Don't Neglect ICD-9: Why Hospitals Should Look at Current Processes First

Many healthcare associations and experts have urged providers to begin preparing for ICD-10 now even though the deadline is two years away. While starting ICD-10 training now will help hospitals meet the Oct. 1, 2013 deadline, healthcare leaders may need to examine current processes before focusing on the new code set. Steve Nitenson, RN, BSN, MS, MBA, PhD, adjunct professor at Golden Gate University, San Francisco, and a health IT expert, says hospitals should perfect their processes for ICD-9 coding to ensure a smooth transition to ICD-10. "[ICD-10 preparation] is not about just planning for ICD-10. It's how are you doing with ICD-9 today," he says. He also suggests using ICD-10 training as an opportunity to update other hospital processes that may be inefficient.

Start with ICD-9

Dr. Nitenson differentiates between the "current state," which is ICD-9, and the "future state," or ICD-10. He says hospital employees and physicians must understand the current state in order to be successful in the future state. As U.S. healthcare organizations have been using ICD-9 for more than 30 years, many people have become complacent and imprecise in their coding, according to Dr. Nitenson. For example, he says many employees have the most common codes memorized but may not know how to look up the correct code for a less common diagnosis. If this behavior occurs with ICD-10, the hospital can potentially lose a lot of money from claim denials and or the need for appeals, particularly because the new code set will be more granular. "If you're not documenting well today, you're going to be documenting even worse tomorrow. We need to start practicing now, in the current state." Becoming more efficient in the area of medical documentation as it relates to ICD-9 coding will help the health information management department in hospitals prepare for the much larger and more detailed ICD-10 code set (both clinical modification and procedure coding system).


Business reengineering
In addition to assessing and improving current processes for ICD-9, Dr. Nitenson suggests hospitals use ICD-10 training as a way to begin a business process reengineering project. The transition to ICD-10 presents an opportune time to improve other processes in the organization because leaders can capitalize on employees' and physicians' mindset during this time of change. "Change is resisted as a normal process; resistance to change is always there," Dr. Nitenson says. By combining voluntary changes to the hospital with the mandated change to ICD-10, leaders can face resistance from stakeholders only once instead of twice, which would occur if the changes were implemented separately. "This is an excellent opportunity to change what people do in their environments to make sure what they do is actually what should be done," he says.

Dr. Nitenson says hospitals can use ICD-10 training to improve workflow by looking not only at a process itself, but also the reason for the process. "Training is not just about the code, it's how you work and understanding that so you can modify what you did last time," he says. From this perspective, the ICD-10 transition is really about optimizing hospitals' efficiency. "At the end of the day, ICD-9 to ICD-10 is not an IT project, it is a business project, and training needs to be done from the business perspective," Dr. Nitenson says.

Leaders in operations, not health IT, should thus be the drivers of ICD-10 implementation, according to Dr. Nitenson. He says the CMO, CFO and CNO would be appropriate leaders for the ICD-10 strategy for training because compared to an IT department, they may have a broader view of the impact of the transition, including operational and clinical implications. "The IT organization needs to be a follower in this. They need to be told what to do and how to do it. If the CIO leads this effort, you could marginalize or lose the clinical perspective."

Related Articles on ICD-10:

How ICD-10 Will Impact Cardiac Rhythm Management Procedures
Will ICD-10 Kill the Superbill?

Cut Your Losses: Maintaining Productivity in ICD-10

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