Debating the ICD-10 deferment
June 11, 2012
CDI Strategies - Volume 6, Issue 12
A delay in ICD-10’s implementation has definitely caused angst, especially for coding staff, says Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, regional managing director of HIM, NCAL revenue cycle, at Kaiser Foundation Health Plan, Inc. & Hospitals in Oakland, Calif. “I think this is a disappointment among coding professionals, and this can extend the anxiety of the change in general terms,” she says.
Rather than seeing the delay as a setback, healthcare professionals should view it as valuable time to continue to improve processes and enhance readiness, says Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates in Plantation, Fla. A delay will give CDI specialists and coders and others more time to drill down into data, identify areas for documentation improvement, and implement CDI efforts, she says.
Bryant agrees. “More time in and of itself is an advantage,” she says. “This may spread cost out a little farther, which might help some. For those who are currently behind in planning and implementation, a delay will be an advantage.”
The delay could also serve as a foundation for more meaningful dialogue among coders, CDI professionals, and physicians, says James S. Kennedy, MD, CCS, managing director of FTI Consulting in Atlanta. “I hope that [these individuals] welcome this as an opportunity to engage their physicians, hear what their fears are, and negotiate win-win solutions,” he says.
Ideally, physicians should direct the development of ICD-10 with coders, hospitals, payers, and the Centers for Disease Control and Prevention, says Kennedy. “I believe that adding a physician group, such as the College of American Pathologists, the AMA, or the American College of Physicians, as a fifth Cooperating Party would be a strong move that unites all parties invested in the clinical language we are to use in our day-to-day patient care activities,” he says.
However, some drawbacks also accompany delayed implementation of ICD-10. A delayed compliance deadline could be problematic with respect to scheduling training and perhaps incurring additional training costs, says Sue Bowman, MJ, RHIA, CCS, director of coding policy and compliance at the American Health Management Information Association (AHIMA) in Chicago.
“This is an area where I think we will see additional cost. The people who have been trained to become trainers will have to maintain their skills and stay up to date,” she says. “Coders will need to be in some type of holding pattern with their knowledge. If you’re not using it every day, it’s hard to keep it up.”
The delay will affect any organization or training program that modified curricula to accommodate the 2013 date, says Bowman.
“It’s not an easy process to change an entire academic curriculum, particularly because you’ve got some students in the system already,” she says.
“There has been a lot of work already done in the healthcare industry in preparation for ICD-10,” says Bryant. “This work equates to monies spent already. The education and training timeline may need to be moved. Those that have already had some ICD-10 training may need refresher training now to retain the knowledge going forward.”
Experts agree halting ICD-10 preparations is not the answer. “Hospitals should continue with their education plans,” says Clark. “Hospitals can’t sit in fear and become immobile.”
Bryant says hospitals should determine the following:
- Which milestones require revision because of the delay
- What effect will the delay have on previously secured funding
- How will implementation costs be extended beyond current budget estimates, and by how much
Other plans for 2012 should include documentation assessment and preliminary coder training, says Bryant, with a focus on the following foundational core competency areas:
- Medical terminology
- Anatomy and physiology
- Disease process and pharmacology
- ICD-10 coding guidelines
In-depth ICD-10 coder training should begin approximately six months before the go-live date. Kennedy says several hospitals had planned to start using the new coding system January 1, 2013, prior to announcement of the possible delay. These hospitals plan to begin in-depth coder training as early as this summer, he says.
Hospitals should be reviewing queries to ensure that they are up to date and incorporate information necessary for ICD-10, says Kennedy. They should determine whether their electronic health records (EHR) are compatible with the specificity of ICD-10. If not, vendors should provide a clear timeline for activating this capability regardless of the compliance deadline, he says.
The timeline shouldn’t affect when or whether hospitals educate physicians about documentation necessary to support ICD-10, says Clark. “[Y]ou don’t teach doctors how to code,” she says. “You teach them how to build better documentation in order to assign an ICD-10 or ICD-9 code. You can continue that process of documentation improvement without uttering the words ICD-10.”
“I think that one thing this has taught everybody and shown is that this is a big transition that was perhaps underestimated by some in the beginning,” says Bowman. “So keep it at, and that will ensure that you’re ready.”
Editor’s note: This article was originally published in the May issue of Briefings on Coding Compliance Strategies.
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