ICD-10 beyond billing: Readying a practice’s clinical function

While most discussion of the October 1, 2015, transition to ICD-10 focuses on the billing function, ICD-10’s impact will extend significantly to the clinical side of practices as well. Documentation captured in electronic medical records (EMRs) must give coders information that supports the new coding standard if claims are to be accurate and complete. Fortunately, providers have less learning ahead than coders do. And unlike coders, they don’t have to wait until the transition date to begin actually performing in ICD-10 terms. They can, and should, start soon.

Clinicians who are not yet familiar with the impact of ICD-10 on their function can read a two-page summary titled “Effects on Clinical Documentation” in the CMS ICD-10 Implementation Guide for Small and Medium Practices. In addition, each practice will want to form a game plan for readying clinicians for the effect the transition will have on its particular specialty.

While ICD-10 replaces ICD-9’s 14,000 diagnosis codes with 69,000 new codes of greater specificity—such as laterality and stages of healing—each specialty will be concerned with its own small subset of the new codes. In some cases, coders will no longer be able to select “other” or “unspecified” where they could with ICD-9.

In other cases, they will need to select among multiple options within a similar group of diagnoses previously covered by a single code. For example, under ICD-9 all cases with a diagnosis of psoriasis would be assigned the same code; however, with ICD-10, dermatologists and epidemiologists can now break down each psoriasis diagnosis more specifically, using different codes for psoriasis vulgaris, guttate psoriasis or pustular psoriasis. For training purposes, most health information management (HIM) departments have already identified the codes that affect them, and it’s good for providers to review those codes as well to understand documentation needs.

With that understanding in hand, there’s much to gain, and no adverse effect, by beginning to document for ICD-10 now. Starting early will support more meaningful training across both the clinical and billing functions for overall operational benefit. Coders will be able to practice ICD-10 using actual charts from the providers they support, and gap analysis can reveal where issues stem from in cases of incomplete clinical documentation. That, in turn, enables the creation of new policies and procedures to drive more complete documentation, as well as the fine-tuning of EMR templates, well in advance of the transition date. Template customization will be made far easier if the practice’s EMR offers extensive ICD-10 transition automation.

Getting documentation and coding synched up in this way will ultimately save practices time and overhead costs, minimizing instances in which coders must return records to providers for additional information. More importantly, it will protect the practice’s revenue cycle by enabling smoother billing through the transition date. Those practices that are best prepared for ICD-10, from documentation capture through claims submission, will be least vulnerable to the potential revenue impact that concerns practices that are lagging behind.