By: Tammie Lunceford, CPC BSHA with Warren Averett CPAs and ADVISORS
It is now less than 40 days until the implementation of ICD 10 on Oct. 1, 2015. Most medical entities have completed training but not assessed provider documentation for improvement goals. Many providers and billing offices are completely relying on their electronic medical record to code diagnoses for them.
While conducting training sessions, I have encouraged practices to assure they are able to view ICD 10 coding in their current EMR workflow. They should walk through the ICD 10 options on at least one or two patients a day and let the billing office review the electronic superbill. If there is not consistent use of the EMR, the physicians may not be fluent in using the diagnosis coding option in the EMR. Many physicians utilize voice recognition or continue to dictate to avoid clicking through the EMR. These physicians likely rely on a paper superbill or handwritten descriptions to list diagnoses.
Allowing a “Burger King Have it Your Way” workflow for physicians can create multiple problems for ICD 10 implementation. The billing office will deal with different workflows related to charge capture for each physician, if it is a group practice. One practice removed all the ICD 9 codes to force the physician to write in diagnoses, but the physicians were not specific enough in the description to code a valid diagnosis, which then caused the staff to refer to the documentation. The physicians are not going to write multiple diagnoses needed for risk adjustment.
Practices without an EMR are dealing with more workflow issues. There are resources to code through an electronic app or crosswalk but those who elected to not implement an EMR are not likely to look for technology to assist them.
What Should You Do?
• Reach out to a consultant for assistance
• Look for options to create an electronic superbill – EMR or other source
• Assess the number of provider workflows- discuss with your physician champion
• Review provider documentation and benchmark for improvement goals
• Review clinical best practices with your EMR vendor
• Prepare or obtain a top 50 diagnosis crosswalk as a quick reference for workstations
While CMS has offered some leniency, other carriers have not. It will cost commercial carriers if the risk adjustment is not accurate. The risk adjustment relies on ICD 10 for accuracy and specificity, which is why ICD 10 was not delayed. There are tools and resources to assist in your success, don’t wait, and get prepared now.
While conducting training sessions, I have encouraged practices to assure they are able to view ICD 10 coding in their current EMR workflow. They should walk through the ICD 10 options on at least one or two patients a day and let the billing office review the electronic superbill. If there is not consistent use of the EMR, the physicians may not be fluent in using the diagnosis coding option in the EMR. Many physicians utilize voice recognition or continue to dictate to avoid clicking through the EMR. These physicians likely rely on a paper superbill or handwritten descriptions to list diagnoses.
Allowing a “Burger King Have it Your Way” workflow for physicians can create multiple problems for ICD 10 implementation. The billing office will deal with different workflows related to charge capture for each physician, if it is a group practice. One practice removed all the ICD 9 codes to force the physician to write in diagnoses, but the physicians were not specific enough in the description to code a valid diagnosis, which then caused the staff to refer to the documentation. The physicians are not going to write multiple diagnoses needed for risk adjustment.
Practices without an EMR are dealing with more workflow issues. There are resources to code through an electronic app or crosswalk but those who elected to not implement an EMR are not likely to look for technology to assist them.
What Should You Do?
• Reach out to a consultant for assistance
• Look for options to create an electronic superbill – EMR or other source
• Assess the number of provider workflows- discuss with your physician champion
• Review provider documentation and benchmark for improvement goals
• Review clinical best practices with your EMR vendor
• Prepare or obtain a top 50 diagnosis crosswalk as a quick reference for workstations
While CMS has offered some leniency, other carriers have not. It will cost commercial carriers if the risk adjustment is not accurate. The risk adjustment relies on ICD 10 for accuracy and specificity, which is why ICD 10 was not delayed. There are tools and resources to assist in your success, don’t wait, and get prepared now.
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