Specificity key for smooth transition to ICD-10

Take-home message: Training and well-planned implementation will serve practices well as they anticipate the transition to ICD-10.

By Nancy Groves

Duncanville, TX-Barring any further Congressional action, ICD-10 implementation goes “live” Oct. 1, 2015.

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Ideally, most practices are already preparing for the transition and training the staff to use the new system. If not, there’s no time to lose, according to Patricia J. Kennedy, COMT, CPC, COE.

“Planning really has to start now,” Kennedy said. “It’s not going to be something you can do overnight.”

Why the change?

ICD-9 is outdated due to changes in technology and medicine. Reflecting these changes, ICD-10 has 69,000 codes compared with 14,000 in ICD-9, and additional sixth and seventh digits to identify greater specificity will be required.

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While these changes may seem scary, that’s really not the case, Kennedy said.

For instance, the system will tell users when the additional digits are required.

Also, the learning curve might not be as steep for ophthalmology as with some other specialties, given the limited number of codes for eye care.

Next: Document!

The main requirement with ICD-10 is more and improved documentation.

“What we need to do is somehow get what’s in the physician’s head very precisely into the medical record,” Kennedy said. “We should have been doing it all along, so we’re going to have to step up to the plate this time around.”

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Documentation will require more details in patient histories to substantiate medical necessity, more precision in naming the disease (severity, location, underlying conditions, manifestations, sequelae, stage), and sequence of treatment, both initial and subsequent.

“Specificity is the key,” Kennedy emphasized.

Documentation is particularly critical in cases of trauma or injuries, which should be handled as if they are workers’ compensation matters. More details should be elicited from the patient, including those pertaining to the external cause.

Ophthalmologists rarely see emergency cases in their offices and may never need to provide this documentation, Kennedy acknowledged, but nonetheless should be aware of the requirement.

More practice management tips

Providing examples of differences in documentation between ICD-9 and ICD-10 and the specificity that will be required, Kennedy noted that the currently sufficient entry “hyphema” would have to read something like “traumatic 40% hyphema OS, secondary to racquetball injury.”

Next: Practice pearls

Or instead of “cataract,” the entry would read “NS cataract, OS, floppy iris syndrome; “eyelid laceration” would be entered as “laceration, left eyelid, hit in eye with tree branch.”

Despite having nearly five times as many codes as the current system, ICD-10 includes some silver linings, according to Kennedy.

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For instance, glaucoma codes have been combined so that a single code will include status and severity, whereas the codes for diabetes include the type of disease as well as whether the patient has any associated underlying conditions.

Practice pearls

Kennedy shared some tips for practices that are lagging in preparation and training for ICD-10.

First, set the practice attitude.

“It starts at the top,” Kennedy said. “If we want this to be difficult, it can be difficult, but I think you can find somebody in your practice who will embrace it.”

Everyone in the practice needs to be familiar with the new system, but the staff members who should be trained first in most instances are the techs and scribes who take patient histories, document exams, and input the physician’s findings.

Others who should be considered for the ICD-10 team-those who are trained first and in turn will teach others-will vary by practice, but the most likely candidates are billing clerks, coders, physicians, receptionists, and administrators.

If this hasn’t already been done, form the team now, Kennedy urged. Schedule regular team meetings every week or two to ensure that staff members are competent by the time ICD-10 goes live.

One of the important steps is teaching the staff to take better histories, Kennedy said, describing many of those she reads in EMR charts during practice audits as nonsensical and embarrassing.

Also, use an ICD-10 code manual, whether the full manual or one written specifically for ophthalmology, to help prepare for the transition.

Next: Avoiding complications

ICD-10 is complicated and is best taken on in incremental steps. Identify the most commonly used ICD-9 codes in your practice, Kennedy recommended, then find out what the comparable codes are in ICD-10 before trying to learn others you may need. Acknowledge progress along the way and recognize errors while reviewing the correct procedure.

Allocate sufficient time to train personnel, at least 4 to 10 hours initially, although some sources recommend 16 hours for experienced coders and 24 for less-experienced staff.

Training can take many forms, such as online courses or web seminars specifically for ophthalmology, training through professional societies, or onsite training in the practice. Allow time to test the staff’s understanding of the new documentation process before Oct. 1, since it is likely errors will need to be corrected.

Finally, be patient, Kennedy said. Documenting for ICD-10 will be a new experience for everyone, including physicians, so anticipate problems. Despite the training, documentation may sometimes be inaccurate, and billers will have to ask for clarification.

In addition, some in the practice may be resistant to change, and there could be staff turnover, increasing workflow for employees until replacements are hired and trained.