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    ICD-10: You can do it with these pointers

    New Orleans—The 10th edition of the International Classification of Diseases is coming in 2014 if the rule proposed by the U.S. Department of Health and Human Services takes effect, but most physicians should not be overly concerned, Jeannine Z. P. Engel, MD, FACP, told those attending a session at the American College of Physicians (ACP) annual meeting here.

    The new coding system, already used in all industrialized nations except the United States and Spain, is “not as scary as a lot of people think it may be,” she says, even though diagnosis codes will increase to about 69,000 from about 13,600. Preliminary work at University of Utah, where she is an assistant professor of internal medicine in the oncology division and an investigator at the Huntsman Cancer Institute, suggests that those who document well under ICD-9 should not find it daunting to document under ICD-10, Engel adds.

    You and your staff must implement the new system carefully, however, she says.

    Two keys to the execution process, independent consultant Ann Zeisset, RHIT, CCS, CCS-P, told session attendees, are establishing a team to handle it and determining your business and technical strategies for the process. An impact assessment can reveal potential changes to workflow, business processes, and systems, as well as identify a budget for implementation.

    “Any delay in doing these steps will jeopardize your ability to be finalized with your implementation timeline,” she says.

    Training plays an important role in implementation, and Zeisset says that those performing the coding function in your practice should undergo training 6 to 9 months before implementation through in-service events, Web seminars, or in-person instruction. Any earlier and they will forget what they learned, she says, and any later and they may disrupt implementation.

    The Centers for Medicare and Medicaid Services offers many implementation resources on its Web site, Zeisset adds.

    Another speaker at the session, Cheryl Gregg Fahrenholz, RHIA, CCS-P, of Preferred Healthcare Solutions, recommends that practices, at minimum, customize documentation and coding audits now. Doing so means identifying the most common diagnoses made in the practice, mapping the top 50 principal diagnosis codes to equivalent ICD-10 codes, and auditing the documentation to determine whether it supports the assignment of the ICD-10 equivalent.

    Get in the habit now of being more specific in your documentation, if possible, Fahrenholz suggests. Doing so will make the transition easier for you.

    The session speakers offer these additional pointers for implementation:

  • Trained coders are going to be in great demand, so consider giving coding staff members an incentive or bonus so that they are not lured away by another practice during the implementation process.

  • Try to get the timing of your accounts receivable down to 30 days so your practice finances can stay healthy in the transition, during which payments may be delayed.

  • If you care for patients covered under workers’ compensation, contact your state Bureau of Workers’ Compensation to see whether it is changing to ICD-10. Not all such departments are required to do so; it varies by state. If yours isn’t converting, then the systems you use will need to accommodate both ICD-9 and ICD-10 long-term.

  • The speakers also relayed this information about ICD-10:

  • Office-based doctors will continue to use evaluation and management codes as they do now, regardless of where they provided the care being billed.

  • ICD-10 includes a new code for underdosing that lets you document patient nonadherence.

  • Don’t use the unspecified codes in ICD-10 when more specific ones are available. “Your severity and risk of patient base will not be where you want it to be, so you won’t be reimbursed properly in the future,” Fahrenholz says.

  • Of the disease processes typically encountered by internists, the ones that are most affected under ICD-10 are cardiovascular disorders, cerebral infarctions, diabetes, gout, musculoskeletal conditions, neoplasms, respiratory disorders (bronchitis and asthma), and underdosing.

  • Overall, the types of medicine that will be most affected by ICD-10 include cardiology, cardiothoracic surgery, emergency medicine, general internal medicine—hospitalist and outpatient, neurology, obstetrics, oncology/hematology, orthopedics, psychiatry, and vascular surgery.

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