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Preparing for ICD-10: Education and Clinical
Documentation
Agenda
BackgroundRoad to ReadinessEducationClinical DocumentationQuick Start
Today’s presentation and recording will be sent to all attendees via email by Friday, July 19th
ICD-10 Recommended Timeline
Background: why?
ICD-9 is a 30 year old framework that cannot accommodate additions
Limits ability to add codes to describe clinical conditions and use of healthcare services
Details can help with claim processing, healthcare utilization, treatment planning, public heath improvements, among others
Reminders…
Diagnosis codes are used in many places for many different reasons by many different systems and people.This is not the usual annual update: it’s a new language
Common cold: acute nasopharyngitis• ICD-9 460• ICD-10 J00
ICD-10 is different from ICD-9 in:LengthNumberValueTerminology
ICD-10 Is Different
ICD-9-CM ICD-10-CMSize: 3-5 characters Size: 3-7 characters
Number: 13,000 Number: 68,000+
Format: Mostly numeric and always begins with a number except for “E” and “V”
Format: Alphanumeric and always starts with a Letter except for “U”
Alphabetic characters NOT case sensitive
Terminology
Do I Have To Do This?
YES! It’s not optional.
Professional claims must contain ICD-10 values for dates of service on and after October 1, 2014.
Institutional claims must contain ICD-10 values for dates of discharge on and after October 1, 2014.
7© 2013 Navicure, Inc.
Lets review key activities that you have hopefully finished or are a work-in-progress
Road to Readiness: First half 2013
Highlight of items that should be finished or underway:
Does your practice have an ICD-10 champion/coordinator?
Does the ICD-10 planning team have a basic understanding of ICD-10? Enough to understand the scope and breadth of effort?
Do you have physician and practice management staff: Awareness Commitment
Organizational awareness Administrative and clinical staff Internal plans, educational events, regularly scheduled meetings
Road to Readiness: First half of 2013
Highlight of items that should be finished or underway:
IT and service vendor outreach Do your IT and service vendors know about ICD-10? Have they communicated update plans, timelines, costs? Have they communicated required and enhanced capabilities and services?
Identified other initiatives that must be done in tandem or coordinated along with ICD-10.
Began preliminary budgeting.
Road to Readiness: First Half of 2013
Highlight of items that should be finished or underway:
Diagnosis Use Assessment – a diagnosis inventory Do you have a document that describes where, how and who uses
diagnosis codes throughout your practice? Administrative and clinical? Front, middle and back office Electronic and paper, e.g., Superbills, processes Contracts, quality reporting, public health reporting, spreadsheets Creators, senders and receivers
Road to Readiness: First Half of 2013
Highlight of items that should be finished or underway:
Create an Action Plan (Last Month June 2013)Review and assess facts and information obtained
with your assessment Determine what additional information you need Create a list of things that need to be done to get your
practice ready to be accurately using ICD-10 by the October 1, 2014 compliance date.
Action Plan Components
Critical plan elements can be generated from your practice diagnosis assessment and outreach to vendors, but your plan should also contain:
Education strategy planning – personnel, when, where, levelReview of payer contractual arrangements, quality reporting requirements, and fee schedules based in part or whole on diagnosis codesClinical documentation assessment, auditsCompliance requirements and/or monitoring efforts to ensure performanceImplementation steps of new or changed technology, processes or information.Monitoring steps to ensure things work as expectedRisk mitigation
Keys to Readiness: Education and Documentation
Our focus today will be on two critical and essential ICD-10 components:
EducationClinical documentation
14© 2013 Navicure, Inc.
Education
Education and training are not optional and essential to success.
What are the costs associated with under-training?
• Denied claims, revenue take-backs, lower quality scores result from under trained or poorly-trained coders.
• Education is not the place to shave costs.
15© 2013 Navicure, Inc.
Education Planning: Where to Start
First a goalensure staff acquire the necessary skills and knowledge about ICD-10, business processes, procedures, and policies and system updates to implement ICD-10 use in our practice.
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Assess Training Needs and Develop a Plan
Who? List affected staff membersIdentify staff competence and skill gaps
How? Determine how to tailor training to individuals or user groupsChoose the best approach training methods
Timetable? Decide on optimal timing to receive training and certification
Evaluate! Assess icd-10 proficiency after training and provide additional training to address identified areas of weakness
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What Needs to Be Learned?
