list of most frequently occurring diagnoses in your practice.  When you have an encounter that includes a diagnosis on your list flag that chart.  Start small – just review your documentation in one chart at the end of each day. Does it meet guidelines? Did you address laterality or episode of care, if necessary?  Is all the information to support accurate code selection included?

The increased granularity in ICD-10 allows also you to capture information you currently document. For instance, asthma was described as extrinsic or intrinsicin ICD-9.  In ICD-10, asthma (J45.-) can be defined as mild, moderate, or severe, and some codes include persistent or intermittent options.

Identify areas requiring remediation as well as opportunities to adjust your workflow. Estimate the amount of time and effort necessary to successfully implement ICD-10. You’ll need to adapt prior to the ICD-10 transition to make the transition seamless.

3. Keep a close eye on claims processing

Since payers are also new to the ICD-10 system, claims processing times are going to be extended, so the time-to-reimbursement may take longer. Inaccurate documentation and coding can cause a delay in reimbursements and potential denial of claims.

A disruption in revenue flow can be avoided by understanding your ICD-9 claims history. To paint a full picture, look at all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue. This includes precertification, pre-authorization, scheduling, referrals, billing functions, denials, remittance and payer contracting. Identify areas requiring remediation and estimate the amount of time and effort necessary to successfully implement ICD-10.

Just in case you do experience post-implementation payment delays, you should clear out billing and reimbursement backlogs in accounts receivables now and consider setting aside a minimum of six-months of liquid assets.

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