Medicare Compliance & Reimbursement

Tip: Stay ahead in the documentation race.

Some providers may be breathing a sigh of relief, while others may be muttering under their breath — but whatever your level of ICD-10 readiness, you will have to face the latest ICD-10 delay with grace — and a game plan.

Latest delay: HR 4302, the Protecting Access to Medicare Act of 2014, officially set a new course for ICD-10 on April 1, when President Obama signed the bill into law. In addition to patching up the sustainable growth rate formula, the measure prohibits the launch of ICD-10 before October 1, 2015. Whether the Centers for Medicare and Medicaid Services (CMS) will use that date as their implementation date remains to be seen; at press time, the agency had not clarified its stand on the matter.

What To Do Now

Essential to moving forward will be maintaining the momentum toward ICD-10 readiness.

That is, don’t let valuable training go stale, coaches Joe C. Nichols, MD, an orthopedic surgeon, ICD-10 coding trainer, and president of Health Data Consulting Inc. in Seattle, WA. Physicians and other clinicians should stay focused on enhanced documentation, since that will be the key to successful coding once the ICD-10 deadline does come to pass.

Physicians should view the reprieve as practice time for detailed documentation — an opportunity to solidify new skills, Michelle Leavitt, director of courseware and product strategy at HealthcareSource, a Woburn, MA-based group that works with hospitals and healthcare organizations on training for that transition.

Providers who are fairly up to speed on ICD-10 may want to slow the intensity of their final training, so that the final push coincides with the six or nine months before the new implementation date (October 1, 2015, at the earliest). 

But providers who were sweating it before the latest delay was announced should forgo any further procrastination. If you have lagged in your preparations, use the time wisely, rather than forgetting about the coming of the new standard for another year, coaches Leavitt.

A study suggests that the extension will probably be welcome to many providers. According to a study released in March by Aloft Group, nearly half of U.S. healthcare providers have completed only 25 percent or less of their ICD-10 implementation plans.

Reality check: Physicians already spend about 22 percent of their time on non-clinical paperwork, according to the Physicians Foundation, and with ICD-10 coding for diagnoses and procedures will jump from 7,600 codes for physicians to approximately 69,000.  

To make the best use of the newly extended training time, stay focused. Keep tabs on what ICD-9 codes you use most frequently. Devising a top-25 list that will help guide you to the most relevant chapters in the ICD-10 coding manual. Bolster documentation skills in these areas in particular, so that by 2015, your records will regularly feature the kind of detail coders will need.

To build on training to date, opt for live, real-time sessions in 2014, says Emily Rafferty, associate director of the ICD-10 program at OptumInsight. In the physician office setting, have a coder code on a “real-time” basis, so physicians can compare their coding choices, helping to identify opportunities for greater documentation clarity.

Journalists and comedians have created buzz recently by spotlighting some of ICD-10’s more unusual codes (W53.21 Injury caused by a squirrel), but many groups make a compelling case that drilling down to a more detailed clinical story can help patient care — and practices.

Revenue boost: Becoming a master at painting a more detailed clinical picture through documentation can help practices improve revenue while using ICD-9, suggests the American Medical Association. 

Orthopedic practices, for example, should continue the shift from the general (documentation noting unspecified polyarthropathy or polyarthritis, multiple sites, which would support ICD-9 diagnosis code 716.59), trying instead to support a level of specificity that would enable coders to select easily from the following codes in the M15, Polyosteoarthritis category:

• M15.0 — Primary generalized (osteo) arthritis;
• M15.1 — Heberden’s nodes (with arthropathy);
• M15.2 — Bouchard’s nodes (with arthropathy);
• M15.3 — Secondary multiple arthritis;
• M15.4 — Erosive OA;
• M15.8 — Other polyosteoarthritis;
• M15.9 — Other polyosteoarthritis, unspecified, or generalized OA not otherwise specified (NOS).

Coders Can Bolster Their Skills, Too

Physicians aren’t the only ones who may benefit from a little additional training time before the ICD-10 launch in the U.S. While physicians are learning about codes, coders should brush up on clinical matters. Specialized training, such as anatomy and pathophysiology training geared to the new code set, can ease the eventual transition to ICD-10. Why? Coders who have strong clinical knowledge are likely to thrive under the new system — helping physicians and practice administrators connect the dots between coding, claims, and the medical record.

Stay positive: Critics contend that ICD-10 is an unfunded mandate, forcing clinicians to a new level of specificity in documentation and coding, but others, including Nichols, point out that the system really pushes clinicians to an adequate level of record keeping.

“Good healthcare requires complete and accurate observation and documentation,” he says. ICD-10 provides the overlay that turns that specificity into guideline-driven coding and meaningful data. As it stands, the United States doesn’t have the data to understand why we spend three times as much per capita for healthcare as Japan, and why Japan is number one worldwide in terms of life expectancy while we are 38th, or why we have three times the infant mortality rate of Japan, Nichols says.