Like it or not, the clock is ticking down to ICD-10 transition. Despite physician angst and political pushback, ICD-10 coding will soon be underway. While the uncertainty of any grace-periods for providers remain, the question persists: Will October 1, 2015 be a day of progress for U.S healthcare or its day of reckoning?
According to the CDC, the new coding system that promises to improve data quality and streamline reimbursements will have nearly 19 times the procedural codes and five times the diagnostic codes than ICD-9, amounting to more than 69,000 codes for each respectively. Making the near-mythical leap to effective ICD-10 coding is going to take a lot more than provider faith—which is why few in healthcare have got any at this point.
The fears of plummeting productivity, technical glitches, and coding complexities are very real for providers, who will also have to fit the bill for ICD-10 implementation. Canada saw a 67% drop in coder productivity after ICD-10 was implemented during its government-funded rollout of the program, which was staggered between 2001 and 2004.
According to Edifecs white paper, 5010 & ICD-10: Testing Strategies to Achieve Compliance, Canadian authorities severely underestimated the work required to implement ICD-10 codes, including the following as reported by Healthcare IT News:
– “Underestimation of how much work was involved in preparing for the new technology environment and what additional cost would be incurred.”
– “Both timelines and budgets were grossly underestimated due to unavoidable delays and unknown variables that were not planned / anticipated.”
– “As business process’ were reviewed, variation in practices, process redundancies, and inefficiencies where identified. Magnitude of change was underestimated.”
With all that in mind, it’s easy to see why the U.S healthcare hasn’t jumped into ICD-10 transition enthusiastically. Still, one could argue whatever Canada lost from its ICD-10 rollout, the U.S stands to gain—if providers heed from Canada’s mistakes, that is. Here’s a few of the lessons that emerged from Canada’s ICD-10 transition:
1. Don’t underestimate the importance of coder training:
Canadian implementation placed little emphasis on coder training and it showed. In Canada, coder training is regulated at the provincial level and changes from year to year, region to region, and hospital to hospital. Exceptionally, when ICD-10 was implemented the Canadian Institute for Health Information (CIHI) delivered a two-day workshop that was given to all provinces/territories six to 12 months in advance of the change, and several took advantage of additional resources, including self-learning and hospital-sponsored practice time.
Trainers and coders in leading roles underwent more intensive six-month program online, which proved to reduce loss of productivity. However, as previously indicated, Canada saw significant drop in coder productivity, although it allotted six years for the transition process in its hospital settings; U.S transition period is slated for three years across all healthcare settings. Furthermore, Canada only jumped from 3,500 to 20,000 codes, yet still felt the repercussions as they greatly underestimated the increased of coding complexity.
Given the increased detail required by the new codes, the initial impact on coders will be significant. Implementation requires significant investment in coder education as well as ongoing assessment of coder skills. “Coding staff will need to completely unlearn what they know and relearn ICD-10 as almost a complete new skill set,” said Cynthia Grant, director of Canadian consultancy Courtyard Group. “If you think you’ve estimated the right amount of training time, increase it by another third.”
In 2010, Grant said that productivity in Canada had yet to bounce back to ICD-9 levels.
2. Know where you stand with current biller/coder productivity:
You can’t possibly understand how to move forward with ICD-10 transition without first understanding where your organization currently stands. That’s why coding and billing managers must understand current productivity to prepare for any future changes with ICD-10. Some crucial questions to ask and steps to take are as follows:
– How do current and future documentation practices affect productivity, and what will be the anticipated impacts when ICD-10 goes into effect?
– How might the practice’s/organization’s EHR help streamline and capture clinical data that can improve current productivity?
– Re-evaluate the diagnoses and procedures your inpatient coders are currently assigning. Focus on coding only significant reportable conditions and procedures. For example, if your inpatient coders routinely code blood transfusions, something that will take much longer in ICD-10, consider training the blood bank staff to assign these codes.
– Perform a study of the top 50 diagnoses and procedures to determine reporting relevance. If codes are assigned for internal purposes only, determine the benefit verses the cost of doing so with ICD-10.