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Will Medical Coders Be Needed in the Future? – HIM Scene

Posted on October 26, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

After spending time with so many HIM professionals at the AHIMA Annual conference, I’ve come back thinking about the future of medical coders. No doubt, many HIM professionals are moving well beyond medical coding into other areas such as healthcare analytics, clinical documentation improvement (CDI), EHR optimization, and much more. However, there’s still a massive need for high quality medical coding and the HIM professionals that provide that service.

As we look into the future, the techie in me feels like medical coding should be automated. Why are we paying people to do medical coding? Why can’t that be automated and be done by robots? It’s not like medical coding is a particularly fun job. I’m sure there are some times it’s fun working on unique cases, but it can be quite monotonous and tedious. Why not have a computer do it instead?

What I’ve learned over the years is that medical coding is more art than it is science. Certainly there are some clear cut cases where it’s basically science. However, a large part of what a coder does isn’t set in stone. There’s some artistic licence if you will, or at least some interpretation that has to happen in order to code a visit properly. Computers aren’t good at interpretation, but humans are.

The other reality is that doctors don’t produce perfect documentation. If they did, then we probably could code a robot to code a patient visit. Since there are nuances to every physician’s documentation, we’re going to need humans that interpret those nuances as part of the coding process. I don’t see this changing in our lifetimes.

One word of caution. Many people fall into the trap that we need automated robot coding to be perfect for it to accepted. That’s just not the case, because human coders aren’t perfect either. In fact, there’s some research that human coders aren’t as good as we thought they were at coding, but I digress. The reality is that automated coding just has to be better than humans, it doesn’t have to be perfect. Even with this said, I don’t see it happening for a while.

What we do see happening now is a collaboration between humans and computers: computer assisted coding. While we don’t have to worry about computers replacing humans in medical coding, we do need to focus on ways that technology can make the work humans do better. That’s a powerful concept that we’re starting to see happen already.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Integrating CDI Efforts Across Inpatient and Outpatient – HIM Scene

Posted on October 19, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

One of the main topics HIM professionals have been discussing for a couple years is around CDI (Clinical Documentation Improvement). These programs have taken all sorts of shapes and sizes. Some are completely human driven. Others are largely tech driven, but most are a mix of the two. In fact, most CDI programs have gotten quite sophisticated and are really impacting the bottom line of healthcare organizations.

While most healthcare organizations realize that there are benefits to CDI, most of them have restricted these programs to the inpatient environment only. This was illustrated to me really well when I ran into a transcription vendor from India. It was his first time attending AHIMA and he was considering new areas of business including CDI. When we talked about CDI, his first comment was that he’d only ever seen CDI in hospitals, not in the ambulatory world.

While this is the case today, one HIM expert at AHIMA told me that one of the next big frontiers for CDI is going to be outpatient CDI. She went on to tell me that it’s fertile ground that could really benefit every healthcare organization. However, she also suggested that there shouldn’t be two CDI programs: 1 for inpatient and 1 for outpatient. Instead, CDI should be an integrated effort across inpatient and outpatient.

Clinical documentation improvement is only going to become more important in healthcare. Certainly, most CDI projects were started as a way to improve reimbursement. That’s a good goal and a benefit of a high quality CDI project. However, over time CDI is going to become even more important to an organization’s value based reimbursement efforts. In fact, if your clinical documentation isn’t accurate your reimbursement will really suffer. How can you keep a patient healthy if you’ve documented the wrong information for a patient?

How is your organization approaching CDI? Are you doing CDI in both inpatient and outpatient?

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Looking Forward to #AHIMACon16 – HIM Scene

Posted on October 12, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

As we prepare to head to the 2016 AHIMA Annual convention (see our full list of conferences we attend), we’re excited to talk about how we’re planning to expand HIM Scene to include as many HIM voices and perspectives as possible. HIM Scene will still be hosted here on Hospital EMR and EHR and will still have its own email list where HIM professionals can receive great HIM related content from thought leaders across the industry. However, we’ll be using HIM Scene to share a wide variety of people and perspectives.

The HIM industry is an amazing group of devoted people and that really comes through at every AHIMA annual convention I attend. Plus, HIM has a lot more influence than many people realize. So, we’re happy to do what we can to raise the voices and perspectives of HIM professionals here at HIM Scene.

