Countdown to ICD-10: Speakers offer tips to prepare
With the ICD-10 compliance start date a little over one year away, it is imperative to start planning for the transition now, according to speakers at Health Language’s webinar on Sept. 17. The greater specificity and complexity of ICD-10 codes, which move from five to seven characters, mean that providers must take care to code in greater detail a service for billing purposes, according to Kara Howard, clinical informatics manager at Health Language. There are 14,567 codes in ICD-9 compared to 69,832 codes in ICD-10. For example, a code would need to specify the cause of meningitis, whether bacterial, from Lyme disease, etc.; the specific type of diabetes; and for fracture of a femur, whether it occurred on the left or right side. “With ICD-10, unspecified codes should be rare,” she said. Hospitals and groups should take time to create simulated claims or test their ICD-10 coding with payer systems designed for that purpose, said Brian Levy, MD, senior vice president and chief medical officer at Health Language. Levy advised using general equivalence maps, or GEMs, to simulate ICD-10 claims, which gives providers a sense of what their future will look like under the new system. Financial analytics also are important, he said, as the more specific codes mean that providers could receive greater or less reimbursement from a payer. “Focus on mastering the codes that have the highest financial impact to make sure coders are trained on those areas,” he said. Howard also advised that providers identify the top 20 diagnoses, referral specifics, diagnostic procedures and orders and focus education at the place of service. Providers should educate office managers, certified coders and ICD-10 champions as much as possible of strong documentation practices. Strong documentation not only is important because it serves as a legal document, informs quality reviews, validates the patient care provided and complies with federal guidelines, but also because it impacts coding, billing and reimbursement. Other guidelines shared regarding documentation—which should be legible, dated and authenticated by physicians, document each patient encounter and the date and reason for the encounter, including appropriate history, review lab, x-ray data and other ancillary services and explain the discharge plan. The codes reported should reflect this documentation, Howard said. In the meantime, ensure that unspecified codes are avoided as much as possible. “We’ve heard that payers will be reluctant to pay for unspecified codes,” Levy said. To align with Meaningful Use, terms in the EHR should be coded in SNOMED. “Have it coded in SNOMED to support Meaningful Use, then code it in ICD-9 and ICD-10,” he said. Both speakers stressed that despite the difficulty of the transition, there are many benefits to be realized under ICD-10. These include improved operational processes across the healthcare industry, updated terminology and disease classifications, increased flexibility for future updates, enhanced accuracy through specificity, more refined reimbursement models to provide equitable payment for more complex conditions, a more streamlined payment operations, greater detail in data to analyze disease patterns and greater ability to detect fraud and abuse.