6 Observations on Hospitals and ICD-10 Going Into 2013

Hospitals and health systems are officially less than two years away from the go-live date of ICD-10. By Oct. 1, 2014, all providers must have made the transition to ICD-10.

Amanda Brenegan, principal at Cumberland Consulting Group, shares six observations she's seen regarding hospitals and ICD-10 as the calendar is set to flip to 2013.

1. Most hospitals are in a readiness assessment phase.
In February 2011, the American Hospital Association surveyed its hospital members to see where the sector stood in its ICD-10 implementation. Roughly 41.8 percent of hospital respondents said they had completed an ICD-10 implementation plan, and Ms. Brenegan says more hospitals are landing in the stage of readiness assessment, right before implementation can begin. Usually, this means hospitals have taken measures to train physicians and staff, and they are taking the time to make their code sets more operational from ICD-9 to ICD-10.

2. Competing priorities make the ICD-10 implementation harder. Although HHS announced earlier this year that the ICD-10 implementation date would be delayed from Oct. 1, 2013, to Oct. 1, 2014 — giving hospitals an extra to year to prepare — the healthcare sector is still amidst a perfect storm of revenue cycle and technology projects.

Between meaningful use of electronic health records, telehealth implementation, enhanced security measures and others, hospitals are finding it difficult to juggle so many projects at once.  

"Everyone has major initiatives on their plate. From a resource perspective, the ICD-10 transition requires a lot of resources, and you need some degree of knowledge and expertise from most areas of the organization," Ms. Brenegan says. "Staff members are already at capacity and challenged with other priorities and projects while also trying to deal with ICD-10."

3. Hospitals must prepare for ICD-10's impact on orthopedics and cardiology codes. As hospitals prepare for their ICD-10 transitions, they must identify codes and procedures that have high and low risks. This does not necessarily mean revenue cycle teams should be focusing solely on high-volume, high-paying codes and procedures. Instead, hospitals must conduct internal research.

Ms. Brenegan says based on talking with ICD-10 vendors and other market leaders, the transition from ICD-9 to ICD-10 may have a lot of impact on orthopedics and cardiology codes, especially on the procedure side. "However, on the outpatient side, it's not going to be as significant," Ms. Brenegan adds.

4. Clinical documentation improvement programs are a must. Ms. Brenegan is helping a large health system with its transition to ICD-10. She says the biggest piece of advice she can give a hospital or health system is to implement a CDI program.

"If you do [have a CDI program], go through an assessment phase to see where documentation gaps are today," Ms. Brenegan says. "It will enhance strategies that will produce quality documentation in today's ICD-9 world that will support ICD-10 coding."

5. Hospitals should teach concepts, not memorization. Training is one of the biggest components of ICD-10 preparation, but hospital executives and managers must have a grasp of the pertinent training lessons.

Ms. Brenegan said there's a misconception that physicians and other providers will have to memorize tens of thousands of new codes. Hospitals must focus on the concepts behind the ICD-10 codes and train providers on how to work those concepts into their documentation and coding behaviors. For example, hospitals should train physicians how to document a hip replacement case more specifically in the notes rather than worrying about the memorization of all orthopedics codes for that case.

6. It may be too early to look at ICD-11. The World Health Organization is set to formalize the ICD-11 structure in 2015, less than a year after ICD-10 will be live in the United States. Many have wondered if the entire U.S. healthcare industry should skip ICD-10 in favor of ICD-11, and while that macro-level debate goes on, Ms. Brenegan says hospitals should focus on what they can control.

"From talking to vendors that are market leaders and folks that are ICD-10-certified, ICD-11 is going to come out, and ICD-10 will provide that foundation for transition," Ms. Brenegan. "Focus on getting comfortable with ICD-10. ICD-11 will come. ICD-11 appears to be a more natural progression from ICD-10, but don't put the cart before the horse."

More Articles on ICD-10:

Put Your ICD-10 Transition in Fast-Forward
5 Things Hospitals Should Know About Their Chargemaster and ICD-10
Tackling ICD-10: Why Physicians Play the Largest Role in Adoption

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