Introduction

The International Classification of Diseases, 10th Revision (ICD-10) represents a major change in how healthcare information will be collected, documented, and ultimately used, both in the United States and worldwide. In fact, ICD-10 has been used in many countries around the world for several years. The expanded ICD-10 list of codes for conditions and procedures provides a much more specific picture of the physician-patient encounter than can currently be captured with ICD-9. Moreover, ICD-10 will play an essential role in everything related to the practice of medicine, from how claims are processed and paid to analytics, research, and quality measures.

All practices can make a successful transition to ICD-10, but to do so they need to start planning now -- and physicians themselves must become engaged in the process. They must be educated about the facts of ICD-10, its implications, and what their responsibilities are in the transition. This article, based on a conversation with Dr Joseph Nichols, an orthopedic surgeon and principal, Health Data Consulting, Seattle, Washington, provides some valuable information to help physician practices begin the transition process.

Implementing ICD-10

Implementation of ICD-10 will vary a great deal by the size and type of organization. The larger healthcare providers -- eg, hospitals, hospital-based systems, and even clinic provider organizations -- have more sophisticated systems that need to be remediated and more work that needs to be done than smaller practices, but they also have a greater number of resources, including administrative personnel. Smaller practices may face more challenges in obtaining the information or resources they need, but they will also, at least to some degree, have less work to do than the larger organizations. Regardless of their size, the bottom line for all organizations is that all providers need to start planning now.

1. Improve Documentation Now

All of the information that is required to code according to ICD-10 is information that is necessary to an individual patient's care and is already documented in the medical record.

A very clear focus on better documentation is absolutely critical to the success of ICD-10 -- and to good patient care. The codes will affect so many facets of health care downstream, ranging from quality measures to analytics, research, payment, and surveillance, that they must be as accurate as possible, and accurate coding cannot be achieved without the physician's efforts to provide good documentation. As such, there is no reason to delay implementation of good documentation practices. All of the information that is required to code according to ICD-10 is information that is necessary to an individual patient's care and is already documented in the medical record. Therefore, the primary focus for all physicians now is to identify what is included in the documentation and make an assessment of their current practices. Address questions like: "What are you documenting today?" "Are there ways you can more appropriately document?" "How can you ensure that you document accurately for ICD-10 and for good patient care?" Failure to fully and properly document a patient encounter has many medical, financial, and even regulatory ramifications, but will also significantly impede progress in moving to ICD-10.

2. Develop the Relationship Between Coders and Clinicians

Clinicians do not need to understand all of the intricacies of coding, and coders do not need to understand all of medicine -- but the 2 must work together to ensure optimal accuracy.

The relationship between clinicians and coding professionals will have to evolve for ICD-10 to run smoothly. Clinicians do not need to understand all of the intricacies of coding, and coders do not need to understand all of medicine -- but the 2 must work together to ensure optimal accuracy. As discussed, clinicians must accurately, precisely, and comprehensively document the patient's health state and/or procedures performed. For their part, coders need to understand basic anatomy and pathophysiology to better understand the provider's documentation. There will be an inevitable increase in questions from coders, at least until everyone is accustomed to the new codes and system. Anything that practices and providers can do to improve and facilitate the working relationship between clinicians and coders will contribute to a smoother transition. Ultimately, practices want to encourage clear documentation by clinicians and accurate coding by coders.

3. Institute Strategies for Training

There is no one-size-fits-all training for ICD-10, which really has to occur at multiple levels. The first step, though, is for leadership, those individuals who are responsible for moving things through the organization, to understand what the impact of ICD-10 will be, what challenges can be anticipated, and what the necessary steps are to implement the changes. Leadership needs to make sure that hospital executives and senior physicians within large and small practices are aware of the changes, that they support the planned changes, and that the organization is able to move to the next step.

Training for personnel further down the line should take place closer to the implementation date. Coders, for example, should have training about 6 months (and no more than a year) before the implementation date. Still, the timing is variable. One strategy involves parallel coding, which means taking the same cases and coding them according to ICD-9 and ICD-10 for up to a year prior to implementation. This approach allows for parallel training and testing. By coding the same condition in ICD-9 and ICD-10, providers can work with their payers to identify any issues related to payment in ICD-10 -- before the point that cash flow might be substantially affected. It should be noted, however, that ICD-10 codes will not be accepted for payment (outside of testing scenarios) before the implementation date.

Although the timing for training will vary by organization, leadership should get started. They should understand enough about the coding changes to be able to understand what the implications are for documentation and business practices.

4. Locate the Resources for Help

The Process

Numerous resources have been developed and are available to help in implementing ICD-10; the key is for providers to take advantage of them. Official resources are available at the Centers for Medicare & Medicaid Services (CMS) ICD-10 website. The site, which is well vetted, provides good background and perspective, has a number of free papers to help in implementation, and includes all the official codes and guidelines. Implementation guides for both small and large practices are available that walk the user through the process. Indeed, much of the information available at other sites is derived from the CMS site.

Training

There are 2 major, well-respected, accredited societies that offer training for coders: the American Association of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA). In addition to providing formal training for coders, these organizations also provide training for trainers, as well as those who assist in the management of business operations and information technology.

...the AAPC and AHIMA, are actively working to help clinicians and coding professionals improve their respective abilities to take what actually happens during a patient encounter and convert it into a code.

Currently, the AAPC offers training for clinicians on documentation, highlighting what they need to document and why it is important. The AAPC is also working with coding professionals to show them how to better interpret what is written in the medical record in a way that is understandable, clear, and consistent with what they are coding. Professional organizations, such as the AAPC and AHIMA, are actively working to help clinicians and coding professionals improve their respective abilities to take what actually happens during a patient encounter and convert it into a code.

Other helpful resources include the Healthcare Information Management Systems Society (HIMSS) and the Workgroup for Electronic Data Interchange (WEDI).