Volume Thirteen                                                                                          Number Ten       ...
Crossing the great  divide: Transitioning                                                       ICD-9 system. The number o...
Crossing the great divide: Transitioning to ICD-10            ...continued from page 53                    intricacies of ...
practice management system, or          range of areas, including anatomy,     codes used with ICD-9; anbilling software t...
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ICD-10 Transition - Compliance Today


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Given the abundance of serious issues facing health care today, it’s understandable that many providers may not yet view the 2013 ICD-10 coding transition as a top priority. Yet, physician groups that fail to take advantage of the long lead time for meeting
the ICD-10 requirements could
experience serious financial and
operational disruptions once the
deadline arrives.

Why is it essential for providers to begin their ICD-10 preparations sooner rather than later? Although ICD-10 may be viewed primarily a coding issue, the scope and
magnitude of the transition is such that nearly every aspect of the organization will be affected. That means all personnel—from physicians
to the front and back office
staff—will be required to modify
long-standing practices and procedures in one way or another.

Editor’s note: Bess Ann Bredemeyer is Director of Coding & Compliance Consulting for McKesson Revenue Management Solutions. She is
responsible for McKesson’s national
consulting services related to physician
practice coding and compliance
and she serves as McKesson’s lead
consultant on ICD-10 planning,
transitioning, and implementation with expertise in ICD-9-CM/CPT®/
HCPCS coding and education, and ICD-10-CM/PCS. Ms. Bredemeyer may be contacted by e-mail at

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ICD-10 Transition - Compliance Today

