Outpatient coding and ICD-10-PCS

Initially, we thought that outpatient coders didn’t have to learn to code in ICD-10-PCS. They would still use CPT® codes to report physician services in the outpatient world.

Now it looks like that might not be the case everywhere. During the AHIMA Conference in Atlanta October 26-30 the topic of outpatient coders using ICD-10-PCS came up repeatedly.

Some facilities now require coders to report ICD-9-CM procedure codes for outpatient services so they can compare data for inpatient and outpatient services, outcomes, etc. Some commercial payers also require ICD-9-CM procedure codes for outpatient services.

The jury is still out on what payers will do once we transition to ICD-10. But facilities should start to think about training outpatient coders on ICD-10-PCS. Outpatient coders are used to looking for information in the operative report that inpatient coders don’t need to see now. That should help outpatient coders in ICD-10-PCS.

However, what physicians need to document for CPT code assignment is not always the same as what they need to document for ICD-10-PCS. You knew it couldn’t be easy, right?

Having everyone code in ICD-10-PCS could be a good thing. We would get standardized data on all procedures, regardless of the setting. We would also have more coders who can fill in when someone is on vacation, out sick, or leaves the organization.

On the downside, training all coders on ICD-10-PCS costs money and takes time. It will also probably decrease productivity, which could result in a slowdown in reimbursement.

Weigh the pros and cons at your organization and talk to your payers. Then decide whether to bring the outpatient coders into the ICD-10-PCS world.

- See more at: http://blogs.hcpro.com/icd-10/2013/11/outpatient-coding-and-icd-10-pcs/

AHIMA: Hospitals lag on ICD-10 planning, steering committees

Author Name Jennifer Bresnick   |   Date June 3, 2013

When AHIMA is worried, hospitals should be, too.  A new survey by the American Health Information Management Association and vendor TrustHCS reveals that hospitals are still struggling to get off the ground when it comes to ICD-10 implementation less than two years before the mandated conversion date.  More than 50% of the 293 healthcare facilities surveyed in the fall of 2012 admitted that they were still in the beginning stages of planning for ICD-10, and 25% hadn’t even appointed an ICD-10 steering committee to head the project.

Teaching community hospitals and academic medical centers fared slightly better than the average, with 30% reporting that they regularly met with their ICD-10 steering committee and were moving through their project plans at an acceptable pace, as opposed to only 17% of other types of hospitals with a plan underway.  Critical access hospitals (CAHs) were the slowest to begin ICD-10 conversion, with the survey’s authors concluding that their exception from DRG-based reimbursement was the likely culprit.

“The move to ICD-10 is a long assembly line requiring a monumental amount of teamwork and coordination,” say Torrey Barnhouse and William Rudman, PhD, RHIA, writing for AHIMA. “Once organizational buy-in is achieved, rapid action with quarterly auditing of progress is a must.”  Buy-in is likely to be stymied by the increased financial burden that ICD-10 will place on hospitals, including funding for coder education.  While the survey found that 72% of hospitals have begun their education programs, it also noted that the cost of these programs averaged$12,200 per coder, with academic medical centers spending closer to $27,000 per staff member.

“Budgets for ICD-10 training are higher within groups who have already established committees and have transition projects underway,” the study notes.  “The researchers behind the study believe this finding indicates that deeper and more extensive ICD-10 education is certainly required by many providers.”  This may come as unwelcome news to budget committees who will be asked for more funding as the true need for financial support reveals itself.  The cost for undertraining will be even higher, however, if claims are denied and revenue streams encounter roadblocks due to poorly coded documentation or ICD-10 mistakes.

Medical coders with ICD-10 experience will have the luxury of choosing from numerous job offers in the next few years as hospitals widely expect to increase their coding staff to mitigate potential dips in productivity.  Sixty-three percent of respondents plan to hire new coders, and 25% plan to outsource their coding needs to staffers working at an hourly rate.  Computer assisted coding (CAC) will supplement the effort in more than three quarters of hospitals, but human experience will be in increasingly high demand.

“This year is a crucial time for organizations to make progress on ICD-10,” Barnhouse and Rudman conclude. “With half of the nation’s hospitals still in the beginning stages, according to the 2012 survey, HIM professionals must dig deeper and push harder to entrench themselves in the implementation process. More than ever, communication and planning are the key factors to a successful transition.”

http://ehrintelligence.com/2013/06/03/ahima-hospitals-lag-on-icd-10-planning-steering-committees/