The International Classification of Diseases, Tenth Revision (ICD-10), comprises two sets of codes, one for documenting diagnoses (ICD-10-CM) and the other for documenting procedures (ICD-10-PCS). Compared to ICD-9, these codes are more extensive and more numerous. ICD-10-CM codes number close to 68,000 and contain 3–7 characters compared to ICD-9-CM total more than 14,000 3–5 digit codes. Similarly, ICD-10-PCS comprise 7 characters and approximate nearly 87,000 compared to 4,000 ICD-9-CM codes of 3–4 numbers in length.
Given the size and scale of ICD-10, the new code set will demand more from hospital staff, not just coders. Unless physicians improve their methods of documenting clinical encounters with patients, they and their hospitals could find themselves in dire financial straits:
Essentially what’s going to happen is physicians are going to have to have more specific documentation in order to meet medical necessity so that they can even be paid and in order to be able to make sure they’re getting the most appropriate reimbursement when they do get paid, both for the physicians and the hospitals. When a physician is treating a patient in the hospital, you have two patients: one to the physician and one to the hospital. They both are dependent on better documentation with ICD-10.
To avoid loss in revenue and uncertainty in productivity, experts recommend that hospitals pay special attention to their clinical documentation as well as the templates used by physicians in their electronic health record (EHR) systems.
In this second installment of ICD-10 Best Practices, we address how hospitals undertake an important health information technology project necessary to ensure a smooth transition to ICD-10: identifying and making improvements to EHR templates.
Modifying EHR templates for ICD-10
The most successful ICD-10 implementations begin with an assessing of current procedures and systems. Considering that ICD-10 demands more information than ICD-9, hospital leadership must first identify where physicians presently fall short in capturing data necessary for ICD-10.
Those tasked with updating EHR templates need strike the right balance so as to avoid stimulation overload for physicians using the system:
ICD-10 has a lot of detail that you can collect that’s informational only, and it allows you to assign a more specific code. However, that code is not based on or will not lead you to a change in the way a physician manages that patient, and it won’t have an impact financially. Your alerts have to be focused on those areas where you’re improving documentation because it’s going to improve payment or capture of severity of illness and risk of mortality.
The real challenge is identifying what’s necessary versus what’s superfluous. And this extends to the details physicians will now have to capture. By and large, many parts of ICD-9 carry over to ICD-10; however, the level of specificity changes greatly:
Most of things that you have to document for ICD-9 to improve reimbursement are going to still hold true with ICD-10. But there are some additional things in ICD-10 and the problem is that they’re buried. It’s not easy to identify where the shift in payment is going to come from based on all the specificity that we have available, and that’s why you need to have the assessment to really drill down and identify. You take that information to improve the templates you have because some of it is not intuitive. You wouldn’t think that adding this little is going to have a financial impact, but it does.
While the modifications to the EHR templates represent a significant undertaking, they are only successful if preceded by a thorough assessment of ICD-10 and its requirements on physicians and hospitals.
Source: www.ehrintelligence.com; Kyle Murphy, PhD; October 30. 2012.