ICD-10 Transformation: I’m On It!

ICD-10 Transformation: I’m On It!

So now that you understand the need to involve yourself in your practice’s transition to ICD-10, let’s talk about some action items. After all, doing something makes us all feel a little more in control. You don’t need to be the person who does all the work, you just need to take the lead and delegate responsibilities. Hopefully you are reading this because you are the practice’s ICD-10 provider champion!
If transition to an EHR has taught you anything, it should be the following:
  • thoughtful workflow is key
  • having buy-in from the entire office is imperative
  • this is a team effort–no one person can do it all
If these things still haven’t happened in your office, I bet you spend some part of every day feeling frustrated with the implementation of technology.  But that’s a blog for a different day.

 

Let’s begin with workflow. Start by taking one patient visit and walk it through your office, being sure to pay attention to all of the places that a diagnosis code might be used. Create a workflow diagram, being careful to note what forms are used where an ICD is applied, and who in your offices uses those forms. The diagram attached here is just the beginning of a sample…this is by no means meant to be complete. You must walk through your office and examine how diagnosis coding is handled, based on staff responsibilities.
 

Next take your workflow diagram and make a list that includes what forms are affected in the EHR, who usually documents that information, and who can edit the information if it is a system default. Some examples:

  • Appointment reason: users include schedulers, nurses, providers, anyone who makes an appointment in your office (who has the authority to edit templates in your office and would be responsible for changing the default ICD-9s to appropriate ICD-10s?)
  • Patient survey:  users include patients, staff, providers (who edits surveys in your office?)
  • Apply a template in an encounter: users might include providers, nursing/MAs (who edits templates in your office?)
  • Add a diagnosis to a note: all providers (usually no template defaults here)
  • Add a diagnosis to a lab/order: MA/nursing staff, providers (are some orders defaulted with a diagnosis? Who has the ability to edit those defaults?)
  • Administer a vaccine and auto-populate diagnosis: MA/nursing staff (who edits default vaccine information in your office?)
  • Add a diagnosis to an Rx: all providers, as well as nursing staff in offices that use proxy meds

 

We haven’t even begun to discuss the actual superbill once it is created: turning the superbill into the claim, preparing the claim for the clearinghouse, sending the claim out the door, checking to see if the claim was received, processing payments, and turning around to a secondary payer if needed. You will need your billing staff for this work, which is why I recommend having a practice administrator champion in place who understands the back end of the process.

 

Get team buy in. Once you have your workflow written down, schedule an office meeting to discuss the implications and how it will affect everyone. Yes, WRITE IT DOWN!  You can’t share information easily and provide opportunity for others to ask questions if this great plan is all in your head.  Give folks time to ask questions. Use external resources to educate staff about ICD-10. They may think of things you forgot or didn’t realize had an impact on coding. You may have missed critical pieces of your workflow diagram. Ask them to take a few days to note everything they do that has a diagnosis code attached to it. Review and integrate these changes.

 

Create an ICD-10 transition team. Ask for volunteers.  Every key role in your office should be represented. Set aside time for the team to dedicate the attention they need to do this well. Block out time in your schedule now to meet at least once a month to check your progress and brainstorm new ideas. Set some benchmarks and milestones and work to meet them. Evaluate what is working, what isn’t, and readjust. Be realistic about timing. Don’t decide to do this over the summer when your team is never in the office at the  same time. Don’t wait until September. Put some cushion in your work plan to allow for the unforeseen obstacles. Don’t do this yourself. If your practice doesn’t function well as an integrated team, use this as your first Quality Improvement/Change Management project. Plan-Do-Study-Act.


Feeling better already? You should be. Together we have this covered!