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Are Physicians Ready for ICD-10? How to Make a Smooth Transition

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Mike Hodgson is the executive vice president of healthcare products and partnerships for Career Step, a Provo, Utah-based company that provides online education and training solutions. At the 2013 American Health Information Management Association Conference, Career Step launched its ICD-10 physician training programs.


Here Mr. Hodgson discusses why ICD-10 training is important for physicians and how practices can most effectively prepare their physicians.

Question: In what major ways will ICD-10 affect physicians? Will their day-to-day practice look different?

Mike Hodgson: The major impacts of ICD-10 on physicians are:

1.    More documentation at a greater level of specificity so that coders can properly interpret and align them with ICD-10-CM diagnoses and ICD-10-PCS procedure codes.
2.    Increased workload, at least initially, as coders query physicians for additional documentation.
3.    Increased reliance on their documentation knowledge and the knowledge of their coders in order to ensure full reimbursement for their services.
4.    More time spent with patients investigating all underlying conditions and history and more time spent in EHR or EMR documentation.

Although physicians don't typically have to code, they will have to enhance their documentation practices in order to support ICD-10. This means understanding ICD-10 fundamentals and specific impacts on their own specialty. Physicians will now have to consider and document elements and factors that they haven't before, such as laterality and specificity. Let's not forget that ICD-10 arrives hand-in-hand with full implementation of HIPAA 5010, so physician practices that maintain an IT infrastructure and handle their own claims submissions will need to marry these two initiatives.

Q: What general areas should physician training cover?

MH: Physician training needs to be concise and relevant to the individual's specialty. Physicians don't have time to sit through a 20-hour course on ICD-10, and they don't need to know about all the changes that ICD-10 presents. What they do need is a good foundation that centers on how they practice and document. It should present the most common scenarios and payment drivers they are likely to encounter. Most importantly, training should include realistic practice exercises so that they understand very clearly how they will need to document going forward.

Q: Do you think physicians are appropriately concerned about the ICD-10 implementation? If not, what's the first step toward getting them on board?

MH: Perhaps more important than their level of concern is their state of readiness. Just because a physician has taken some training in ICD-10 does not mean that he or she is ready to flip the switch when October comes. How relevant has their training been? How recent? How much practice have they performed? How well have they internalized this new knowledge?

Physicians who have not had ICD-10 training really should start soon. Presenting them with a program that is relevant but brief and works around their schedule is the key to getting them engaged. If already exposed to some ICD-10 training, physicians should be assessed at least once between now and October to make sure that knowledge is appropriate and has been retained. Training reinforcement can then target those specific areas where more clarification and practice are needed.

Q: What is the best way to present training materials to physicians?

MH: Online – hands down. Physicians need to be able to access training from their office, from their kitchen table, and even from their couch, whenever they have a free moment to spare. Online training provides immediate feedback, can be adaptive, provides practice opportunity and is accessible almost anywhere.

Q: What are the most overlooked training areas?

MH: The most overlooked areas are how ICD-10 will affect the technology and processes that are currently used and what needs to change. For example, how it will affect system-generated communications sent out to patients that might include ICD-9 codes? What about changes to forms? How will they handle a patient record that is part ICD-9 and part ICD-10? What changes need to be made to EHR/EMR templates and superbills?

Q: What are some of the biggest challenges physicians will face?

MH: The biggest challenge physicians will face is frustration with queries requesting additional documentation and clarification. The coders aren't at fault here. They can't submit codes that aren't properly substantiated in the medical record. And if they can't submit a proper code, reimbursement will suffer.

Physician ICD-10 education is not a one-time event. Organizations will need to look at how they will review document and code accuracy and provide physicians ongoing information for optimum results.

Q: What benefits will physicians see from undergoing an ICD-10 education and training program?

MH: A proper ICD-10 training course that is designed specifically for physicians and other providers will drop the veil. It will take them from, "I don't know what I'm supposed to do" to, "Oh, that's it then?" without any confusion. They will find themselves aligned with the professional coders who have taken many more hours of ICD-10 training. Furthermore, they will hopefully understand that ICD-10 is necessary to improve accuracy, improve quality measures and research, and to accommodate new procedures, new technologies and new conditions.

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