6 Tips for Taking a Holistic Approach to ICD-10


While some view ICD-10 implementation as a stand-alone project, affecting only financial departments and billing workflows, the effort actually touches all areas of a healthcare organization. In fact, an ICD-10 transition poses a large potential for error due to its many moving parts, and the negative ramifications of a poorly executed transition may be felt throughout an organization.

To navigate the path to ICD-10 and anticipate potential risks, organizations must take a holistic approach to implementation, carefully examining, refining and integrating clinical, financial and administrative workflows.

Due to the size and scope of ICD-10, many organizations struggle with where to start and how to plan for success. Consider these six tips for launching your ICD-10 effort and ensuring it meets the needs of your entire organization.

1. Get started…now. Although experts have been telling healthcare organizations for years to begin work on ICD-10, the industry is still moving slowly. One reason is that many organizations are choosing to focus on other large-scale initiatives, such as CMS' meaningful use of electronic health records program. The financial incentives associated with MU make it a more attractive choice for organizations with limited resources and bandwidth. However, if an organization waits until it finishes MU attestation before starting ICD-10, it won't have enough time to adequately prepare for the new code set. If you haven't already, you must commit to starting the transition. It's not too late, but the window is rapidly closing.

2. Review all your systems. An ICD-10 transition affects not only an organization's data systems, but also its downstream and feeder systems, inventories and applications. The impact of ICD-10 on these systems will range from something as simple as a new field size on an electronic template to something more difficult, such as ad hoc reports and dictionary codes. For example, as diagnosis codes change from four or five digits to seven or eight digits, there will need to be an adequate field size for this data in every system in which it has traditionally been reported. It's important that each system is able to capture and pass the information while recognizing its value.

To ensure nothing falls through the cracks, an organization must review all its systems where ICD-9 has been used. This will provide a clear picture of the size and scope of the implementation and the cascading effects of the new code set.

3. Designate a project leader. An ICD-10 assessment is a massive undertaking that requires work stream leaders to review the potential ramifications of the code set on their respective work areas. In addition, a successful migration will require a designated project leader to keep all the moving parts focused on the same goal. This leader must be able to facilitate communication across work streams while identifying where they might be crossing, addressing conflicting goals within the overall project.

4. Move beyond — and before — billing workflows. While billing is a large part of ICD-10, a holistic transition requires organizations to also take a step back and look upstream, examining where information for billing is captured. The best point to begin is where providers document clinical data in the EHR system. Organizations should aim to pinpoint and evaluate every place within the documentation and subsequent processes where diagnosis is a critical element, keeping an eye on the impact of ICD-10 in those areas.  

5. Develop customized training. Adequate training is a chief predictor of a strong implementation. To design an effective training program, organizations must first evaluate staff's current behaviors in relation to ICD-9 and determine the types of training that will be needed to ready staff for ICD-10. Training needs will vary by audience, such as physicians, non-physician clinicians and coders, and it is important to identify and respond to each group's specific education needs. As you think about training requirements, don't forget to consider your organization's capabilities for delivering the necessary training. This will help you determine whether additional resources — and funding for those resources — will be needed, such as consultants, off-site training programs and so on.

6. Establish key performance indicators. Rumors abound about ICD-10's impact on reimbursement. Yet, an individual healthcare organization won't fully understand the impact unless it measures it. Establishing a baseline of measures before implementation is critical to fully gauge progress once the code set goes live. Organizations may want to measure reimbursement levels by payer, procedure or patient type. These indicators can reveal potential failure points and areas of success as the organization moves through the process.

ICD-10 implementation is like a collage or mosaic. There are many different elements that both compete with and contribute to the effectiveness of the entire work. If some of these items are left unfinished or omitted, it can result in a lack of cohesiveness. Just as when designing a collage or mosaic, organizations must view ICD-10 at a higher level while keeping in mind the details.

Jim Akimchuk is vice president of revenue cycle services at Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation and information technology.

More Articles on ICD-10:

5 Signs Your Clinical Documentation Program is Not Ready for ICD-10
ICD-10: Healthcare's Information Age

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