The race towards
ICD-10 is quickly becoming a sprint as we hurtle towards the October 1, 2015 implementation date, and the time has come for providers to start thinking about how to prepare the troops. Both coders and physicians need somewhat training and education when it comes to the complicated new code set, but both paths have clinical documentation in common. In order for coders to do their jobs properly, physicians must learn how to bring their clinical notes up to par.
Mel Tully, MSN, CCDS, CDIP, Senior Vice President of Clinical Services and Education at Nuance, explains some of the strategies that will help physicians and coders understand and accomplish their goals ahead of the
ICD-10 implementation date.
What seems to be the best method for approaching ICD-10 education for physicians?
We actually started ICD-10 education about 18 months ago, and we started with steady, monthly educational sessions that would provide boots-on-the-ground support to the physicians, meaning that we imbedded the education for our documentation specialists and coders into the current ICD-9 clinical documentation improvement programs that our clients actually practice now. We feel that physicians should be educated from a clinical perspective, not a coding perspective. The minute that you start showing them codes, they say, “Oh, I’m not going to remember this. I don’t want to be a coder.”
So, when we talk to physicians, we say, “Here, please tell us clinically the information that we need to be able to code it in ICD-10.” This is where it’s very important that the documentation specialists realize what is the clinical threshold for this particular diagnoses, and what specificity is required, and let them actually interact with physicians in a concurrent fashion or, hopefully, real-time with technology, supporting that real-time interaction in the future. We’ve advocated that this is a practice model. The more you do it, the better you get.
What are some of the specifics that providers need to focus on right now?
We’ve advised our clients to identify their top 20 DRG codes for medical diagnoses, as well as procedural diagnoses. Make sure that you’re very efficient, you’re very proficient, that you understand exactly the clarifications and the clinical documentation that’s needed for those particular top diagnoses and procedures in ICD-10. We have software that actually supports this process, so CDI specialists are able to use a “practice pad” in ICD-10. And it’s amazing how quickly they get it. They’re quicker than I am, to be honest with you, because they do it all day, all day long.
It’s something that I call dual CDI. There’s a lot of talk in the industry about dual coding, and most facilities are probably starting their dual coding right now. When they start a code in ICD-10, it’s important that the documentation specialists are also doing dual CDI, so they’re actually practicing together. They’re collaborating.
Will providers have enough time to pack in all the necessary education before October 1?
Well, if they start now, I really think that they could pull it off. It’ll be a lot more intense than what I envision as being a perfect model or best practice. First of all, they need to actually make sure their current documentation program is top notch, that they have the right documentation specialists in place, and that they have the clinical acumen and ability to work in ICD-10, because it does require a higher level of clinical knowledge, anatomy and physiology, medical terminology, especially in the procedural documentation in coding. So, the very first thing I would recommend to them is do you have the right CDI specialists and support in place? And so, after you determine that, then you’d really need a very strategic, a very step-by-step educational program for ICD-10.
And I don’t think that this education should be homegrown. I don’t think you can ask your HIM department to actually teach ICD-10 while they’re still trying to learn ICD-10, so it’s an opportunity to choose your consultants very carefully. Put a lot of thought about what your vendor is going to bring to the table to help you. It’s not exactly time for drinking from the fire hose, but we’re past the time for the steady stream.
If you have a mediocre program in ICD-9, you’ll have a mediocre program in ICD-10, so it’s time to make those changes, hire appropriately, getting the right people in line. And then, also make sure that you have the tools and the software so that the documentation specialists can actually start practicing and be successful.
The number of diagnoses and procedures is so voluminous that book-based education, in my opinion, is just not an option. Make sure you have the software, and make sure that you’re getting value from your vendor, and that the vendor has a proven track record of being able to provide education. Choose those very carefully.
And it may be that you use a combination of vendors. As I said before, I’m never offended when one of my clients says, “Oh, we’re using so-and-so to help us with this as well.” I usually say, “Oh, that’s great.” Do everything that you feel is necessary to get all the education required.
The ICD-10 National Pilot showed that providers might experience significant losses in productivity. Do you agree with this assessment?
Everybody here talks about how much longer it’s going to take to code in ICD-10, and I don’t disagree with that. I think it will take a little bit longer. There’s a learning curve, but what also impacts the final coding is if the coder has to go back to the physician and say, “We need additional documentation.” So you need to bring those two professions very much together in a collaborative approach to ICD-10.
One way to mitigate that, of course, is physician awareness. As you get very close to the ICD-10 launch, that’s when I would start providing very specific, specialty education. You wouldn’t teach your orthopedic surgeons about cardiology and vice versa, so you provide the education that they need for their documentation and do that as closely as possible. And the other thing is that I really recommend that the documentation specialists actually create and send physicians ICD-10 clarifications right now. You don’t have to sell them the ICD-10. You’re just asking for a clinical documentation improvement, and so you slowly start teaching them extra documentation that’s going to be required in ICD-10.