Looking forward to the AHIMA Annual convention next week in Baltimore, we’re excited to learn about a number of important topics. Here are a few we’ll be sure to report on in future HIM Scene posts:

ICD-10 – A year after implementation, I’m really interested to hear the real stories of how ICD-10 has impacted healthcare organizations for good and bad. I bet there will be a lot of stories that haven’t been shared. I’ll also asking the HIM professionals I meet what they think the impact of the end of the ICD-10 grace period will have on healthcare. I wonder how many will have stories of ICD-10 improving care versus stories of ICD-10 for reimbursement.

Information Governance – This is an eternally hot topic in HIM, but it always continues to evolve. This is particularly true as records have gone electronic. This year I wonder how many people have been involved in some sort of health data sharing project. Information governance can get pretty tricky as healthcare organizations start to share data with each other electronically.

HIPAA Privacy and Security – A really hot topic given all the HIPAA breaches and ransomware incidents in healthcare. I’m sure I’ll find a number of HIPAA privacy officers that will share some good insights into how they’re dealing with these security and privacy challenges. I’m afraid many of them will give me exasperated responses about how their leadership isn’t taking it serious enough.

Informatics – I’ve been really intrigued with HIM’s role in healthcare informatics. Once you dive in, it makes since why HIM would be involved, but I don’t think most people saw that at first. What’s also been interesting to watch is many HIM professionals who’ve kind of shunned their involvement in healthcare informatics. We’ll see if many are still in that position or if most HIM professionals are starting to embrace and participate in the informatics efforts of their organizations.

What hot topics will you be looking for at the 2016 AHIMA Annual Convention? The AHIMA 2016 theme is to “Inspire Big Thinking to Launch Our Future.” We’ll be sure to report back any big thinking we hear from people we meet.

ahima-2016

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

ICD-10 Check-Up

Posted on May 13, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

It’s hard to believe it has been seven months since we implemented ICD-10 in the US. We talked about this subject and planned for so many years and now it feels like second nature. Looking back, I would label the implementation mostly successful and smooth. Would you say the same?

If you’re like me, you have forgotten some or most ICD-9 codes and have a nice repertoire of ICD-10 diagnosis codes swimming around in your head daily. At least memorizing the beginning of a code is helpful when you only need to search the encoder for the fourth through seventh digits of the code to further specify laterality and detail.

Conducting an external audit on ICD-10 coded accounts at this point is a good idea to make sure coders are accurate with the new code set. It’s important to watch for any trends in DRG shifts that may be attributable to ICD-10. If claims data for the past seven months have not been reconciled with expected reimbursement, now is a good time to be reviewing for coding and billing accuracy.

We were promised more specificity with ICD-10 and I believe we have somewhat achieved that. There are still opportunities to improve physician documentation and gather more detail in order to assign the correct codes. For the most part, I believe physicians have been affected by HIM teams bringing awareness to specific documentation and education on what is needed for ICD-10 coding and billing. ICD-10 has not turned out to be the burden that everyone was initially so reluctant to; at least from my experience.

In the blog post I wrote soon after ICD-10 implementation, I mentioned that coder productivity was a big issue to watch for with ICD-10. With sophisticated coding tools, thorough training, and skilled coders, the productivity impact has been real but not nearly to the extent some HIM managers were bracing for. We are starting to see coder productivity come to a manageable level that will probably be the norm for the foreseeable future.

I’m happy to report that I feel confident in ICD-10 as our designated code set and based on peer input, I think others will agree. The specificity was much needed after many years of vague or catch-all codes. This paves the way for better data reporting and thus more quality information resulting in better disease management. Accurate reimbursement is an obvious bonus as well.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

A Study on the Impact of ICD-10 on Coding and Revenue Cycle

Posted on January 27, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

Implementing ICD-10 coding has been, in some ways, like learning a new language. We took a specialized task that has been repeatedly performed for over 30 years and turned it on its head with new guidelines, new characters, and new specificity that we have never had before. Many healthcare leaders have been watching for (and possibly expecting) catastrophic effects of the changes to surface after the implementation of ICD-10 such as a reduction in reimbursement and an increase in denials. A recent study commissioned by Primeau Consulting Group surveyed respondents to see how healthcare organizations are doing with ICD-10 and how they are preventing denials.

It’s no surprise that ICD-10 has led to a decrease in coder productivity. In fact, the survey showed that 66% of those surveyed had experienced some negative changes in coder productivity. Some respondents claim somewhere between a 25% to 35% decrease in productivity. I know all HIM leaders want to know if this will be a permanent or temporary loss in productivity and that is yet to be determined. When equating this productivity loss to A/R days, this can have a huge impact on the number of accounts in an unbilled status waiting for coding. Unfortunately, 34% of respondents to the survey have already seen negative impacts on the revenue cycle since ICD-10 was introduced.

