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The Fast Approaching ICD-10 Deadline: How Can ASC Leaders Prepare?

In a March 12th webinar hosted by Becker's ASC Review, Mary Bort, CPC, CANPC, CASCC, COSC, director of coding with Surgical Notes, explained how ICD-10 will impact ambulatory surgery centers and what ASC leaders, coders and physicians can do to prepare for a smooth transition.

CMS Administrator, Marilyn Tavenner assured providers the deadline for the ICD-10 transition remains firmly set at October 1, 2014. In less than seven months, the 17,000 codes in ICD-9 will leap to the more than 140,000 codes in ICD-10. "This will radically change the way coding is done," said Ms. Bort. At this time, ASC leaders need only to hone in on ICD-10-CM codes; ICD-10-PCS is only indicated for hospital inpatient procedures.

Engagement with payers and other trading partners will allow ASC leaders to paint a picture of how their centers will be affected. "Prepare yourself for delayed claims and adjudication," said Ms. Bort. "Set up a financial plan." While keeping in mind that a certain level of productivity loss and revenue cycle impact can be expected, ASCs should work with payers, vendors and clearinghouses to create a timeline for testing and retesting. Identifying issues in advance can lessen the affect the switch will have.

Putting a plan in place
One of the most important areas to focus on is bringing the ASC's staff and tools up to speed.

•    Educate surgeons. A successful switch to ICD-10 hinges on surgeon documentation. Work with them to elicit the level of required specificity in their operative notes.

•    Educate nurses. Nurses are also responsible for a large portion of documentation. Prepare them for the increased need for detail.  

•    Update your electronic medical record and practice management software. EMRs or practice management software will need ICD-10 capabilities for correct coding. Assign someone to update these systems on a regular basis.

•    Revise and update all facility documents and forms. "From the front door to back door, revise all documents, including [advanced beneficiary notices], to accommodate the needed specificity," said Ms. Bort.

•    Conduct regular coder audits. Frequently assess how coders are performing. Are there areas for improvement?

•    Conduct physician documentation audits. Identify the physicians that struggle with providing the needed level of detail in documentation. Work with them to draw out that specificity.

Dual coding
ICD-10 is only required for HIPAA-covered entities, and ASCs may have payers that do not fall under this umbrella. "Find out who these carriers are and if they will make the switch," said Ms. Bort. "If they are not, we may need to code in ICD-9 and ICD-10 for the next few years."

Non-HIPAA covered entities of note include:

•    Worker's compensation
•    Automobile insurance
•    Disability insurance

Dual coding also allows providers to form a picture of what remains to be done in the journey to ICD-10. "If you start to dual code your cases now, you will be able to find the gaps in your documentation and address the physician," said Ms. Bort.

Surgeon documentation
Poor documentation will be a detriment to ASC revenue cycle. "Physicians with good documentation will find this transition so much easier, but this concept of painting a complete picture will be new for most physicians," said Ms. Bort.

In ICD-10 physicians will be required to document:

•    Specificity
•    Laterality
•    Time parameters
•    Site
•    Contributing factors
•    Anatomy
•    Complications

If a surgeon uses a template, update it to ensure physicians will fill out all of the required information.  

Fracture cases are common in the ASC setting. A handy mnemonic, LEO C FAR, has been created by Karen Zupko and Associates to guide physicians through the process of increased specificity.

•    L: Location/laterality
•    E: Encounter
•    O: Open/closed
•    C: Classification/category/cause
•    F: Fracture pattern
•    A: Alignment
•    R: Results

ICD-10 will certainly increase the number of coder queries. As ASCs begin dual coding now, begin that process. Repeatedly querying physicians when documentation lacks the specificity required will benefit in the end. Payers may reject claims for unspecified codes; avoid using those codes as often as possible. "Coders should step out of their comfort zone and educate physicians," said Ms. Bort.  

Many physicians share an indications paragraph within their operative notes. Encourage all ASC surgeons to take on this practice. "If done correctly, an indications paragraph will resolve the majority of coding issues," said Ms. Bort.

Download the webinar presentation here.

View the webinar by clicking here. We suggest you download the video to your computer before viewing to ensure better quality. If you have problems viewing the video, which is in Windows Media Video format, you can use a program like VLC media player, free for download here.

Note: View archived webinars by clicking here.

More Articles on ICD-10:
Avoiding ASC Claims Denials in the ICD-10 Age: 8 Key Concepts
AAPC: 3 Tips on Selecting Proper ICD-10 Codes
AMA: ICD-10 Impact Assessment Checklist

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