Taking control of ICD-10


ICD-10Photo used with permission from Shutterstock.com

With ICD-10 launch time close at hand, how can physicians minimize productivity loss, avoid financial pitfalls and, most important, ensure they will receive proper financial and quality credit for the care they provide in an ICD-10 world?

A good starting point is to create a focused education and training plan that is specific to the needs and challenging schedules of physicians. ICD-10 seems big and unwieldy, but its learning curve is entirely manageable with a program tailored to the “need to know” aspects of the new coding system. As the Centers for Medicare & Medicaid Services has explained to coders, ICD-10 is like a phone book; coders do not need to memorize its entire contents, rather they just need to know how to find the single code they are selecting from this "book."

The same holds true for physicians who will focus on their specialty and some of the common co-morbid disease codes. Physicians do not use every code in ICD-9; the same will hold true for ICD-10. Immediately starting a tailored and specific ICD-10 awareness program will allow physicians to mitigate and perhaps overcome potential hazards that loom on the horizon.

With ICD-10 comes a new dawn in physician documentation and a much more transparent clinical footprint. In this new era, physicians will need to master documentation practices and learn ICD-10’s primary concepts. In a recent physician needs report, providers said training is a key need in achieving ICD- 10 readiness. Providers reported both clinician training (52 percent) and coder/staff training (40 percent) were their greatest needs (Westerlind, 2012).

Without the physician’s detailed documentation, as required by ICD-10, coders will be handicapped. Only well-trained physicians, clinicians and others who work within the medical record can provide the specificity and deep level of detail required. Ultimately, physicians who learn to document with specificity will reduce productivity losses by having fewer queries from coders and position themselves to receive accurate and higher reimbursement. Without this specificity, physicians will face an avalanche of query activity or fail to show the true Severity of Illness in their patients, which will impact quality reporting and possible reimbursement.

[See also: How ICD-10 will benefit physicians]

Create personal learning experiences
ICD-10 learning is not a one-size-fits-all approach. Physicians have varying documentation practices and may prefer differing learning modalities, which is why it is important to develop a customized plan. It is estimated that physicians may require as little as three to upwards of 12 hours of education to learn ICD-10 strategies. Those physicians who do their own coding will be closer to the 12-hour mark.

Physicians must attain education in their practice area that provides a real-world view of how to apply ICD-10 core concepts to common diseases and conditions. ICD-10 training should be targeted primarily on strengthening documentation skills. ICD-10 will not add a huge amount of new content to the medical record. In some cases, it may be a few more documented words per condition, which physicians already know from the workup of the clinical encounter. Most important, physicians do not need to become expert coders or learn how to specifically document 10,000 different diseases in order to survive in an ICD-10 world. However, some knowledge of coding is required for certain groups of physicians, including those practicing in hospital and office settings where they do their own coding. These physicians will need to understand basic coding rules and definitions and need to know how to select the right codes for their specialty.

Key ICD-10 learning goals should include the following:

Focus training around large topic areas. ICD-10 is rooted in about eight to 10 core documentation concepts. When physicians learn these basic constructs, they can then apply them to any disease. Focus on important concepts of ICD-10-CM, including site, specificity, laterality, timing, manifestations, stage, status and drug/alcohol/ tobacco dependence. However, physicians do not have to learn the individual strategies for 5,000 different diseases or a rare one, such as Bubonic plague. Instead, understanding these eight to 10 core concepts will allow concept application to trigger improved documentation for any disease a physician is treating.

Target education on risk areas. The documentation required by ICD-10 for optimal code assignment is not something a physician has to learn. The physician already knows what he or she is treating. Address gaps in current documentation habits. If risk areas or high-volume conditions are known, targeting education to the documentation of these identified conditions is a good strategy to mitigate risk and prepare for what will be needed in ICD-10.

[See also: Applying ICD-10 to Crohn's disease]

Concentrate on specificity and underlying conditions. Physicians need to adopt new tools and strategies to meet ICD-10’s demand for granularity and severity within the medical record. Under ICD-10, physicians must move beyond documenting the principal or first-listed diagnosis and learn how to properly document underlying conditions that may not apply specifically to their specialty to get full reimbursement and to avoid issues, such as coding queries and payer denials. For example: An OB-GYN may have a patient who is losing bone density due to a pregnancy. The underlying condition, osteopenia, must be properly documented to show Severity of Illness and medical necessity for any tests or procedures required.

Incorporate EHR training. Precise documentation for ICD-10 purposes can be facilitated through the use of EHR templates and prompts, as well as clinical data repurposed throughout the EHR to support the “collect once, use many times” concept. However, these templates and prompts must be ICD-10 ready. It is critical that the vendor has considered not just the codes and code descriptions, but the specific documentation requirements needed for ICD-10. Push your vendor to continually optimize the system for ICD-10, which will streamline physician workflows and assist in optimizing the required documentation.

However, it is critical that physicians do not view the EHR as their "savior" for ICD-10. Physicians must understand the documentation foundations of ICD-10 as no system will be able to fully script or capture every encounter a physician may face in their complex clinical work.

Use a variety of learning methods. Physicians have grueling and challenging schedules with increases in patient volumes, administrative efforts and entry of data into electronic systems. For this reason, it is critical that physician learning include myriad approaches to making the education available any time, anywhere, and any way they can consume it.

Also recognize that not every physician can be reached in a classroom setting. Due to pressure on their schedules, organizations must rely on multiple educational modalities for physicians.

A strong ICD-10 education program and plan should use some or all of the following:

  • Online, self-paced e-learning

  • Peer-to-peer ICD-10 education, workshops and staff meetings

  • Smartphone apps and mobile resources
  • Audio webinars

  • Well-trained, adept CDI professionals able to educate the physicians at point of opportunity

  • Simulation training

  • Communication initiatives and collaterals
  • Job aids/printed resources

  • Video games

  • One-on-one meetings

  • Quarterly follow-up

Follow these 5 steps to develop an education and training matrix:

  1. Identify physicians and staff members who need training and form a training timeline for those groups.
  2. Assess physician documentation modalities. Physicians and other clinical staff can be assessed in terms of the specificity they currently use in their documentation and code selection, and the deficiencies that exist today that will pose risks in ICD-10. These assessments will reveal the degree and type of ICD-10 education that physicians will require and the potential documentation gaps. Over the long-term, make these types of assessments and audits a recurring program to ensure optimal documentation and identify educational opportunities.
  3. Develop recommended bundles/tracks for physicians and their staffs based on their role and function. It is key that physicians are only required to take education they need, nothing more and nothing less.
  4. Estimate the total number of ICD-10 education hours for physicians based on the level of education they need.
  5. Identify start and end dates for each impacted population.

Start now
Although ICD-10 will not be live until Oct. 1, 2014, there is no reason to wait. Preparing now for the enhanced documentation required in ICD-10 has no drawback. Unlike teaching coders too early who will "lose it without using it," these are concepts physicians can incorporate today. In fact, more specific and improved documentation will actually drive benefits in ICD-9 by reducing queries, maximizing reimbursement and reflecting accurate Severity of Illness and medical necessity.

Ultimately, the longer the period of the education, the more opportunities there will be to repeat, refresh and promote.

Adapted with permission from a white paper titled "Helping Physicians Succeed in an ICD-10 World" by Tom Ormondroyd, Bruce Scott, MD, and Christian Oliver.

Photo used with permission from Shutterstock.com.