In preparation for ICD-10, it was difficult to predict if additional training and education would be needed after the ICD-10 go-live. Some feedback in the survey showed that respondents did not necessarily plan for additional formal ICD-10 training for coders in 2016 but will keep up with the standard continuing education that has always been part of a coder’s job. I think this is still yet to be determined pending the results of coding audits that will show areas for education and documentation improvement.

While ICD-10 has been relatively smooth thus far, HIM leaders are still proceeding with caution and bracing for any potential downsteam impacts that could result from the drastic changes we have undergone. The study revealed that the most commonly perceived risks with ICD-10 in 2016 center on physician documentation and specificity. Again, I believe auditing will be key in determining education for coders as well as physicians.

How has the ICD-10 experience been for you? Are you seeing similar issues or risks?

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

What is the CCA Credential?

Posted on January 13, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

There comes a point in an aspiring coder’s life when they are ready to earn a credential but might not have coding experience yet. This is when the Certified Coding Associate (CCA) credential comes in to play to provide the opportunity to prove the credential holder’s coding knowledge and competencies. The CCA credentialing exam is administered by the American Health Information Management Association (AHIMA) and is one of three specific coding credentials offered by AHIMA. The other coding credentials through AHIMA are the Certified Coding Specialist (CCS) and the Certified Coding Specialist- Physician based (CCS-P).

The CCA exam is offered to anyone with at least a high school diploma interested in coding. The content of the exam includes clinical classification systems, reimbursement methodologies, health records and data content, compliance, information technologies, and confidentiality and privacy (source: AHIMA). The largest portion of  questions on the exam covers the clinical classification systems which includes assigning codes and applying coding guidelines. Candidates prove they are able to apply coding methodologies for all levels of care including inpatient hospitals and physician offices.

The CCA credential is ideal for HIM and Coding students or new HIM professionals who are eager to earn a credential to add to their resume. While this credential proves competencies in the key coding domains, someone with this credential may not be qualified for a seasoned coder job posting which will typically require years of coding experience. However, the benefit of having this credential is that it shows the hiring manager that the applicant has had enough education and exposure to coding to be able to pass a thorough credentialing exam on the subject. Many students take this exam while completing coursework for HIM and Coding degrees to prepare themselves for the job market.

Medical coding is a career in high demand and has been recognized as a very important role in healthcare. Anyone interested in launching a career in coding will have to learn the ropes from the ground up. It is appropriate for CCA credentialed coders to look for entry level coding positions that will develop their coding skills and potentially lead to further specialization in the HIM field.

For more information on the CCA credential, see the AHIMA website.

Access additional resources for HIM credentials here: CCS, RHIA, RHIT.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Why Should Medical Coders Have the CCS Credential?

Posted on November 18, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

In continuation of my posts on the value of HIM credentials, one very important credential is the Certified Coding Specialist (CCS). This tried-and-true credential shows current and potential employers that you are skilled in all of the domains of medical coding. The CCS exam is designed for experienced inpatient and outpatient coders to show competency in all of the potential functions a coder will be required to perform on the job. Disclaimer: this credential is not ideal for new graduates who have no prior experience in medical coding at some level although they may meet eligibility.

For those not familiar, medical coding involves reviewing clinical documentation in a medical record, assigning the appropriate ICD or CPT codes using established coding guidelines, and grouping the codes to determine a Diagnosis Related Group (DRG) for reimbursement. Some coders may be required to analyze DRG usage and report on documentation trends as part of their job roles. The codes and DRGs that are selected by the medical coders are used for a variety of data uses including tracking the prevalence of diseases, monitoring procedure and treatment outcomes, public reporting of quality measures, and the most critical function is to determine a healthcare organization’s reimbursement rate based on the treatment provided.

Coders must be educated on medical terminology and clinical documentation in order to effectively and accurately assign codes and DRGs. The CCS exam tests each applicant on his or her ability to understand the coding guidelines and assign codes properly. Candidates taking the CCS exam should have a working knowledge of both ICD coding guidelines and CPT guidelines. There are also questions on regulatory guidelines and information technology to make sure CCS credentialed professionals are well versed in healthcare operations.

The American Health Information Management Association (AHIMA) administers the CCS exam to those with the following qualifications:

Candidates must meet one of the following eligibility requirements:

  • By Credential: RHIA®, RHIT®, or CCS-P® OR
  • By Education: Completion of a coding training program that includes anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic/procedural and CPT coding; OR
  • By Experience: Minimum of two (2) years of related coding experience directly applying codes; OR
  • By Credential with Experience: CCA® plus one (1) year of coding experience directly applying codes; OR
  • Other Coding credential from other certifying organization plus one (1) year coding experience directly applying codes.

