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ICD-10-CM/PCS News Archives

ICD-10 provider preparation: A practical approach

July 24, 2015:

By Tom Darr, MD, chief medical officer, Optum360 Coding Solutions

Even with the ICD-10 transition date quickly approaching, HIM leaders like you may feel like they need to fit ten pounds of problems into a five-pound bag. If engaging physicians remains an issue, here is some information that may help them feel better about ICD-10 and help you manage your stress level.

We all know that there are more than 68,000 ICD-10 diagnosis codes. But did you know that an Optum360 analysis showed, and our clients confirmed, that 25 (or fewer) codes constitute a vast majority of a single provider’s work? That means physicians can focus most of their efforts on the less than 0.1 percent of the ICD-10 diagnosis codes in existence.

Here, then, is a practical approach to preparing a physician for ICD-10:

  • First, identify the diagnosis codes they work with routinely, likely a list of 25 or less.
  • Next, check to see which of these codes are actually different in ICD-10. Sixty-five percent of all ICD-10 codes are the same as they were in ICD-9 (using the same description, not the same code). Set aside the ones that are the same. Your documentation will not need to change for these.
  • Now, for that subset of your original 25 that are actually different, check an ICD-10 reference source to see whether your current documentation already satisfies the requirements for the code. For those that do, set them aside. Again, your documentation for these will not need to change.
  • Finally, for the subset of the subset that you actually need to do something about, likely a number much less than 25, decide how to adjust your documentation.

When it comes to documentation, ICD-10 has been the catalyst for documentation improvement efforts. But it isn’t the real reason documentation needs to be improved. If your organization is like most, the real issue with documentation is poor documentation to begin with. So, address your documentation issues. Here are some ideas:

  • Address the issues around point-and-click fatigue and the counting mechanisms used to define evaluation and management services.
  • Help your providers understand the need to better explain the complexity of the patient’s problems. Show them how better explanations will improve their reporting on risk of mortality, severity of illness, present on admission, patient safety indicators and core measures. These are all issues that affect, either directly or indirectly, provider reimbursement.
  • Focus on the importance of providing the foundational information for the diagnoses they ultimately list
  • Call out important history and present illness reports, past medical history, risk factors, physical exam and lab findings and their differential diagnoses in their Medical Decision Making documentation
  • Concentrate on defining treatment provided, how it was monitored and the impact it had on the patient
  • Finally, help providers connect the dots of the entire evaluation. Define cause and effect when applicable.

One more thing: In addition to addressing preparation and documentation issues, address the tools you have to work with for documentation. Focus on templates, diagnosis pick lists, super bills, etc.

Getting providers excited about ICD-10 may be a lost cause. But if you can focus on making ICD-10 work for them, then your ICD-10 preparation will have made a difference for physicians, for your organization and for you.


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