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Careful and incremental project planning throughout the full timeline until Oct. 1, 2013, will help ensure a successful transition to ICD-10-CM/PCS (referred to as ICD-10 for the remainder of this article.) Consequences of poor planning include increased claims rejections and denials, improper claims payment, coding backlogs, increased physician queries and compliance issues. This article will discuss three things you can and should be doing now to successfully move toward the implementation date of Oct. 1, 2013.
Make Full Use of Implementation Timeline
The most important advice for a successful implementation is to make use of the entire timeline. The implementation timeline is divided into four key phases:
1. Phase 1 - the planning phase in which the full scope of the impact is determined
 2. Phase 2 - the "doing" stage, in which all of the activities identified in the impact assessment are completed
3. Phase 3- the "go live" phase
4. Phase 4 - the "post-implementation follow-up"
One of the key actions in phase 1 is the impact assessment. This involves identifying all impacts for every department of the organization. The steps are to analyze the impact on operational processes, documentation processes and work flow, and both internal and external reporting. An assessment of the detail in clinical documentation should be done to identify if it is adequate to support the new code sets.
Key components to the impact assessment are:
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Complete a systems inventory of all databases, systems applications and interfaces currently using ICD codes.
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Prepare a multi-year ICD-10 implementation budget.
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Establish a detailed training plan.
The actual suggested end to Phase 1 was middle 2011, with phase 2 actually starting early 2012. If the impact assessment is not completed, or well underway, this is a critical activity that must be a priority activity for any organization.
Develop Training Plan
There are two types of required training:
Awareness Training
A basic awareness about ICD-10 must be provided to all key stakeholders (senior management, information technology, clinical department managers and medical staff.) This was to be provided by early 2011. Then for all those currently involved with ICD data, HIM and coding professionals, more intense awareness training is indicated. This should include the structure and changes to the systems, differences in definitions and code composition, data comparability issues and longitudinal data analysis issues. This stage of training should be completed by March 2013.
Coder Training
The actual "hands-on" coder training is suggested to start 6-9 months from implementation; so early 2013. But additional knowledge is needed before that actually occurs. The coder training plan must be well-thought out and organized starting with the early awareness training and ending with the intensive "hands-on" coder training provided in 2013. There are many steps to consider in the timeline.
Part of the impact assessment consists of an evaluation of current coder knowledge, and a gap analysis on individual needs for training or retraining in the biomedical sciences. Success in ICD-10 coding involves knowledge of anatomy and physiology, medical terminology, pathophysiology and surgical methodologies and techniques. Assessing staff knowledge early and then providing that individualized training based on knowledge gaps is critical to progressing into later stages of training. After the training has been provided on the biomedical sciences, coders can and should start learning new coding guidelines and definitions. Also the fundamentals, structure and conventions should be presented. Role-based training models and coder training timelines are available to assist in the development of this training plan.
Clinical Documentation Improvement (CDI)
More specific codes require improved documentation; so to assign the most specific code available, high-quality medical record documentation will be needed. The quality of current medical record documentation can be assessed. This can be done in steps:
1. Evaluate samples of various types of medical records to determine whether the documentation supports the level of detail found in ICD-10. Include your top MS-DRGs and diagnoses and a good sample of various types of medical and surgical cases.
2. Implement documentation improvement strategies to address the areas where documentation is found to be lacking.
It is important to work on this CDI project during the full timeline, rather than wait for implementation, and then try to deal with documentation issues at the same time that ICD-10 is being implemented. Waiting will cause many physician queries, and delayed payment.
Contrary to what some say, there are still nonspecific codes available when necessary. All unspecified codes can't be eliminated because sometimes even the clinician doesn't have the information necessary about the disease process in order to assign a more specific code. It is important to remember though, if nonspecific or unspecified codes are consistently assigned, no improvements will be seen in the data.
Examples of documentation that might require more specificity:
ICD-10-CM
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Laterality
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Additional specificity in coding injuries
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More detail in fracture coding
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Classification of open fractures
ICD-10-PCS
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The extent of the removal (differentiation between excision and resection, i.e. lymph node(s) or chains
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Embolization (differentiation between partial (restriction) or complete (occlusion)
Start early to guarantee that all steps are completed in a logical progression to help mitigate any risks to the successful implementation of ICD-10. Many implementation tools and models are available, and several are listed in the references section of this article.
References
AHIMA. ICD-10-CM/PCS Transition: Planning & Preparation Checklist. http://www.ahima.org/downloads/pdfs/resources/checklist.pdf
AHIMA. ICD-10 Rose-based Model for ICD-10 Implementation. http://www.ahima.org/icd10/role.aspx
G2N. G2N ICD-10 Training Timeline. http://g2n.org/Training-Timeline.htm
G2N. G2N ICD-10 Implementation Timeline. www.G2N.org/ICD10.htm
For more information, including an implementation timeline, and coder training strategy timeline, see www.G2N.org/ICD10.htm.
Ann Zeisset is a Special Consultant for ICD-10 at G2N Inc. She is an approved-AHIMA ICD-10-CM/PCS trainer and can be reached at azeisset@g2n.org.
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