Now that football season is in full swing, the commonalities between the NFL (or SEC college football, which is my favorite) and health information management (HIM) teams are quite apparent: all the training, strategy development, and those incredible milestone wins. And, of course, we must be ‘all in!’
When training for anything, it is always advisable to pause periodically and evaluate how things are progressing. After all, we have to track our milestones in order to achieve success. Although taking this time can seem like a luxury, in reality, it is an important step in the preparation process. It enables you to compare your current status, review and revise your playbook, determine what needs more work, and develop new tactics. Having this discipline will help drive your HIM team to a victory when game-day comes.
With the ICD-10 deadline eleven months away, now is a good time to do a quick pulse check to determine how your preparation is coming along. Below are some key questions to consider when evaluating the efficacy of your ICD-10 coding program:
Do the ICD-9 and ICD-10 code assignments being entered accurately reflect the information provided by the physician?
Conducting an evaluation of the clinical documentation content being provided, either using a tool such as computer-assisted physician documentation or the insight of a clinical documentation specialist, enables health information managers to evaluate the accuracy of ICD-9 code assignment in relation to the ICD-10 code assignment. It is very important to pay close attention to how coders reach certain coding conclusions, as they may be using automated tools with logic and/or mapping that does not account for the level of specificity needed to accurately move from ICD-9 into ICD-10. Remember, these code sets do not operate on a 1:1 ratio and attempting to do so may result in non-reimbursable, unspecified codes. The most accurate approach is native ICD-10 coding.
What do you anticipate your coding staff’s productivity to be when the ICD-10 conversion occurs? By establishing and monitoring your productivity standards today in ICD-9, as well as the productivity as your coders practice native coding in ICD-10, you will be in a better position to gauge where they will be next October. One case per hour is the quoted ICD-10 coding average for an individual coding an inpatient chart today without a computer-assisted coding (CAC) tool.
What are you doing to provide coders with time for ICD-10 coding education and practice time? Education is the number one way to ensure ICD-10 coding success. Working with your coders, clinical documentation specialists (CDSs) and physicians to establish efficient workflows and practice physician querying will help to reduce the stress levels as the deadline approaches, build relationships between departments and highlight potential areas for improvement, which can be addressed well in advance of October 1, 2014.
What are the results of your organization-wide IT assessment in preparation for ICD-10 compliance? At this time, your organization should be well on its way to implementing its IT action plan, including: identifying deficiencies, gaps and opportunities to strengthen the integration of people, processes and technology currently involved in any part of ICD-9 procedures. You need to ensure all systems that currently contain ICD-9 codes are fully prepared to handle the transition to ICD-10.
Was a CAC solution recommended as one of the critical success factors in your transition to ICD-10, and if so, where are you on the timeline for assessing your CAC readiness and preparing for implementation? In order to achieve success with coding compliance, you must identify the clinical documentation record set that is used by your coders and ensure it is compatible with the natural language understanding (NLU) engine of your CAC solution. Coders can only validate suggested codes that are read by the NLU engine based on the clinical record set provided.
Is your CAC program both ICD-9 and ICD-10 ready? The quality and productivity of the coders must be enhanced by IT solutions, not hindered; CAC programs will only be valuable if they can provide suggested codes in ICD-9, ICD-10 and current procedural terminology (CPT).
Do your coders validate ICD-9 and ICD-10 codes? The time is now to evaluate and strengthen the efficiency of people, technology, processes and workflows in your coding environment. What is your workflow for coding today? Are your coders using an encoder for coding ICD-9 as they practice for ICD-10, or are they also using a CAC solution with an encoder for validating encounters in ICD-9 while practicing native coding in ICD-10? Deciding which processes can be modified and improved now will help iron out any wrinkles that might impact workflows down the road.
Successfully making it through the ICD-10 transition to the compliance date is like winning the Superbowl — it will be no small feat. But taking the time to ensure your organizational teams – from physicians to clinical documentation specialists and coders – are properly educated, trained, have the tools they need, know the playbook, and are well-versed in the hand-offs, will assure your big win in ICD-10 compliance come October 1, 2014!