Source: AHIMA.org/certification/CCS

It is important to note that a majority of CCS credential holders also have either the RHIA or RHIT credentials (according to the 2012 AHIMA job analysis). This is because the RHIA and RHIT credentials cover all of the many different HIM job tasks and domains while the CCS is a specialty credential for coding. HIM management positions may be looking for RHIA or RHIT credentials while coding specific positions frequently require the CCS.

With the recent change to ICD-10 in the US, medical coders have become a hot commodity. As a side note, the CCS exam is also offered to some additional countries internationally yet the test covers US coding practices. Many organizations are experiencing a decrease in coder productivity therefore additional coders may need to be hired or contracted. While it is a great time to be a coder, we must also take into account that the role of a coder has changed over the years and will continue to change with new technologies and tools. Continuing education credits are required for all CCS credential holders to keep coding competencies up as well as educate coders on other hot topics and changes in healthcare.

For more information on HIM Credentials visit: RHIT, RHIA, CCS

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Has ICD-10 Been a Smooth Transition for You?

Posted on October 7, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

So here we are after a long awaited transition to a new code set. Is anyone feeling the sting yet? I haven’t seen much change over the past few days which is to be expected since we are only beginning to code in ICD-10 and we are still cleaning up some remaining accounts in ICD-9. The accounts we have coded in ICD-10 are moving along the revenue cycle smoothly so far and we are watching every step of the way closely just in case we hit a snag. I speak from the hospital side of things so I’m curious to see how physician practices are doing with ICD-10.

During our training and preparation, we thought of possible scenarios that could cause issues such as DRG mismatches, system glitches, and payer rejections for split claims and we set up some extra workflows to catch these potential issues. We trained the coders, trained the physicians, and then trained everyone again. We communicated with referring providers to make sure referral orders and forms were updated prior to patients arriving for appointments after October 1. I must say, we have felt very prepared for the transition for a while now (shout out to our awesome coding and revenue cycle teams!) and it appears to be paying off so far.

The biggest concern I have is the potential slowdown in coder productivity. Not that I have any doubt in the capabilities of the coders, but ICD-10 is different. When you take a process that was already extremely time sensitive and change almost everything about it, this creates an understandable amount of concern. We want to ensure we are coding accurately so coders are double and triple checking their code selections until they feel comfortable. We don’t have codes memorized yet which was a nice benefit with ICD-9 for frequently used codes. We are sending queries for things like initial, subsequent, and sequela clarifications due to some misunderstanding of the rules for documenting what will become the seventh character of the ICD-10 code. We haven’t had to code any complicated procedures in ICD-10-PCS yet therefore I’m anticipating using extreme caution when we get to this scenario.

We are anticipating the potential downstream affects of coding accuracy mainly as it applies to reimbursement. If our DRGs shift from what we normally captured prior to October 1, this drastically affects our reimbursement, reporting structures, and financial planning. Once these accounts start making their way to the payers, we will hopefully get some helpful feedback on anything that needs to be adjusted. It will be a couple of weeks before we get to that point so until then, we will code and bill to the best of our abilities. The coding accuracy is also important for quality reporting which uses codes, severity of illness, and DRGs to identify trends in our patient population.

I hope everyone is also having as smooth of a transition. I asked the question on Twitter and Facebook and it appears that most are still proceeding smoothly with little fanfare. I share the sentiment of Mitch Harris on Twitter:

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Another Giant In Play: 3M Looking At “Strategic Alternatives” For HIS Unit

Posted on September 14, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Given the staggering number of EMR launches that took place in the wake of the Meaningful Use kickoff, mergers, sell-offs and business failures were quite predictable. Despite the feds’ doling out $30B in incentive dollars, even that wasn’t enough to keep hundreds of EMR entrants afloat.

It hasn’t been as clear what would happen to large vendors with HIT interests, given that they had enough capital to ride more than one wave of provider adoption. The field has just begun to shake out, with only a small handful of major transactions taking place. Recent plays by large tech players include Cerner’s $1.3B acquisition of Siemens Health Services, which included the Soarian EMR. There’s also ADP’s sale of EMR solution AdvancedMD to Marlin Equity Partners after previously acquiring e-MDs. Not to mention Greenway and Vitera Healthcare Solutions joining forces and Pri-Med acquiring Amazing Charts.

