When it comes to ICD-10 coding, the waiting may well be the hardest part. The new coding system was set to take effect in October, but it experienced a delay as part of the Protecting Access to Medicare Act of 2014, which was signed into law last April. It was the second delay for ICD-10, which was originally slated to go into effect in October 2013. Now, CMS has announced a new launch date — Oct. 1, 2015. For those charged with readying health systems and physicians for the new coding procedures, it’s been a roller-coaster ride.
While at first frustrated by the latest delay, Adelaide LaRosa, system director of HIM/CDI & charge master, Catholic Health Services of Long Island (CHSLI), now views the additional year as an opportunity for more and better training at CHSLI. She recently offered her insights on how her organization has dealt with the delays.
By Scott Westcott, Contributing Writer
How you use the extra year to prepare for ICD-10 could be instrumental in the ultimate success or failure of your transition.
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When it comes to ICD-10 coding, the waiting may well be the hardest part. The new coding system was set to take effect in October, but it experienced a delay as part of the Protecting Access to Medicare Act of 2014, which was signed into law last April. It was the second delay for ICD-10, which was originally slated to go into effect in October 2013. Now, CMS has announced a new launch date — Oct. 1, 2015. For those charged with readying health systems and physicians for the new coding procedures, it’s been a roller-coaster ride.
While at first frustrated by the latest delay, Adelaide LaRosa, system director of HIM/CDI & charge master, Catholic Health Services of Long Island (CHSLI), now views the additional year as an opportunity for more and better training at CHSLI. She recently offered her insights on how her organization has dealt with the delays.
Q: Where were you in your ICD-10 preparation when Congress delayed its implementation again in March?
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A: We were almost done training the coders and the clinical documentation specialists in ICD-10 coding knowledge. We had started in August 2013 using the 3M ICD-10 education tool which includes various modules for staff to progress through. We supplemented that with classroom training, so we were almost done with getting everyone fully trained on how to code in ICD-10. When the word came that there was another delay, my initial thought was “not again,” because I had been very active in getting the training to where it needed to be based on the existing deadline. I was thinking, “We just need to get this over with and move forward.” But, then I quickly began planning how we could use this delay to our advantage. I realized we could use this additional time to further enhance the knowledge of the coding staff and clinical documentation specialists, as well as start dual coding. We are now taking current information and building a database of how something would be billed in both ICD-9 and ICD-10. The delay also gave us more time to develop our plan for physician education on ICD-10 with an increased level of specificity.
Q: How did the delay affect your ICD-10 preparation? How did you alter your strategy as a result of the delay?
A: We did not slow down or pause. Instead, we continued our education program. I work closely with the chief medical officer here, and he and I both felt the delay gave us more opportunity to go back to each hospital and be at their medical executive committee meetings with the decision makers to further communicate the importance of documentation improvement with this incoming new code set. The physicians here are very much made aware that their profile is totally dependent on the communication of care they put in their chart. I used to say in “the old days” that every time you put your pen to paper, you are creating a profile. Now, in today’s world, everything is transparent. Every time a physician puts fingers to a keyboard, that doctor is communicating the care provided to the patients being treated. How sick a patient is and a host of other information are only going to be known through codes, and those codes feed many different databases. So, this delay is our opportunity to engage physicians during a longer period of time; to prepare them for understanding the importance of entering a code in the right “bucket” so we can best identify the severity of illness and risk mortality on the population of patients they treat.
Q: What do you feel are the most important areas of emphasis for your facility to ensure a smooth transition?
A: Obviously, proper documentation is going to be key. I can have a team of coders perfectly trained and ready to accurately code based on what is documented, but if the doctors are not documenting properly, then our reimbursement is not going to be where it should be. ICD-10 relies heavily on showing how sick a patient is. I think we have considerable emphasis on training those who will be coding, but we have to have the physicians ready to start documenting with an increased level of specificity. For example, in terms of further specificity, if a patient had an MI (myocardial infarction), then what coronary artery was involved in the MI? Physicians need to know that, going forward, they just can’t say MI; they need to provide more specifics.
