After months – and in many cases, years – of anxious preparations related to the ICD-10 transition, October 1 came and went without any major glitches. This is definitely good news for providers that had feared the worst. Rumors had run rampant that healthcare operations would come to a screeching halt once we flipped the switch.
However, unlike Y2K, the conversion to ICD-10 is a slow dimmer switch – not an on or off button. The ICD-10 story will continue to play out in the decades ahead, just as it did with ICD-9.
Join ICD-10 Front Lines and Executive Insight every month to watch the ICD-10 conversion unfold for hospitals, physician practices, payers and vendors. Every column provides new insights and learnings from healthcare’s front lines. I’ll share insights and intel from Agency Ten22 consulting, and from service and technology companies as they work hand in hand with their provider customers to navigate the new waters of ICD-10.
This month’s issue highlights the journey from Denver-based Haugen Consulting Group and Allentown-based H.I.M. ON CALL.
Although consultants remain prepared for an influx of coding questions, many facilities seem to be on track in terms of coding compliance – at least upon initial claims submission. “The majority of questions we’ve received so far have come from acute care facilities or larger medical centers that employ facility and professional fee coders,” says Mary Beth Haugen, MS, RHIA, founder and CEO of Haugen Consulting Group.
“These questions arise when coders onsite are unable to come to a consensus about how to code a particular case. There have been a variety of coding questions, which have included thoracentesis, MS-DRG shifts for rehabilitation, verifying that back fusions are being coded correctly in PCS, and OB cases with a principal diagnosis of O30.043.”
Cassie Milligan, RHIT, CCS, manager of quality improvement at H.I.M. ON CALL, witnessed an increase in the volume of unspecified codes at various client hospitals. “It will be important to monitor these codes, provide physician education, and inform CDI teams accordingly,” says Milligan.
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Sneak Peak on Payer Problems
Payers are processing ICD-10 claims and and clients are receiving payment. As they do, “hospitals and physician practices may see an uptick in coding questions,” mentions Haugen. Healthcare providers should maintain a watchful eye on claims denials and additional documentation requests (ADRs) as they negotiate this first round of ICD-10 claims response from payers.
So far, one of Haugen Group’s clients experienced denials related to ICD-10 E-codes. However, Haugen suspects this issue should be resolved once the payer cleans up its edits and groupers. “Another client saw a denial for a bilateral code because the payer inappropriately requested two separate codes instead (left and right),” she adds.
In October, Haugen Consulting Group assisted their hospital clients and resolved ICD-10-related problems within 24 hours using the following tactics:
– Apply a vendor hotfix to an application
– Notify payer that an edit is no longer valid in ICD-10
– Update forms within the HER
– Update organizational coding guidelines.
– Monitor post implementation metrics and facilitate daily huddles
Coder Productivity – Know the Cause
Finally, many hospitals and outsourced coding companies witnessed an expected decrease in coder productivity during October 2015. “Mitigation of productivity drops is critical,” says Milligan. “The first step is to open the lines of communication with coders to better understand the reason for productivity decreases. Is it due to insufficient documentation? Poor EHR navigation? Slow connectivity? Frequent system log-outs? Lack of coder confidence?”
Join ICD-10 Front Lines next month as we explore the initial ICD-10 response and ramifications from physician practices and outpatient ancillary services.
Beth Friedman is the founder and chief content officer of Agency Ten22. Prior to starting the firm in 2005, Beth served as director of marketing for A4 Health Systems, McKesson, and eWebCoding. Beth holds a bachelor’s degree in healthcare administration and is a registered health information technician (RHIT). She is a member of HIMSS, AHIMA, HFMA and the American Marketing Association. Beth began her career as a clinical coder and supervisor for two large Pittsburgh hospitals. From coding, she moved to quality assurance and data management before joining the vendor community in 1991.