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The implementation of ICD-10 brings an exciting challenge. Some see it as an obstacle but it really is an opportunity to enhance our skills and knowledge in our careers. There will be a learning curve that comes with ICD-10; the codes are very different, the guidelines have changed in some areas, and we are going to be communicating with physicians more closely to make sure all the necessary information is available. Initially, we will have to learn all the new guidelines and coding processes. Today, the codes are still considered “unstable” and are subject to change prior to implementation.
ICD-10 implementation will impact productivity on many levels. Documentation is the most obvious and largest area that will be affected, which will have a direct impact on productivity. If the documentation lacks specific elements required for accurate and precise code selection, the physician or provider will need to be queried for additional information. If they are not immediately available, the service can not be entered or billed until the information is obtained. Charge tickets (superbills) may become a thing of the past because of the increased amount of code choices in some areas. Physicians can not be expected to document appropriately if they do not understand what is required in the first place.
The education process for coders and physicians should begin early to have the least impact on productivity throughout implementation. Those who do not embrace the changes, and wait until the last minute, will be at a disadvantage and may have to take extensive training classes (time away from work) to quickly learn all the changes. A coder should expect to devote around forty to sixty hours towards ICD-10 education prior to implementation.
Productivity will not return to normal upon implementation. There will be a delay as we assess how the payers interpret the new coding system. Payments and remittance advices will need to be closely scrutinized to ensure that claims have been processed appropriately and when additional information is required, it must be sent in a timely manner. Staff must be prepared to focus on assessing payer responses throughout the first few months of implementation to identify deficiencies immediately.
Today, diagnosis codes are mostly numeric (with the exception of V and E codes), but with ICD-10 the codes are alphanumeric. The process of entering the new codes alone will slow productivity because we will no longer be able to rely solely on a number keypad to enter all the codes. Also, it will be very important to distinguish between letters and numbers when a diagnosis code is written as opposed to a narrative description. For instance, depending on penmanship, it may be easy to mistake a number two for the letter Z, or the number zero for the letter O.
The key to minimizing the impact on productivity is to begin raising the awareness of each individual physician/provider regarding how documentation will specifically be affected by the changes, and encouraging them to become familiar with the terms and specificity of their specialty. This will allow plenty of time to become familiar with the requirements and will not feel like such a significant change all at once. It is very important to keep in mind though, that ICD-10-CM codes have not yet been officially finalized and are subject to change.
When preparation is done early, we should expect that productivity will return to normal about four to six months after the official implementation date. The bottom line of an office will be only minimally impacted if the office has anticipated, learned, and prepared for the changes as well as for the potential setbacks.
An office that waits until the last minute to prepare for the changes or which relies too much on outside sources (EMR, billing company, etc.) will be consistently striving to catch up with the changes. Such an office may even experience an increase in claim denials and not be able to make corrections because of a lack of understanding the guidelines. Timing and awareness are crucial in making a smooth transition to ICD-10.
Tags: Coding, diagnosis code, documentation, education, ICD-10, ICD-10 implementation, ICD-9-CM, implementation, productivity, superbill