A Guide for the Safari through the ICD-10 Jungle

The American Hospital Association (AHA) Central Office director of coding and classification Nelly Leon-Chisen, RHIA, has authored the 2014 edition of the ICD-10-CM and ICD-10-PCS Coding Handbook, which was published recently and is now available.

The new 2014 Handbook follows the popular Faye Brown edition style. Key features include Coding Clinic ICD-10-CM/PCS advice and clarification on “gray areas,” more than 60 new exercises and case studies, engaging illustrations and visual elements, and a built-in workbook of case summary exercises. The 2014 Handbook reflects the most recent versions of the Official Coding Guidelines, including the latest updates from the Cooperating Parties.

According to the AHA, because of Leon-Chisen’s close involvement with the ICD-10-CM/PCS code sets, the new Handbook contains the most accurate and up-to-date ICD-10-CM/PCS information available. Leon-Chisen encourages use of the Handbook as a training tool and reference. She advises that, “With ICD-10-CM/PCS coding changes just around the corner and effective October 1, 2014, it is imperative that organizations do what they need to do now to prepare.”

We could not agree more.

If you are not truly concerned about the financial risks of transitioning to ICD-10, you should be! Nearly every aspect of your healthcare delivery process will be impacted by this transition, including reimbursements, quality of patient care, your overall costs, and several other critical aspects of your financial and clinical workflows. Unless you have a plan of action to mitigate those risks, your revenue is going to be severely impacted, possibly to point of devastation.

How might your revenue stream be affected? Simply put: by severe increase in delays and denials! The increased granularity of the new ICD-10 coding system, which consists of well over 70,000 codes, will create the opportunity for potential errors in your coding workflow. Even your most experienced coders are going to find this transition challenging. Being well conversed in the new codes outlined in the AHA Coding Handbook will help tremendously, but here are four additional steps you can take to mitigate your risks:

1. Create a plan that includes an ICD-10 readiness review.

ICD-10 will mandate a huge change in your entire organization. This change will require a documented plan and strategy to ensure your ICD-10 compliance transition is successful. To deal with this change management, select a key person within your organization to be in charge of your ICD-10 transition project. This person’s responsibility will be to monitor all changes that will inevitably occur before and after the October 2014 deadline, and report these activities to the rest of your staff. This individual will also be responsible for engaging key stakeholders to convince them that ICD-10 compliance is critical to the financial health of your organization, and to ensure there is “a sense of urgency” within your organization to drive the necessary changes forward.

2. Understand how ICD-10 will impact your organization, enterprise-wide

Your plan should include a gap assessment and analyses.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your organization. The assessment should include your people and their present expertise, your business processes and your legacy technologies to determine the impact of ICD-10, enterprise-wide. Any aspect of your organization that will be impacted by the transition to ICD-10 should be carefully examined, including the programs and systems you are presently using for claims processing, analytics fraud detection, enrollment, eligibility and benefits. This gap assessment will let you know where you need to make proactive critical process changes before the deadline falls and your revenue is impacted.

3. Take advantage of educational opportunities.

Specialty associations, such as AHIMA, AMA, MGMA, AHA, HIMSS and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need some kind of training. The learning curve is going to be tremendous. Online educational programs that your staff members can access any place they have Internet availability will impact their daily productivity the least. Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones.

Another educational exercise that you might want to consider is to identify and evaluate the potential high-risk codes and claims that will most likely have an impact on your specific revenue stream — in advance of the ICD-10 deadline. These simulated ICD-10 claims can provide important data, enabling you to make critical financial analyses to your revenue stream before your coders ever begin working with ICD-10. This information will allow you to proactively make needed changes within your organization to help ensure your financial well-being and stability during the transition.

4. Enlist technology to help with your transition

Finally, don’t try to do everything on your own. Enlist technology to help you mitigate your financial risks. Technology is available today in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns medical codes from within clinical documentation. Many are presently ICD-10-ready.

With this kind of technology, your organizations can “hit the ground running” and streamline your revenue cycle processes, while becoming increasingly more compliant with the requirements of payer and quality reporting. Some of the CAC technology vendors even offer on-site coding expertise to ensure there is no lag in your coding workload. These technology solutions can work with your electronic health record (EHR) and financial systems to produce extremely accurate coding.

The benefits of CAC are many and you are going to need all the help you can get during this trying period. These systems do not replace your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes. This approach will alleviate the negative financial effects that will come from the October 2014 “hard cut over” deadline to the new system.

Mitigating Financial Risk

The transition to ICD-10 will have a tremendous impact on your organization and its revenue stream, and this impact will be felt for years after the ICD-10 migration has begun. Being well acquainted with the new, greatly expanded coding structure and having a documented plan in place — that will help you understand how your specific revenue stream will be affected — will go a long way toward mitigating any negative impacts. Taking advantage of the educational programs that are available will help you manage the ICD-10 transition and ensure that the risk remediation programs you put in place can be maintained over time to mitigate future impacts to your revenue stream. And finally, employing some form of CAC tool, possibly with onsite coding expertise, will ensure your reimbursements and your revenue stream will survive the transition to ICD-10.

For more information or to reserve a copy of the New AHA Coding Handbook, please visit: http://www.ahacentraloffice.org  or call 800-242-2626.