Inpatient: ICD-10-PCSOutpatient: ICD-10-CM
Because of ICD-10's specificity:Biomedical knowledge:
• anatomy, • physiology, • medical terminology,• pharmacology
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Assessing Who Needs Training
Include both Administrative and Clinical Staff
Physicians NursesNurse practitioners Physician assistants Medical technicians Administrative staff and coders
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Assessing Who Needs Training
Understand experience, current skill set and gaps in understanding
coding medical and administrative recordsuse of diagnosis codes in documenting patient activitiesuse in information technology systemsof medical proceduresin health plan relations and contracts
20© 2013 Navicure, Inc.
Sample Training Types
Type DescriptionICD-10 Basic Understanding Understand differences between ICD-9 and
ICD-10Why adopt ICD-10?Understand existing toolsUnderstand ICD-10 structure and format
Clinical definitions ICD-10 clinical terminology and meaning
ICD-10 Coding ICD-10 coding knowledgeICD-10 Clinical Documentation Affects on ICD-10 on clinical documentation
Updated business and IT systems
Understand how both ICD-9 and ICD-10 are used in updated systems
Match Type with Group Type GroupBasic Physicians, NP, PA, clinical researchers,
administrative staff, codersClinical definition Physicians, NP, PA, clinical researchers,
administrative staff, codersICD-10 coding Coders and administrative staff
ICD-10 Clinical documentation Physicians, NP, PA, clinical researchers, administrative staff, coders, compliance staff
Updated business and IT systems
IT staff, administrative staff, compliance staff
Approaches to Training
Attempt to tailor training to individuals or user
groups as much as possible:
administrative v. clinical staff
Many ways and formats:On-site
Community courses
Web-based and Webinars
Certification courses
Boot camps
Train-the-trainer
Education Resources
American Academy of Professional Coders (AAPC)http://www.aapc.com/
American Health Information Management
Association (AHIMA)http://www.ahima.org/
Practice Management Institute (PMI)
http://www.pmimd.com/
Example: AAPC BootcampICD-10 Code Set Training
16 hour intensive training course
On-line or in-person
Covers such things as • ICD-10-CM format and structure
• Coding conventions
• General coding guidelines
• Complications, principal and secondary icds, symptoms, previous conditions,
abnormal test findings
• Chapter specific coding guidelines
• Infectious and Parasitic Diseases Neoplasms
• Diseases of Blood, Nervous System, Eye, circulatory System, etc
Basic Understanding Resources
WHO ICD-10 Introduction Tool
http://apps.who.int/classifications/apps/icd/icd10train
ing/ICD-10%20training/Start/index.html
WHO ICD-10 OverviewWHO ICD-10 Introduction Tool
http://apps.who.int/classifications/apps/icd/icd10training/ICD-10%20training/Start/index.html
Basic Understanding Resources
CMS ICD-10-CM Official Guidelines for Coding and
Reporting 2013http://www.cdc.gov/nchs/data/icd10/10cmguidelines_2013_final.pdf
CMS ICD-10 Coding Guidelines
Training: how long and when?
AHIMA estimates it will take50 hours of education for hospital inpatient coding staff needing
both ICD-10-CM and ICD-10-PCS
8 hours for physicians
10 hours for outpatient coders
Coding staff should complete comprehensive
education no more than 6 to 9 months before the
compliance date to make sure info is retained.
Training: Important Last Step
Evaluate!
Assess staff for proficiency after training Identify, document and review common inaccurate coding and
clinical documentation errors
FAQs, quick reference sheets, system user prompts, refresher
courses
Training: Questions to Consider
What resources will staff need after training
to resolve questions as they come up?
For example, manuals, system prompts,
troubleshooting guides, or FAQs lists
How much will the training cost?
Average cost of training per coder is 12,200.
Training: Questions to Consider
How will staff maintain operations during the training
process?
Consider the need for additional coding staff to during the transition
period.
Consider the need for auditing services on and following the
transition.
Assess whether outsourcing some or all coding pre-during-post
transition.
How will staff experience and knowledge be used during the
period when both I-9 and I-10 will be necessary?
Training: Tips and Timelines
Focus on and train to your medical specialty
ICD-9 and ICD-10 TimelinesOct 1, 2011 last regular updates to both ICD-9 and ICD-10
Oct 1, 2012 and 2013 limited code updates to both ICD-9 and ICD-10
Oct 1, 2014 limited code updates to ICD-10• no updates ICD-9 since it will no longer be used
Oct 1, 2015 regular annual update to ICD-10 will begin
Medical Documentation and ICD-10
The Cornerstone upon which success starts and rests!