Another major move was announced this April at HIMSS 15, when GE Healthcare announced that it was phasing out its Centricity Enterprise product. According to news reports, the Enterprise product only generated 5% of the Healthcare division’s EMR revenue. I could keep going, but you get the point.

Now, 3M has joined the fray, announcing this week that it was “exploring strategic alternatives” for its HIS business, including spinning off or selling the unit.  (It’s also considering keeping its HIS business on board and investing in its future.)  The company, which has signed Goldman, Sachs & Co. as strategic advisor and investment banker, says that it will probably announce what direction it will head in by the end of the first quarter of next year.

On the surface, 3M Health Information Systems looks like a very solid business. The HIS unit, which is focused on computer-assisted coding, clinical documentation improvement, performance monitoring, quality outcomes reporting and terminology management, reportedly works with more than 5,000 hospitals, plus government and commercial payers. According to 3M, the HIS business generated trailing 12-month revenues of about $730M, and has sustained 10%+ compounded annual growth for 10 years.

That being said, it’s hard to say what the fallout from the ICD-10 switchover will be, and it’s not unreasonable for 3M to consider whether it wants to compete in the post-switchover world. After all, while the HIS unit seems to be quite healthy, it’s certainly faces stiff competition from several directions, including EMRs with integrated billing and coding technology. Also, the company may be saddled with outdated legacy infrastructure, which makes it hard to keep up in this new era of revenue cycle management.

By the end of the first quarter of 2016, 3M will have had a chance to see how its customers are faring post-ICD-10, and how its customers needs are shifting. 3M will also find out whether other HIS players with (presumably) newer technology in place are interested in doing a rollup with its business.

Truthfully, if 3M doesn’t think it can benefit from investing in the HIS unit, I’m not sure who else would benefit from doing so. In fact, I’d argue that 3M is undermining its chances at a deal by waffling over whether it plans to invest or divest; as I see it, this implies that the HIS unit will be on life support without a major cash infusion, which is not something I’d find attractive as an investor.  If nothing else I’d want to buy the unit at a firesale price! But I guess we’ll have to wait until March 2016 to see what happens.

Are All the Reports You Run Ready for ICD-10?

Posted on September 9, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

ICD-9 codes provide a wealth of statistical information for healthcare organizations. There are many details that are captured within each code that tell a story of the complexity of each patient’s diagnoses and treatment course. These codes also provide a basis for determining reimbursement for healthcare organizations therefore the importance of coding in an organization cannot be understated. ICD-10 promises to bring even more specificity and detail to patient diagnoses and procedures which will be very beneficial but we have work to do to ensure a smooth transition. Are your organization’s reports ready to accommodate ICD-10 data?

The upcoming change to ICD-10 codes is going to make a huge impact for the HIM workflow especially when it comes to reporting. At this point, we should already be well along the way with updating administrative systems to capture the new code set once we begin officially using it. The best way to get moving with this is to identify all of the current reports that contain ICD-9 data and determine the steps it will take to update these reports to shift to ICD-10 data. If this requires working with vendors, these conversations need to be taking place on a regular basis to make sure important updates are installed as needed. Since the structure of ICD-10 codes is different from ICD-9, we must use precise fields to capture enough characters and details in reports beginning Oct. 1, 2015.

In HIM, we rely on many different reports to monitor data that impacts the daily functions of the HIM department. A major source of our information comes from coding data including ICD codes and DRGs. One of the biggest uses of coded data in HIM is the discharged not final billed (DNFB or DNB) report. Most organizations use this type of report to capture accounts that need to be coded or accounts that are missing documentation. Since we have used ICD-9 data for the last few decades, these reports are hard-wired for ICD-9 and will need a major overhaul or may need to be started again from scratch. Have you accounted for the time and resources it will take to get your DNFB report back in working order come Oct. 1?

A large amount of coded data is used for quality reporting purposes therefore we must update all of the systems that generate and export these reports. Many reports are used to compare current data to previous months and years. We must ensure our publicly reported data is accurate and that our historical data is maintained for reference as long as it is needed. Also remember that claim denials and audits can go back several years and we will need to be able to reference our logic used at the time the accounts were coded. Once we are live with ICD-10, we will need to validate trended data and make sure the data that we rely on for future planning is accurate. So now the challenge comes with determining how much historic data to maintain in order to run these comparison reports and for how long. This will be a significant transition period for us to update systems and maintain these reports in both code sets as needed. If you haven’t started this project yet, now is the time to prepare.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.