# Training your doctors



## eaglecloudnebula@yahoo.com (Nov 15, 2011)

We've recently been debating the daunting task of how to educate our doctors about the new ICD-10-CM. They're familiar with our old stand-by paper superbill. But with all these new codes, that may go to the wayside. In any electronic form, they're going to come across the new codes, and have to be more specific about each and every diagnosis they assign. This is not going to go over smoothly with them. I don't see any of them readily embracing the new system. 

I was wondering...how is everyone else addressing this situation? How are you guys planning on educating your doctors and "breaking the bad news", as it were?


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## ajs (Dec 7, 2011)

eaglecloudnebula@yahoo.com said:


> We've recently been debating the daunting task of how to educate our doctors about the new ICD-10-CM. They're familiar with our old stand-by paper superbill. But with all these new codes, that may go to the wayside. In any electronic form, they're going to come across the new codes, and have to be more specific about each and every diagnosis they assign. This is not going to go over smoothly with them. I don't see any of them readily embracing the new system.
> 
> I was wondering...how is everyone else addressing this situation? How are you guys planning on educating your doctors and "breaking the bad news", as it were?



Coders need to be working with providers now and giving them a "heads-up" with regard to ICD-10.  Due to the amount of codes that will be available, paper superbills or fee tickets will not be efficient.  Providers need to be working on their documentation now, as always.  Certified coders will become even more in demand as providers will most certainly be turning some of the work of finding the codes over to the coders.  Electronic systems will most certainly be required.  Start the conversation now if you haven't already...we are closing in on the deadline and it will be here before we know it!


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## kevbshields (Dec 9, 2011)

The focus now should be on having Coders ready for the conversion through solid clinical foundations (terminology, anatomy, physiology, pathophys), if necessary.  It should not be on "teaching" providers ICD-10.

Although not tapped to participate in practice conversion yet, my approach would be to eliminate encounter forms and work on providers' documentation.  If you take away the crutch of providers and coders using encounter forms now, refocus coders on abstracting from the record and have coders query for information when documentation is insufficient, you should have a superior level of detail by 2013.

The providers and coders will not be so reliant on encounter forms and the folks who know the guidelines (Coders) are then applying them to the coding.  This supports coding compliance and minimizes provider coding error.  It also supports a working relationship between providers who really need re-trained on documentation integrity and detail and the coders who just need practice in abstraction and utilizing a new coding system.


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## espforu (Dec 30, 2011)

kevbshields said:


> The focus now should be on having Coders ready for the conversion through solid clinical foundations (terminology, anatomy, physiology, pathophys), if necessary.  It should not be on "teaching" providers ICD-10.
> 
> Although not tapped to participate in practice conversion yet, my approach would be to eliminate encounter forms and work on providers' documentation.  If you take away the crutch of providers and coders using encounter forms now, refocus coders on abstracting from the record and have coders query for information when documentation is insufficient, you should have a superior level of detail by 2013.
> 
> The providers and coders will not be so reliant on encounter forms and the folks who know the guidelines (Coders) are then applying them to the coding.  This supports coding compliance and minimizes provider coding error.  It also supports a working relationship between providers who really need re-trained on documentation integrity and detail and the coders who just need practice in abstraction and utilizing a new coding system.



We are being the training now, not by showing the codes but improving our documentation a you had mentioned.  We are hoping that once we see improvement in this area it will be time to train them in the ICD-10 codes.  I feel our organization is ahead of the implementation game, but this is our current focus.  We are trying to brainstorm the encounter form issue.  I would like to find a way to no rely on the use of encounter forms.  We have looked at cheat sheets for the dx codes, but the biggest issue is getting the providers to be more detailed with the selection of codes as some will select a non specific code because it is so easy but not realizing that the docuemention may have more specificity.


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## Pam Brooks (Dec 30, 2011)

For 2012, we're working on concurrent review of records/notes to assist our providers with more comprehensive and clear documentation. They'll get feedback in terms of how their documentation will need to read for ICD-10. I'm also doing a monthly article in our CMO's newsletter, taking one chapter at a time and going over some of the documentation guidelines, with brief bullet items. Anything too overwhelming or lenghty, and they won't pay attention.  

The actual ICD-10 training for providers won't take place until summer of 2013, as close to 10/1 as possible. 

Meanwhile, I'm assessing the clinical readiness of my coding staff; that is their understanding of Anatomy, Pathophysiology, and terminology. We'll be doing the AAPC's online A&P course this year. I'm also doing a brief audit of my coders' current ICD-9 knowledge. If they are having difficulty with I-9, I need to get that straightened out before I-10. Also, our coders will have the opportunity to train with whatever courses the AAPC offers for staff coders. 

