October 16th, 2015

ICD-10 in these First Few Weeks

Now that ICD-10 is here, we can finally set aside the lingering debate about whether the change would occur in our lifetimes—or ever. We can begin to see the pay-off of months and years of training and preparation—and we can look forward to fewer articles about “truly bizarre” ICD-10 codes.

That’s got to be a relief for everyone, especially those who have walked into a lamppost at some point.

In these first few weeks of ICD-10, as we’re seeing mostly business as usual—and as providers have little choice but to take a wait-and-see posture toward the impact on reimbursement for the first rounds of ICD-10 claims—it’s time to make an adjusted set of contingency plans. This isn’t just checking a box—it’s following through on your commitment to a successful ICD-10 transition.

Address training needs strategically

If you haven’t already, formalize your process for gathering ICD-10-related feedback from your team—and for finding ways to share this insight across your organization. This will help everyone who is working together to form new processes around ICD-10. For example, when physicians understand the specific challenges of coders, they will better understand the adjustments they need to make to their documentation process. And when clinical documentation improvement specialists understand the developing trends in denial management, they can pay special attention to documenting medical necessity or take other steps that help prevent similar denials from occurring in the future.

Ask your staff which specific parts of their workflow are taking longer or becoming more cumbersome; where additional (or alternative) resources would be helpful; where they notice opportunities for improvement or the need for additional training.

Once you’ve gathered and analyzed this feedback, act on it by adjusting your training plans and resources accordingly. Don’t stop there—look ahead at the coming months. Examine your Q4 2014 and Q1 2015 claims data and pay special attention to the most common families of codes you’re likely to need through the rest of this year and the first part of 2016.

Depending on where you’re located, for example, you may need to be ready to document and code snow-sports injuries throughout the winter while next summer you’ll need to master mountain-bike-related codes. And wherever you’re located, you’re more likely to need to code flu and flu-related conditions in winter and spring—get a jump on those trainings and reference materials now.

Here are a few other ways to add strategic focus to your ICD-10 training and planning:

  • As remits start to roll in, immediately identify and continue to monitor denial trends by payer. Get staff comfortable with specialized or strategic work-queues so that you’ll be better prepared to segment workload by payer as needed.
  • Apply the lessons learned from commercial payers to government-payer claims. The announcement from CMS regarding “families” of ICD-10 codes has been thoroughly written about elsewhere—but a less-discussed risks is that processes for ICD-10-coded Medicare claims will evolve differently due to CMS’ adjusted rules.

To guard against this, code and develop processes for Medicare claims as though nothing had changed about CMS’ rules for these claims. The goal should be to abide by the full specificity and documentation necessary for ICD-10—if you don’t, there will be a gap in your processes for Medicare claims when CMS’ rules re-adjust a year from now.

  • In anticipation of a potential spike in ICD-10-related denials, focus on reducing preventable, non-ICD-10-related denials. Until meaningful feedback begins to roll in from payers—and perhaps more importantly, if that feedback shows little ICD-10-related impact—the greatest single sources and root-causes of your denials will be the same as they were before ICD-10. If a spike does occur, the effect on your organization will be lower overall if you’ve addressed root-causes of denials and streamlined workflows for preemptively addressing them.

Remember the front office.

The flow of information relevant to ICD-10 begins when the patient makes their appointment. In fact, the specific ability to code initial, subsequent, or sequela encounters accounts for a significant percentage of the overall increase in number of codes, as does laterality—information that can often be gathered effectively during check-in or appointment-setting.

A real-world example: let’s say a physician forgets to document whether it’s an initial, subsequent, or sequela encounter. If your coders can find this information on the appointment record, that might make the difference between the claim going out the door on time or being delayed due to incomplete documentation.

Everything’s fine so far—so keep making it better

While signs in the industry are positive thus far, there’s still a long way to go on ICD-10. The right ongoing training plan and the right insight into your organizational performance will help you build on the momentum of this positive start—and help you move forward strategically so that no matter what, your organization is stronger if and when ICD-10-related disruption occurs.

Crystal Ewing, Product Manager at ZirMed, Oct. 16, 2015