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:

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