In my blog, ICD10 Watch, I often cover the increased specificity in the ICD-10 code set and a need to improve clinical documentation. In doing so, it's acknowledged that one of the great fears of ICD-10 implementation is that it will create a documentation burden for physicians.
But maybe clinical documentation improvement (CDI) doesn't need to be so onerous. Here are four steps to making ICD-10 implementation work for physicians.
First, let's deal with why there are so many more ICD-10 codes than ICD-9 codes. Paul Weygandt, a CDI expert with Nuance Healthcare, likes to illustrate this with an example for orthopedic surgeons. There are 12 ICD-9 codes for femoral head and neck fractures. There are 576 ICD-10 codes.
Weygandt says surgeons really need to give anatomic specificity of where the fracture is. Then "they've already given us five of the necessary seven digits." The rest of the digits account for the increase in codes:
- Laterality (right, left or unspecified) can cut the number of diagnosis codes by a third.
- Is this an initial or subsequent encounter? There also is a digit for sequela - all other encounters.
- Is this a routine healing or delayed healing? Non-union or malunion.
To document or code those fractures, no one needs to remember 576 codes.
Avoid medical coder queries
Second, physicians will want to improve their clinical documentation on the front end. The alternative is the bigger problem.
"I think that the challenge of ICD-10 is not so much that it adds a lot of front-end work to physicians. It adds a tremendous amount of work for coders if the physicians have not provided all the necessary information," said Weygandt. "If a hospital gets into an iterative cycle where just to get to one diagnosis requires three or four questions back from a coder, physicians will revolt."
That's why the medical leadership needs to be engaged. Weygandt noted that the chief medical officer needs to be part of the ICD-10 transition and engaging the physicians.
Physicians, teach thyselves
Third, "The most impactful way to get information across is peer-to-peer," said Weygandt.
"Physicians -- right or wrong -- won't listen to a coder or documentation specialist addressing them about how they need to document," said Weygandt, who is also an orthopedic surgeon. That experience shows up in his examples. "Typically, orthopedic surgeons would shut down that kind of discussion in two or three minutes."
And he focuses training for different types of physicians. "Every sub-specialty needs the information relevant to their sub-specialty -- not to the other sub-specialties."
That's an important point in keeping physicians interested and reducing the complexity of education. For example, on the procedural side, there are 31 root operations. But Weygandt says physicians don't need to know all of them. He said most physicians need to know only about six.
Fourth, choose technology that fits into physician workflow. "The vast majority of physicians -- with the exception of maybe a few recent graduates -- are more comfortable speaking than they are typing in terms of data entry," said Weygandt. "Spoken word is how they communicate."
Which is why many healthcare providers are turning to natural language processing (NLP) to assist physician documentation, said Weygandt. "If we can embed assistive devices into the natural language process, that will concurrently ask physicians for clarification where needed, it's going to greatly reduce the negative impact of ICD-10 implementation."
While choosing a NLP technology seems to be a function of IT specialists, Weygandt said physician leadership needs to be involved. Physician input is necessary to choosing IT solutions that work properly in hospitals and medical practices.
These steps are necessary to making physicians feel that the ICD-10 transition is something that will work for them and not hinder their ability to practice medicine.