Why a great ICD-10 steering committee is so important

Author Name Jennifer Bresnick   |   Date June 5, 2013

You can order all your coding workbooks, schedule your physician lectures, hand out ICD-10 lollipops by the dozen, and nag your vendors until you’re blue in the face, but the chances of your hospital being fully prepared for ICD-10 without a strong project plan and central leadership are slim at best.  The ICD-10 steering committee is a critical component of a successful conversion plan, and is the best defense against important initiatives slipping through the cracks as hospitals scramble to coordinate end-to-end testing, vendor updates, physician and coder education, and employee buy-in to one of the most frazzling and disgruntling transitions in healthcare.

Why should my hospital have one?

The purpose of the steering committee, executive leadership board, project plan commission, or whatever you want to call it, is to provide a centralized authority to establish a direction and achieve consensus when big decisions have to be made.  ICD-10 is a project with a very firm deadline.  Plain and simple?  You won’t get paid for ICD-9 codes used for services provided on or after October 1, 2014. With the majority of hospitals dragging their feet on implementation, and the compliance date approaching quickly, the only way to galvanize a reluctant organization with hundreds of moving parts is by establishing a board that can plan, delegate, and hold all parties responsible for their various tasks.

“It’s going to take longer than people think,” warns AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, FACHE.  “It really does take a village.  What we’re finding that there are so many systems that are impacted by this coding change that you have to work together with your entire organization to get you where you need to go.”

Who should be on the committee?

While it’s definitely important to get the thumbs-up from the executive leadership of the hospital, the steering committee shouldn’t just consist of your C-suite.  It is vital to bring in representatives from the clinical side, recruit physician champions who are enthusiastic about the project, and make sure you’re keeping your coding staff and IT wizards informed about your progress and concerns.

Project management is the key to a successful transition, and having strong, experienced managers to lead the charge can make all the difference.  “There are just so many projects that contribute to your overall ICD-10 approach,” explains Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS, former President of AHIMA who now works with Nuance.  “But within each one of those, you need people who are good, strong, solid project managers.  You want people who get up in the morning and think project management.  They’re the ones who are going to be very disciplined, very structured.  So if there’s any slippage in any of those projects, they’re going to know right away.”

A steering committee that represents all the major players in the ICD-10 transition – physicians, coders, financial staff, the IT department, and executive decisions makers – can secure the willingness of participants and craft a targeted, encouraging message for employees who may be hesitant to embrace the changes that ICD-10 will bring.

What should the committee do?

A steering committee should set up sub-committees in charge of the major aspects of ICD-10: coder training, physician education, and technical testing and compliance projects.  CMS has released a series of checklists and timelines for each of these areas to help guide organizations to the finish line.  The committee should establish benchmarks and meet monthly with representatives to ensure that goals are being met in a timely manner.

Communication is one of the biggest challenges of the transition, and the need for hospital-wide buy-in shouldn’t be underestimated.  Appointing physicians or nurses as advocates to help other clinical staff understand what will be required of their documentation habits can help ease fears about massive changes to workflow or patient notes. Checking in with the budget department will also be crucial, as the ICD-10 transition is expected to have a major impact on revenue cycles, and all that staff education is an expensive ordeal.  Putting your hospital’s CFO on the committee will ensure that there are no monetary surprises at the end of the day.

Make sure that the committee meets regularly and stays active and engaged in the entire ICD-10 process, including the weeks and months after October 1.  Your ICD-10 process isn’t going to end on the implementation date: no one really knows what the impact will be on productivity and claims processing, so you’ll need to keep making adjustments if your coders can only do half as much work as they get used to the new system.

There’s no doubt in anyone’s mind that ICD-10 is going to be a headache.  But a strong steering committee that takes charge, engages with stakeholders, and makes the tough decisions can help mitigate the pain.  If you’re one of the 25% of hospitals that haven’t taken this vital step yet, consider recruiting some leaders right away in order to prevent a big disaster next fall.

ICD-10 implementation: Myths and facts from CMS

Author Name Jennifer Bresnick   |   Date May 28, 2013   

Scary stories from Canada, dire warnings from the AMA, and a stream of experts alternately comforting providers and warning them to hunker down and prepare for the worst are leaving providers confused and conflicted a mere seventeen months beforeICD-10 implementation on October 1, 2014.  In response to the jumbled avalanche of information hitting providers at a time when the industry is in the midst of several massive changes, the Centers for Medicare and Medicaid Services (CMS) has developed afact sheet identifying several myths about ICD-10 and clarifying the truth behind these common misconceptions.

Myth: Not everyone has to switch to ICD-10

Fact: All HIPAA-covered entities, including physicians and hospitals, are mandated to switch to ICD-10 in 2014.  But that doesn’t include every single type of organization that currently uses ICD-9.  Worker’s Compensation and auto insurance companies, for example, use ICD-9 codes but are not required to make the leap to ICD-10. But it’s in their best interests to do so, says CMS, since physicians and hospitals will be using the newer codes.  The increased detail and specificity will be just as useful for worker’s comp as it is for the emergency department, and CMS will work with non-covered entities to help them make the transition.  State Medicaid Programs will also receive CMS help to ensure that they will meet the deadline.

Myth: Everything is going to get prohibitively more complicated

Fact: ICD-10 has a lot of codes.  140,000 of them, to be exact.  But just as increasing the number of words in a dictionary doesn’t make it harder to use, the greater number of ICD-10 codes won’t significantly affect the complexity of coding, CMS explains.  Electronic decision support tools and organized code books will make finding the right code easy, and the new logical structure of ICD-10 will help coders find exactly what they’re looking for.

