Five Things You Should Read as ICD-10 Approaches

During a session on ICD-10 at the iHT2 New York Health IT Summit this week, Jim Daley, director, IT risk and compliance, Blue Cross Blue Shield of South Carolina, and co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 workgroup, jokingly asked the sparse crowd if they were really there to learn about ICD-10 when the transition to the new coding set was set to take place in less than 48 hours.

Daley’s humor sheds some light onto the ICD-10 state of affairs—if you’re not yet ready for ICD-10, then there’s nothing that a 50-minute educational session two days before the transition can do for you. Nonetheless, Oct. 1 is a day away (yes, sorry Congress, it’s happening!), and while I believe most of the industry is probably hunkered down in their ICD-10 “command centers,” I figured that giving our readers a one-stop-shop of the most important news, tips and stories from the last few months on ICD-10 could prove beneficial. Here are five things to keep in mind as the clock keeps ticking away.

Read your checklists. In late August, the American Hospital Association (AHA) released a “homestretch” checklist soon after a WEDI survey found that nearly one-quarter of physician practice respondents will not be ready by the Oct. 1. AHA’s checklist provides hospital leaders with key steps they should take to ensure a successful transition to ICD-10. The list is divided into three main sections: check internal systems; verify external partner readiness; and consider financial protections. AHA has some pretty neat additional resources on its site as well, including charts to help monitor and triage issues that may arise for registered users. Also, the Centers for Medicare & Medicaid Services’ (CMS) “Road to 10” web page has some helpful references as well. As new CMS ICD-10 Ombudsman, Bill Rogers, M.D., said in a blog post last week, the agency assures the medical community that it has tested and retested its systems, and is prepared to solve problems that may come up. What’s more, at the American Health Information Management Association’s (AHIMA) annual conference this week, the Los Angeles-based Cedars-Sinai Medical Center, one of the nation’s earliest adopters of ICD-10 which began dual coding with both ICD-9 and ICD-10 in October 2013, offered some key recommendations based on the its experience thus far.
Embrace the process change. A few weeks back, I interviewed Josh Berman, director, business analytics & ICD-10 lead at Relay Health (a part of the Alpharetta, Ga.-based McKesson Corporation's technology solutions segment), who admitted that organizations are likely going crazy waiting for the first of October to come, but also offered some sound logic. Berman said, “It’s a process change, not a technology change. When you’re doing a technology change, you can test; for a process change, it’s not that easy. CMS did a good job and did their due diligence, but people are equating that to readiness on both the provider and payer side, and that’s just not the case.” Indeed, we really won’t know what’s going to happen until tomorrow hits, but those who are prepared for that process and have been planning for it will truly be fine in my opinion.
We keep hearing about the increased number of codes, but is that really the story? Bruce Hallowell, managing director in the Chicago-based consulting firm Navigant’s healthcare practice, told me this summer that the concern about the increased codes for ICD-10 compared to ICD-9 is an outright fallacy. He said, “The extra codes aren’t really the problem. The ability to code the record is the issue, and organizations haven’t dealt with that. You have all this money spent with meaningful use and EHRs that built these automation tricks, but all the order sets and protocols attached to them were all built on ICD-9. So you have to train all these coders and modify the system, but if they don’t go back and fix those issues, it won’t make a difference—they won’t be able to code them all. Specificity in the record is what will cause the problem, not the code itself. Clinical documentation improvement (CDI) is key for that.” Indeed, in a recent contributed piece for HCI, Robert Hitchcock, M.D., CMIO, vice president and general manager of physician solutions at Dallas, Texas-based T-System, said that the conversation around ICD-10 needs to change from a coding conversation to a documentation one.
Flexibilities announced by CMS and the American Medical Association (AMA) could be a factor. At the core of the CMS/AMA joint announcement on ICD-10 this summer is flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. Specifically, CMS said that for the first 12 months post-transition, they will not deny or audit physician or other practitioner claims solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. There were plenty of other “flexibilities” announced by the organizations as well, and the best place to see them all, as well as Q&A guidance on the specificities, is here.
Post-October 1 is just as important as getting there. At the end of the day, people can make predictions, but it’s definitely hard to say what the impact of ICD-10 will be. We just don’t know until it happens. That being said, as Navigant’s Hallowell said to me, organizations will likely have a bunch of small problems that will arise due to the lack of experience and understanding. But, as Thomas Selva, M.D., CMIO at University of Missouri Health Care, told HCI Assistant Editor Heather Landi in a recent story, those issues are bound to decrease over time. "I think what you’re going to see is the number of call backs will slowly decrease over time. And, I think we’re going to see the interruptions to physicians’ work flow will decrease over time,” he said. To combat these problems, Selva said that “A lot of institutions right now have rightly taken the approach of contracting with temp organizations to bring in temporary help to get over that initial hump of needing to get call backs and needing to improve specificity with the coding.”