I have done some analysis of our EHR, and whether or not it will meet the documentation guidelines for the more specific codes. Unfortunately, the version of our software that actually supports ICD-10, won't be available until the very last minute. Nice of them, I thought.

I think we can all plan on a busy next two-three years!


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## kevbshields (Dec 30, 2011)

In respect to the encounter forms, abolish them altogether if you can.  If that is not feasible or you get entirely too much resistence, I'd recommend "altering" the I-10 codes you use.  Limit them so that the providers ARE NOT selecting a full and complete ICD-10-CM code for the more detailed laterality codes (e.g., eye, ear, etc).  Allow the coder to finanlize that part of the superbill--although let me be clear, I do not advocate the use of charge slips now nor in the future.  In that respect, the provider's documentation ultimately determines which codes are selected and the coder can opt for the most specific code possible, rather than relying on physicians who will not understand the nuances or granularity of the new system for decades to come.  

If you're going to continue to rely on superbills after I-10, at least consider taking the selections down to very basics for the providers and ensuring a coding review prior to posting.  It may slow things down a bit, but will probably make up for that in rejected or audited claims.  Of course, just speculation, because we have no accurate data to go on there.

Too, pointing your organization back to coder abstraction will create more realistic and compliant claims for services and conditions.

Best of luck.  If you would need to discuss this further, I am a private message away.


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## kbarron (Jan 1, 2012)

We are turning all our offices over to Greenway, an EHR. Our Pedi Practices have gone live and are not using any Encounters forms...The providers are adjusting. Their superbill is being created from their templates they are checking off. It does appear to be accurate per our 1995 guidelines. It will be interesting to see how all the other practices fare when they go "live"


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## mbuskirk@rrohio.com (Jan 10, 2012)

When you talk about the encounter forms...do your practices have the ICD-9 codes on them?  Ours just have the procedure codes and the a place for the doc to write in the dx codes.

Thanks
Mary


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## kbarron (Jan 10, 2012)

We use encounters that have both dx and pro codes. They are updated as needed.


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## janice.moore (Jan 19, 2012)

*Training Doctors*

Question- what answer do I give the physicians when they ask why they need to be more specific when we are generally using unspecified codes now....what is going to change?


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## Peter Davidyock (Jan 20, 2012)

Pam Brooks said:


> I'm also doing a brief audit of my coders' current ICD-9 knowledge. If they are having difficulty with I-9, I need to get that straightened out before I-10.



I have begun this process as well. And what I am seeing is keeping me up at night.




Pam Brooks said:


> I have done some analysis of our EHR, and whether or not it will meet the documentation guidelines for the more specific codes. Unfortunately, the version of our software that actually supports ICD-10, won't be available until the very last minute. Nice of them, I thought.
> 
> I think we can all plan on a busy next two-three years!



Great idea, I wish more of my practices would get started on an EHR system. Procrastinators to the end. Here is a wonderful example:
Me (last winter and spring): Dr's please begin using the escribe program. If you do not Medicare will penalize you 1% next January.

Drs: Yeah yeah we have time.

Me (last June): Dr's if you do not have 10 eprescriptions by the end of this month you will not qualify as an escriber and you will be penalized 1% in January.

Dr's: ok let's do ten.

Me (last fall): Dr's I see you escribed for ten prescriptions last June but I do not see anymore. You need fifteen more by the end of the year.

Dr's: this is B.S. we will get to it when we have the time.

Me (in December) Dr's time is running out and you do not qualify for the hardship waiver options. Please submit some prescriptions electronically or else next month Medicare is going to reduce your income by 1%.


Dr's:  Insert sound effects here; crickets, wind blowing softly across the plains....more crickets... 

This week
Dr's: WTF is this 1% reduction!!!


Ya gotta love 'em.


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## mmorningstarcpc (Jan 20, 2012)

It seems they only ever take note when it "hits em where it hurts!"  Gotta love em!

Its a good thing we love what we do!!!!


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## Pam Brooks (Jan 20, 2012)

oceanlivin said:


> i have begun this process as well. And what i am seeing is keeping me up at night.
> 
> 
> 
> ...


 
rotfl!!


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## mjb5019 (Feb 2, 2012)

*unspecified*

The health plans may not pay on the unspecified codes.


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## mjb5019 (Feb 2, 2012)

*unspecified*

Tell your providers the healthplans may not pay on the unspecified codes.


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## bsesender (Apr 18, 2013)

*documentation*

does anyone have a "cheat sheet" they use as a guide detailing documentation requirements...  we use alot of unspecified codes as well and would really like to train my physicians and not miss anything -- laterality, diabetes combos, duration, stages, etc..


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