Steve Claypool, MD, is vice president of clinical development and informatics, and Allison Errickson, CPC-H, is director of coding compliance and content, Clinical Solutions Division, for ProVation Medical.
Q: One of ProVation Medical's primary focuses concerning ICD-10 is helping facilities with the physician documentation aspect of the transition. Why will this be such a challenge for organizations?
Dr. Steve Claypool & Allison Errickson: The sheer volume of ICD-10 codes will create the need for increased detail in provider documentation. There are approximately 68,000 ICD-10 diagnosis codes vs. 14,000 diagnosis codes currently available in ICD-9. The ICD-10 code sets are much more granular and include changes in terminology as well as expanded concepts for things such as laterality and injuries. Documentation that supported ICD-9 codes may not include the detail to support ICD-10 codes.
More importantly, physicians will not be aware of the detail necessary to properly codify their documentation. Physicians document at a detail level necessary for medical documentation, not for billing documentation. Over time, many have learned to document enough details to support ICD9. Now they'll have to learn all over again at a much more granular level.
Q: What are some of the steps facilities need to take to address this challenging element?
SC & AE: Health information management (HIM) departments are being encouraged to start training physicians now in order to be ready by the Oct. 1, 2013 effective date. It's important to ensure clinical documentation contains enough detail to support code assignment under ICD-10. Facilities should consider evaluating random samples of medical records to identify areas where documentation is lacking, as well as diagnoses and procedures that will require a higher level of detail. Based on the results of these reviews, facilities can implement focused documentation improvement strategies.
Many industry experts have written ICD-10 transition plans that encourage facilities to consider changes in the documentation capture process, including prompts in electronic documentation systems. The ProVation system relies on a series of menus that prompt the physician to document clinically relevant information, while supporting CPT, ICD-9 and, soon, ICD-10 codes.
Q: How will ProVation work with its clients concerning ICD-10 physician documentation?
SC & AE: One of the most salient features of the ProVation MD product is the deep medical content. The ProVation coding and physician teams have been working together to review the current documentation in an effort to ensure the level of detail exists to support the ICD-10 codes. In the majority of cases, the medical content already exists in the ProVation note to support the ICD-10 codes. Additional, clinically relevant content required to support ICD-10 coding will be added slowly from 2011 to the transition date. ProVationMD's anticipatory interface prompts physicians to document critical information, ensuring that enough details are included to properly code medical conditions to ICD-10 codes.
Q: How far in advance of the Oct. 1, 2013 compliance deadline should facilities start working toward addressing this element?
SC & AE: Now! Sites that start the physician training process well in advance of the implementation date will fare much better. Physicians and coders need time to familiarize themselves with the areas that require additional documentation. Early education will help to prepare physicians to consistently document the detail needed for ICD-10.
Q: Can you identify some common mistakes you can see facilities making concerning ICD-10 physician documentation?
SC & AE: The biggest mistake is waiting to start planning for ICD-10. CMS has made it clear that there will be no extension of the deadline for ICD-10. Sites that start preparing now by creating an ICD-10 transition plan will be in a much better position when the codes become effective. According to the AHIMA website, "early preparation using a phased approach has proven to be the key to success in countries where ICD-10 is currently in use." Physician documentation is only one area that will be affected by ICD-10.
The transition to ICD-10 will affect many areas of organizations. A complete assessment of business operations should be conducted to determine areas that will be affected by the transition.
Another mistake is planning to rely on the General Equivalency Mappings. The GEMs can certainly be used as a tool; however, they are not a one-to-one mapping. With five times more codes available in ICD-10, the documentation will need to be more granular in order to code accurately. According to CMS, it will be more efficient and accurate to work from medical record documentation. While ICD-10 includes unspecified codes, sites may encounter reimbursement issues if they are not coding to the highest degree of specificity.
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