February 2010

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Ten Goals for ICD-10 Preparation in 2010

Experts Agree Facilities Must Start ICD-10 Preparation Now

By Laurie Casey

With an ICD-10-CM and ICD-10-PCS (jointly referred to as ICD-10) go-live date of October 1, 2013, organizations may focus their attention on more pressing concerns. But don’t underestimate this great wave of change brought by the transition to ICD-10-CM and ICD-10-PCS code sets. Start your preparations now, so when the wave hits, you’ll be riding on top.
“ICD-10 is a wave of change that’s been coming for 30 years. If you are a coding professional, don’t wait for your organization to train you on ICD-10,” said Gale McNeill, RHIA, CCS, supervisor of coding education and quality for Cleveland Clinic Health System, Eastern Region Hospitals, in Mayfield Heights, OH. “There are great resources you can take advantage of to learn about the new code sets. It’s your education and your career, and you need to take ownership of them.”

HIM managers should build awareness about ICD-10. “Make all key stakeholders aware that ICD-10 is a major change. Get commitment from your organization and begin preparing the workforce now,” said Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM, NCAL Revenue Cycle at Kaiser Foundation Health Plan Inc. and Hospitals in Oakland, CA.
AHIMA member and staff experts have developed a Web site containing a wealth of knowledge that can help you every step of the way. For detailed instructions, see the preparation checklist and role-based model for ICD-10 implementation at www.ahima.org/icd10.

Here are 10 basic goals for 2010 and the early part of 2011 to get you started on the first phase of preparation, which is impact assessment.

1. Gain an understanding of the final rules and implementation timelines. If you haven’t already, now is the time to take a look at the final rules for ICD-10-CM and ICD-10-PCS and the electronic transaction standards (Version 5010). Learn the benefits and value of ICD-10 and learn how ICD-10 fits within the overall electronic health record (EHR) and data quality initiatives.
   
   
2. Establish an interdisciplinary steering committee. The committee should include an HIM services manager and an HIM coding professional responsible for code assignment, senior management, medical staff, financial management, and information services. This committee will develop the organization’s ICD-10 implementation strategy and will identify the actions, people responsible, and deadlines for required tasks.
   
   
3. Create awareness. This is a crucial task. One of the main ingredients for a successful transition is clear, concise, and regular communication. Educate key members of your organization on the ICD-10 final rule, basic structure, organization, and key unique features of ICD-10-CM and ICD-10-PCS.
   
   “I’m like a recurring infomercial to make others aware of the transition to ICD-10,” said McNeill, who is a member of AHIMA’s Meaningful Use Response Team and co-author of AHIMA’s Implementing ICD-10-CM/PCS for Hospitals: A Project Guide and Toolkit. “I keep plugging ICD-10 any chance I get—our newsletter, compliance meetings, whenever I speak to leadership groups. I do this because it’s difficult to break through and get the message across when the organization is so focused on EHR and regulatory issues.”
   
   
4. Employ change management strategies. Minimize the “fear of change” factor. As with any major change, communication is key. Coding professional staff who have worked with ICD-9-CM for years, even decades, may need support during this transitional time.
   
   “There is a lot of anxiety out there,” said Bryant. “If we give people bits of information over time, it will defuse the anxiety. That’s important. Then the mindset will be prepared to accept change and be open to learning. In my particular organization, we have employees who have been coding for 20-30 years. Their comfort level with ICD-9-CM is solid. So when we tell them, we’re going to change what they feel comfortable with, that’s difficult to grasp.”
   
   Bryant gave coding professionals an ICD-10 overview presentation describing how ICD-10 will impact HIM coding and gave some examples of the new codes and descriptions. She created an electronic survey that was sent to 21 hospital HIM departments to get feedback from the coding workforce. “I want to engage them in this coding change. It’s not a situation where we tug and pull our employees to accept the change,” said Bryant. “Through the survey, our staff can give us feedback, such as, ‘Here are the subjects where I feel I’m weak.’ That’s better than us coming in and saying, ‘Here’s what you need to learn.’”
   
   
5. Assess readiness for 5010 transaction standards. January 1, 2012, is the deadline for all organizations that exchange coding and billing information to update electronic data transaction standards (Version 5010). Assess organizational readiness for this milestone. That includes affected staff, information systems (affected systems, applications, and databases), documentation process and work flow, data availability and use, and organizational capacity (including budget) and other key projects that will occur during this time frame.
   
   
6. Inventory processes and systems that will be impacted. The impact of ICD-10 will be seen in systems that contain ICD-9-CM codes. Those include the DRG groupers, encoding software, abstracting systems, and compliance software. The impact to billing systems will need to be considered, such as the size of the data fields. The current payment system will need to be converted to ICD-10 codes. How will new codes that did not exist in ICD-9-CM be handled?
   
   All current systems and reports that contain ICD-9-CM codes will need to be reprogrammed. How will the legacy data from each system be managed? For those systems that transmit the data to external sources, you’ll have to verify that the external system will be able to handle ICD-10 codes. What length of time will both legacy and new coding systems need to be supported? Will current system storage capacity need to be increased?
   
   
7. Plan training. Conduct a detailed assessment of ICD-10 educational needs for your coding professionals, physicians, and others within the organization who currently use ICD-9 codes such as billing, accounting, data quality, and data security. Determine whether education will be provided internally or externally and what media will be used.
   
   “We plan to begin educating key members of our organization in 2010,” said Sarah Glass, MA, RHIA, CCS, FAHIMA, assistant director of health information management for St. Luke’s Episcopal Health System in Houston, TX. “This year we’ll provide additional training in anatomy and physiology to coding professionals utilizing our in-house learning management system. We will budget for a detailed assessment of educational needs at the end of the year.”
   
   The final rule recommends 50 hours of training for hospital inpatient coding professionals and eight to 16 hours for other coding professionals. You should tailor a training plan according to your department’s needs. Training will vary depending on the setting. Coding professionals in the hospital inpatient setting will require education on ICD-10-CM and ICD-10-PCS, while all others will only require training on ICD-10-CM.
   
   
8. Conduct a gap analysis of coding knowledge. Measure coding professionals’ baseline knowledge of anatomy, physiology, pharmacology, and medical terminology. Doing so now will shorten the learning curve, improve coding accuracy and productivity, and accelerate the realization of benefits.
   
   
9. Conduct a gap analysis of documentation practices. ICD-10 (as well as other recent initiatives such as MS-DRG and hospital acquired conditions and present on admission reporting) have brought clinical documentation improvement programs to the forefront. Use this lead time to work on documentation improvement strategies as necessary.
   
   
10. Develop a budget. Identify the specific departmental budgets that will be responsible for the cost of systems changes, hardware and software upgrades, and education.