ICD-10 delay or not, we must still be prepared.


While it’s impossible to know for sure if the ICD-10 ‘go live’ date will truly be October 1, 2015, it seems unlikely there will be another delay. Now that SGR is dead, the odds are slim of a surprise like last year when the SGR bill postponed the implementation from 2014 to 2015. Anything is possible and there is always the potential that some group could push for another delay, but I don’t think many are really interested in seeing another delay. In an article in Health Leaders Media, Mark Bogen, CFO and SVP for finance at South Nassau Community Hospital in Oceanside, NY said “I think most hospital providers would prefer to take the hit than to keep doing this start and stop sort of thing.”

Interestingly enough, an article published in Medical Economics finds many physicians have yet to prepare themselves or their practices with solutions related to the documentation needed for a successful transition to ICD-10. While some doctors have expressed concern about investing in the transition because of the possibility of another delay, we know that most providers want to be prepared.

ICD-10-keep-calm

Are you getting ready for ICD-10 yet?

The boy scouts motto is “be prepared.” It’s now time for our healthcare providers to prepare for the transition and recognize that even if there is another delay, detailed documentation is essential to patient care and accurate data recording and gathering. Not to mention, it’s possible that it will even increase reimbursement. Physicians and coders must learn the details of ICD-10 coding and documentation requirements that are specialty specific but they also must learn how to include the patient’s co-morbidities as it relates to the total health of their patients.

The question is “how can we prepare so many professionals for this transition?” The answer is specialty-specific training addressing the documentation strategies for all providers and clinicians who work with patients, while simultaneously working with coding and billing professionals to teach them the new documentation requirements and how to use the data. All providers can benefit immediately by learning the documentation requirements for ICD-10 in their practices right now. Improved documentation will be reflected in quality and outcome metrics and is likely to increase reimbursement, even in ICD-9. For example, in a chart review of 30 cases for a regional hospital, 8 cases had documentation opportunities in ICD-9, which will continue to be opportunities in ICD-10. More specific documentation would have resulted in higher DRG payments for these 8 cases of $23,279.00, and that is using ICD-9 codes and net dollars today.

Looking at the new ICD-10 codes, we see that the number of codes will increase nearly five fold, but did you know that more than 75% of those codes have a 1:1 general equivalence map? This means, these codes will not require additional documentation for the coder to arrive at the correct code. In addition, providers who understand the 8-10 core concepts of clinical documentation for ICD-10 will have the foundation and should be able to include enough information and data for nearly half of the ICD-10 codes that do not have a 1:1 match, primarily because these codes are specific to laterality (right, left, bilateral). Next we are presented with injury specific codes used for “external cause reporting” where the character values in the code tell the story of the patient’s injury or the cause of death. What’s really new is the requirement for diagnosis documentation to be supported with related notes which link conditions, new diseases, and musculoskeletal conditions and require terms such as “due to” or “secondary to.”

Learning 8-10 core strategies gives the provider a solid foundation from which to develop their ICD-10 skills, and should be a priority for all providers now- between April – June.


RuthRuth Patterson, CHI has been working in  Education for over 30 years.  As a certified healthcare instructor Ms. Patterson has been teaching physicians and clinicians about clinical documentation and has been working with medical coders to help them develop their ICD-10 skills. As the managing partner of MedEd Solutions, Ms. Patterson has led a consortium of educators who have taken ICD-10 clinical documentation training and made it available to all healthcare providers.

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