Proceed with Care to ICD-10 Deadline

After a false start or two, CMS has set a final ICD-10 implementation deadline for October 1, 2015, as widely expected.  In a notice released in July, CMS states that the deadline gives providers, payors, and other healthcare stakeholders ample time to prepare.

While the most recent delay was a source of frustration to many on the provider and vendor sides who were prepared for an October transition, not everyone on the payor side was expected to be ready for the change. Experts widely recommended that practices have sufficient lines of credit in the event of an uptick in denials and slowdown in the revenue cycle.

A year’s delay, even for those who consider themselves prepared, represents an opportunity to go beyond readiness to optimize the transition to ICD-10. As described by Karna W. Morrow, CPC, RCC, Coding Strategies, during the spring meeting of the RBMA California chapter on March 7, ICD-10 is best approached as a process of continuous quality improvement. Most importantly, do not delegate readiness to your billing and coding vendors.

“ICD-10 is not about your vendor,” Morrow told a group gathered at the Queen Mary in Long Beach, Calif. “I don’t care who they are and how may bells and whistles they have. At the end of the day, do they dictate the medical record?”

Morrow made it very clear that this transition represents a challenge for the entire practice in solving a problem that has long plagued the specialty: Getting enough information about the patient from the referring physician. Train and enlist everyone in the effort, she urges: Technologists, schedulers, pre-op clerks, the billing department, payment posters, everyone.

Of course, radiologists need training as well. Morrow boiled down the increased responsibility of the radiologist’s dictation to the following handy algorithm: location (specific anatomical site), severity (acute versus chronic), context (history, underlying condition, intent of imaging), and story (initial, subsequent, or sequel effect, what was patient doing, where was the event, and patient status at the time).

Documentation is critical, Morrow asserts. It allows selection of the correct codes, supports medical necessity, provides clear communication, and protects the claim in an audit. “This is a huge project,” Morrow says. “The biggest mistake we are going to make is assuming everyone knows what to do.”