Non-specific codes are still available for use if supported by clinical documentation, and much of the detail necessary for ICD-10 coding is already present.  Providers do not need to perform unnecessary diagnostic tests just to get to the most specific code that exists in the code book.  Superbills based on ICD-10-CM won’t necessarily be any longer or more complicated than ICD-9 superbills, and codes can be crosswalked to help the conversion process.

Myth: I can just use GEMs for coding medical records

Fact: The General Equivalence Mappings (GEMs) are a handy tool for converting large amounts of data from ICD-9 to ICD-10, and are intended to help update payment systems, risk adjustment logic, quality measures, and research databases by mapping one code set to the other.  They aren’t a one-to-one solution for coding an individual clinical chart.  Mapping isn’t the same as coding, CMS warns, because the GEMs don’t allow for the selection of the most accurate and applicable ICD-10 code.

The GEMs are free of charge and available to any provider who wishes to use them, but code books, which are available in physical hard copies and electronic editions, should be used to deal with individual patient charts.

Myth: CMS is going to push the conversion date back again

Fact: No, they won’t!  CMS and HHS currently have no plans to move the date or extend the conversion process.  Any provider who is not ready to use ICD-10 codes starting on October 1, 2014 will not be reimbursed for services performed on or after that date if they are coded in ICD-9.  The one year delay from 2013 to 2014 has already caused significant disruptions in the planning process, but CMS has repeatedly said that the date will not budge again.

Providers should take advantage of CMS resources, such as detailed timelines andupdated implementation guides, in order to plan their transition.

Docs' Charting Falls Short of ICD-10 Demands

By David Pittman, Washington Correspondent, MedPage Today

Published: April 12, 2013

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SAN FRANCISCO -- Nearly 65% of clinical documentation doesn't contain enough information for coders to use for billing under the upcoming ICD-10 coding system, a coding expert said here at the American College of Physicians annual meeting.

The switch to the new coding system will greatly increase the specificity of diagnostic codes, and most doctors don't provide enough detail for office coders to translate that to ICD-10, said Rhonda Buckholtz, vice-president of ICD-10 education and training at AAPC, a medical coding society based in Salt Lake City, Utah. Her estimate of the percentage of charts that were inadequately documented came from a survey of patient charts done by the AAPC, but further detail on the survey was not provided.

Complicating the switch for physicians, most payers said they won't reimburse for unspecified codes, which are commonly used by doctors who may not know how to exactly diagnose a patient when they see them, she said. "Under ICD-10, if we're not ready, we're not going to get paid."

Doctors have bemoaned the switch to ICD-10 -- short for International Classification of Diseases, version 10 -- because of the tremendous increase in complexity from the current ICD-9. The number of diagnostic codes will increase from nearly 14,000 to around 69,000. The number of procedure codes will jump from around 3,000 to roughly 87,000.

ICD-10 requires much greater detail on location of ailments, cause and type, and complications or manifestations compared with ICD-9. For example, diabetes will require complications to be incorporated within a single code. And asthma is listed as "mild," "mild intermittent," "mild persistent," "moderate persistent," or "severe."

Therefore, Buckholtz said physicians need to start work now to ensure they will provide enough information for billers to properly code.

Like it or not, the ICD-10 coding switch will occur on Oct. 1, 2014, a date the Centers for Medicare and Medicaid Services (CMS) has stood firm on after delaying the launch by a year already.

Jeannine Engel, MD, from the University of Utah School of Medicine in Salt Lake City, said studies range from 4% to 11% in the amount of extra time they estimate doctors will spend because of ICD-10.

Complicating the issue for physicians, ICD-9 won't be going completely away next fall. ICD-10 only applies to patients covered under HIPAA, the Health Insurance Portability and Accountability Act, so Workers Compensation patients -- who aren't covered under HIPAA -- will still be billed under ICD-9.

Buckholtz provided a number of tips for physicians, including:

• Review contracts with health plans and see what additional information they need or what will be changing
• Test systems and procedures before October 2014 to make sure your office is ready to go
• Budget costs of the change
• Train and educate clinicians and other staff members on the changes they need to make
• Update forms, documentation, and internal processes

"You don't want to wait 'till the last minute because there's no quick fix for ICD-10," Buckholtz said.

CMS has produced tip sheets, handbooks, and other content to aid providers on the transition, Dickon Chan of the CMS regional office in San Francisco told attendees. The agency also hosts periodic teleconferences and sends updates via email.

Chan recommended providers not focus on the more than 100,000 codes in ICD-10, but zero in on the ones that are most applicable to their practice. "You don't need to know every single number in the telephone book, but when it's there, you need it," he said.

John Guzek, MD, an internist at Commonwealth Health in Scranton, Pa., attended the talk and said the changes aren't as extreme as he first thought. He'll note what changes there are.

"I've downloaded an app on my iPad to look at the ICD-10 codes," he told MedPage Today in a video interview. "I'm probably going to be looking through that and seeing what the differences are going to be."

Engel said ICD-9 was first employed in 1975 and hasn't been updated much since then.

"Would you use a 30-year-old cardiac stent? Probably not," she said. "With medicine, 30 is pretty old."

Engel argued that the more granular data will provide insurers and researchers with additional information to track public health risks and quality data, and to design payment systems.

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