  1. 1. Volume Thirteen Number Ten October 2011 Published MonthlyMeetJohn P. BensonChief Operating Officer,Verisyspage 14 Earn CEU CreditFeature Focus: www.hcca-info.org/quiz—see page 63Will the AffordableCare Act lead to more Crossing the greataccountable compliance divide: Transitioningofficers? to ICD-10page 34 page 53 October 2011 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org 1
  2. 2. Crossing the great divide: Transitioning ICD-9 system. The number of diagnosis and procedure codes to ICD-10 will expand from approximately 20,000 to more than 155,000—a nearly eight-fold increase. By Bess Ann Bredemeyer, BNS, RN, CHC, CPC, PCS The shift is designed to bring theEditor’s note: Bess Ann Bredemeyer magnitude of the transition is such U.S. in line with other westernis Director of Coding & Compliance that nearly every aspect of the nations, many of which alreadyConsulting for McKesson Revenue organization will be affected. That are using ICD-10, and to provideManagement Solutions. She is means all personnel—from physi- greater flexibility and accuracyresponsible for McKesson’s national cians to the front and back office in the assignment of codes forconsulting services related to physi- staff—will be required to modify medical diagnoses and treatments.cian practice coding and compliance long-standing practices and proce- The improved specificity shouldand she serves as McKesson’s lead dures in one way or another. generate greater efficiency in theconsultant on ICD-10 planning, care documentation and claimstransitioning, and implementation To ensure that all pieces of the processes, and also allow for morewith expertise in ICD-9-CM/CPT®/ ICD-10 transition come together precise quality reporting.HCPCS coding and education, and ahead of the October 1, 2013ICD-10-CM/PCS. Ms. Bredemeyer transition date, physician groups Managers leading the waymay be contacted by e-mail at should take steps now to identify Understanding how ICD-10 willBessAnn.Bredemeyer@mckesson.com. how each department and team affect each department is the member will be impacted. They key to effective planning, educa-G iven the abundance can then map out an implementa- tion, and training. Along with of serious issues fac- tion plan for the training and assessing specific departmental ing health care today, systems modifications required needs, managers must identifyit’s understandable that many to accommodate the change. the resources and steps requiredproviders may not yet view the Practices that begin the hard work to meet those needs. This will2013 ICD-10 coding transition today of focusing on what each likely include setting up trainingas a top priority. Yet, physician team member must do to accom- and system upgrades, develop-groups that fail to take advantage modate the new system stand ing appropriate budgets, andof the long lead time for meeting the best chance of weathering establishing a viable training andthe ICD-10 requirements could the transition without significant transition time line.experience serious financial and financial or operational problems.operational disruptions once the Another key managerial responsi-deadline arrives. Greater flexibility and accuracy bility is to oversee the review of all ICD-10 represents one of the vendor contracts and agreements.Why is it essential for providers to most significant transformations The objective is to ensure that keybegin their ICD-10 preparations ever undertaken on the business partners, such as outsourced billingsooner rather than later? Although side of the US health care system. companies or IT vendors, are fullyICD-10 may be viewed primar- The new coding nomenclature prepared to accommodate theily a coding issue, the scope and will replace the 30-year-old Continued on page 54 October 2011 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org 53
  3. 3. Crossing the great divide: Transitioning to ICD-10 ...continued from page 53 intricacies of ICD-10 and meet Whether physicians code or not, this demonstration should illus- the needs of the practice in the all doctors will be required to trate the differences between the post-transition environment. provide additional details in their systems and the level of specificity clinical documentation. That’s ICD-10 will require. Similarly, managers should also be because ICD-10 demands much in touch with payer representatives more anatomic and physiological Revising the encounter form to determine when the payer will information than the current In all physician offices, both be ready to accept ICD-10 coded ICD-9 system. doctors and billing staff likely claims. They should likewise seek will need to re-think their use of information about the extent to Here are a few examples: the encounter form or super bill. which other payer processes will ICD-9-CM has nine codes Typically one page long, the paper be affected by ICD-10, including to describe pressure ulcers. In encounter form provides a list of medical policies, contracts, and contrast, ICD-10-CM includes commonly used diagnoses and claims adjudication. 125 codes that describe both the codes. Once the patient encounter location and stage of the ulcer. is complete, the physician checks Because a period of transition Similarly, ICD-9-CM volume 3 off the specific diagnosis. The between the two coding systems has a single code to describe form is then taken to the Billing will exist, coding and billing staff angioplasty, but ICD-10-PCS has office, usually by the patient, to must be prepared to code in both 854 codes that specify body part, expedite coding and billing. ICD-9 and ICD-10 for up to two approach, and device. Although years after the cut-over date. It is physicians do not use the ICD But, because ICD-10 will require therefore critical that managers con- system to code procedures, they much more information to code firm that their billing platforms may be impacted by hospitals’ an encounter, it is impractical for will be able to accommodate both need for documentation detail. most practices to assume that a coding systems simultaneously. single-page encounter form will be ICD-10’s granularity means that able to accommodate frequently Documenting the details if physicians fail to provide a used diagnoses. Groups therefore For physicians, ICD-10-CM’s complete picture of the diagnosis will need to develop an alternative impact will depend on whether or procedure, they’ll run the risk system that can be used to convey and to what extent the physicians of not being able to collect for the information about the encounter currently do their own coding. services rendered. in lieu of the current checklist Most physicians today leave encounter form. One option is coding to the office staff, but A useful exercise that any to create a new paper form that those who still do code will need physician office can conduct essentially allows the physician to to be thoroughly trained in the now—assuming they have office write out the diagnoses, although new nomenclature. The Centers personnel with at least one this approach will be cumbersome for Medicare and Medicaid ICD-10 book—is to take the and likely more time-consuming Services (CMS) advises that orga- medical notes of several common for the physician and coder. nizations begin formal ICD-10 patient encounters from the training six months prior to the physicians and code them in both Perhaps the best, long-term compliance date. the ICD-9 and ICD-10 formats. solution is for physicians to utilize For coders and physicians alike, their electronic medical record,October 2011 54 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org
  4. 4. practice management system, or range of areas, including anatomy, codes used with ICD-9; anbilling software to capture the physiology, pathophysiology, increased number of code com-patient encounter data electroni- medical terms, surgical procedures, binations and more descriptivecally. To that end, managers and/or medical science, and pharmacol- codes; and the restructuring ofinformation technology specialists ogy. A comprehensive training conditions (for example, injuriesshould contact the group’s IT program must therefore be devel- are grouped by anatomic site, asvendors to discuss what options oped that can deliver the right opposed to injury type).may exist for replacing the paper knowledge to the right personnelencounter form with an electronic at the right time. Training of In the Billing department, a keyversion. between 25 and 50 hours per task in preparing for ICD-10 coder, depending on their level of will be to ensure that the clear-Assessing the needs of nurses knowledge and experience, typi- inghouse used by the group hasand front-desk staff cally will be required to achieve upgraded its claims software toAs is the case with physicians, the proficiency with ICD-10, accord- handle the alphanumeric, seven-extent to which nurses will be ing to CMS and the American digit codes required by ICD-10.affected by ICD-10 will depend Health Information Managementon how much, if any, coding Association (AHIMA). One step at a timethey’re currently asked to do. In The ICD-10 transition representsEmergency Departments, for Managers should begin by assess- a monumental undertaking. Vir-instance, nurses frequently assist ing each coder’s strengths and tually every aspect of the physicianwith facility coding. Like physi- weaknesses, and then develop office practice must be consideredcians who code, nurses who code individualized plans that can and potentially modified in lightwill need full, formal ICD-10 address areas of deficiency. A of the new documentation andtraining ahead of the deadline. wide range of outsourced training coding requirements, yet the task options are available, from online is not insurmountable. By start-Scheduling and registration e-learning to onsite consulting ing early in the identification ofpersonnel at the front desk will and classroom sessions. Managers specific department requirements,need to be appraised of the new should consult with trade orga- developing an overall plan forprocedures relating to the encoun- nizations to determine the best training and transition, reach-ter form. In addition, any policies training fit for their organization. ing out to key vendors to ensureand procedures that reference compatibility and compliance,ICD-9 should be updated to Along with anatomical and and moving ahead in small butreflect the change to ICD-10. clinical education, training steady steps, groups should beFinally, if front desk personnel will include an overview of the well-positioned when that nowmake referrals or get approvals for ICD-10 coding conventions, distant but fast-approachingsurgeries, they’ll need to understand guidelines, and definitions. In deadline finally arrives. nICD-10. addition to the greater level of clinical and anatomical specificity,Coders face steep learning other key differences betweencurve ICD-10 and ICD-9 include theFor coders, ICD-10 will require use of seven-digit alphanumericdetailed knowledge in a broad codes, as opposed to the five-digit October 2011 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org 55