Q: What’s your ICD-10 transition time line look like now?
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A: It is now focused on hitting certain milestones. For instance, one milestone was getting all of the coders “fluent,” which we have already achieved. The next big milestone is to start dual coding so we can assess the true impact this new coding system will have. Also, we are focused on keeping the momentum going with physician education, holding meetings with specialty groups to go over documentation for their specialty. People think this is only an HIM issue, but it really is an interdisciplinary approach to making sure we are ready when the go-live date does arrive.
Q: What technologies are instrumental in your ICD-10 transition strategy?
A: As with any project such as this, it’s all about people, processes, and technology. When it comes to technology, we use 3M software, which provides us with all the coding resources and clinical documentation and edits we need. In addition to giving us the ability to code in ICD-10, it offers training capabilities that have been helpful to our staff. The software is being constantly upgraded with whatever state or federal regulations are changing, so we are confident we have the right technology in place for when ICD-10 does go into effect.
Q: What third-party support will you leverage, and what internal processes are in most need of evolving in anticipation of ICD-10?
A: As far as third-party support, we have a relationship with outside coding vendors to assist us and be available with any type of coding backlog that may occur. That will provide backup to help make sure we maintain smooth operations. When it comes to processes that need to be changed, payor readiness is important. We can teach the coders to code and have our processes in place, but if we move to ICD-10 and payors are still paying us in the ICD-9 world, then there are going to be problems. We need to focus on making sure that the process of payor and vendor readiness is up to date.
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Q: What advice would you give to other providers as they prepare for ICD-10?
A: First, if you haven’t done anything yet, don’t panic. It’s never too late. The reality is you are never going to get everyone to be able to memorize every code. What you need to know is that your coders can take what is in a chart and translate it to a code. You also need to know your case mix. You need to know your top 25 principal diagnoses and secondary diagnoses and the most frequent procedures your facility does. And then you need to make sure your team is fluent on how to code those. You really need to make sure you are well aware of the population of patients you are treating so your coders can become specialized in how to code those cases. Also, take time to meet with your high-volume physicians, those who are really bringing in the patient population. Just get going with your preparation, and pick a training tool that can be used and updated on a continuous basis. Also, you may be faced with staff turnover, so you need to be able to train people quickly.
When it comes to ICD-10 coding, the waiting may well be the hardest part. The new coding system was set to take effect in October, but it experienced a delay as part of the Protecting Access to Medicare Act of 2014, which was signed into law last April. It was the second delay for ICD-10, which was originally slated to go into effect in October 2013. Now, CMS has announced a new launch date — Oct. 1, 2015. For those charged with readying health systems and physicians for the new coding procedures, it’s been a roller-coaster ride.
A: We were almost done training the coders and the clinical documentation specialists in ICD-10 coding knowledge. We had started in August 2013 using the 3M ICD-10 education tool which includes various modules for staff to progress through. We supplemented that with classroom training, so we were almost done with getting everyone fully trained on how to code in ICD-10. When the word came that there was another delay, my initial thought was “not again,” because I had been very active in getting the training to where it needed to be based on the existing deadline. I was thinking, “We just need to get this over with and move forward.” But, then I quickly began planning how we could use this delay to our advantage. I realized we could use this additional time to further enhance the knowledge of the coding staff and clinical documentation specialists, as well as start dual coding. We are now taking current information and building a database of how something would be billed in both ICD-9 and ICD-10. The delay also gave us more time to develop our plan for physician education on ICD-10 with an increased level of specificity.
A: It is now focused on hitting certain milestones. For instance, one milestone was getting all of the coders “fluent,” which we have already achieved. The next big milestone is to start dual coding so we can assess the true impact this new coding system will have. Also, we are focused on keeping the momentum going with physician education, holding meetings with specialty groups to go over documentation for their specialty. People think this is only an HIM issue, but it really is an interdisciplinary approach to making sure we are ready when the go-live date does arrive.
Q: What advice would you give to other providers as they prepare for ICD-10?