"If it hasn't been documented, it hasn't be done.“
Just as true with ICD-10 as with ICD-9:
ICD-10 specificity requires clinicians to document to greater levels of detail
Assess Documentation Enhancements
Start with most frequently used diagnosis codes by provider.
Assess whether current documentation meets ICD-10 specificity requirements.
Educate providers and clinicians on the specifics relevant to them.
Start including these details now.
Medical Documentation Overview
Must be legible, complete, clear, consistent, and contain precise information about:
patient's health historypresent illnesscourse of treatmentobservationsevidence of medical decision makingtreatment planoutcomes of all tests, procedures and treatments
Should be complete and specific as possible and include information such as
Level of severityspecificity of anatomical siteetiology of symptoms
Uses of Medical Documentation
Disease reporting for physician performance profilingPhysician E&M paymentPay-for-performance ReimbursementQuality reportingCare coordination
Medical Documentation and Queries
Don't forget to review your Query processaka clinical clarification, documentation alerts or clarification
Because of ICD-10, you will likely see an increase in queries.
A routine communication and education tool to ensure complete and compliant documentation.
Must bridge the gap between the clinical language used by providers and what can be captured by ICD-9 or ICD-10 while preserving the provider's intent.
However, as before, coders can't "lead" providers with queries.
Medical Documentation and Queries
If queries are not retained in the clinical record or at all, consider retaining queries indefinitely.
Retaining demonstrates efforts to communicate to the medical staff.
If not already present, consider adding options like "clinically undetermined" and "other" that allow the provider to add free form text.
If you do not have one, consider implementing an escalation policy to address unanswered queries.
Documentation and ICD-10
Because of ICD-10’s specificity requirements, clinicians will need to provide additional medical documentation details in order to support ICD-10’s new specificity abilities.
Medical documentation should be audited to ensure it captures such things as
LateralitySpecific anatomic site(s)Associated and related conditionsCauses of injuryEpisode of care (initial, subsequent, etc)ComplicationsStage of healing (routine, delayed, malunion, etc)
Documentation and ICD-10: all in the details
Examples where more specificity means more documentation
diabetes mellitus• diabetes type, • affected body system, • complication or manifestations,• long-term insulin
Pregnancy• trimester now requires
Fractures• site of fracture,• type of fracture• laterality and location
Injuries• external cause• place of occurrence• activity code
Impact on Documentation
Unspecified ICD-10 codes do exist, but may mean unpaid
Not addressing ICD-10’s impact on clinical documentation, may result in increased denials
Will take clinicians and coders longer to do their job.Monitor productivityAccount for reductions in both coder and provider productivity
Audits are not going away, e.g., RAC.RACs through Dec 2012 took back $1.2 billion in complex denials reviews due to medical record issues
Let’s Hope
With additional information, there will be
reduced need for follow-up with health-plans about pended or claims rejected for unsubstantiated diagnosis code(s)reduced need to additional informationmore precise reimbursementsmoother and better care transitions
If you haven’t already done so, please start today.
Navicure Tools Overview
Appeal denied claims simply, using pre-populated letters and payer forms.Easily research denied claims with access to both denial reasons and remarks.Streamline your denial workflow with personalized work lists for role-based user-specific reporting that fits your practice.
Identify potential problems with rejections that may be disrupting your cash flow.Fix any operational inefficiencies prior to the October 1, 2014, ICD-10 transition date.
Navicure ICD-10 Training - Webinars
Next Month - August:Implementing Updates
Date: Wed., August 7, 2013 @ 1 PM EDT
September:Review and Current Industry Status
Date: Wed., Sept. 11, 2013 @ 1 PM EDT
ICD-10 Resources
48© 2013 Navicure, Inc.
Navicure Clients’ resource for all ICD-10 education and materials
wwwICDHub.com
ICD-10 Industry Resources
ICD-10 Hub – website devoted to making the transition to ICD-10 easier
www.icd10hub.comCMS
http://www.cms.gov/Medicare/Coding/ICD10/index.htmlCMS: Latest ICD-10 News http://www.cms.gov/Medicare/Coding/ICD10/Latest_News.html
Final Rule http://www.gpo.gov/fdsys/pkg/FR-2012-09-05/pdf/2012-21238.pdf
ANSI X12 Website http://www.x12.org/
50© 2013 Navicure, Inc.
