By David B. Chauvin, DO, FACEP
With passage of the Medicare Access and CHIP Reauthorization Act of 2015 it is official that ICD-10 CM will become a reality October 1st 2015. This is a huge deal for your billing company, hospital, payer contracts and you.
ICD-10 CM is an updated and expanded diagnosis coding system that will replace ICD-9.
At the very least, every clinician working in the ED will need to know how to document in an ICD-10 CM friendly manner. ICD-10 CM requires more specificity and details than ICD-9. Trauma and injuries make up a significant percentage of the new ICD-10 CM codes with laterality (left right upper and lower) now essential elements of the chart.
ICD-10 CM is ultimately tied to hospital and professional reimbursement; hence you also may be at risk for increased denials, charts deemed incomplete and an unhappy hospital CEO.
Here is a list of things you need to do now:
Identify your current systems and work processes that use ICD-9.
Diagnosis ICD coding is not just used for the final diagnoses, but is also used to justify ED testing such as CT scans, EKGs and lab tests. How does your current documentation system assign codes to diagnostics that you ordered? Although ED docs rarely order outpatient testing, be sure that your order form includes ICD-10 codes.
ED Professional Billing
Who is doing your professional billing? How are they going to implement ICD-10 CM? How are they conducting their internal and external validation testing?
Get to know your coder
Coder feedback will be critical. Try to develop a professional rapport with your coding staff such that they feel uninhibited to ask clarifying questions. Now might be a good time to buy the coding staff a large box of cookies.
ED Nurse documentation
Can you make your nurse triage note and nursing documentation more ICD-10 friendly? Consider prompts for external cause of injury, geographic location of injury and mechanism of injury. Documentation of laterality, left right and upper and lower now needs to be clearly documented.
Yes, once again physician productivity may go down. Perhaps your group is on the tipping point for the employment of scribes or extenders. ICD-10 may make such a decision more clear cut.
Randomly select 10-20 charts and ask your coders to code the charts via ICD-10 CM. This should provide a baseline to allow for individual provider education.
To help Emergency Physicians prepare for this change to ICD10, ACEP will be providing ICD-10 documentation tips and insights for the busy ED physician. You can find these resources in several locations, including:
ACEP’s monthly magazine, The Official Voice of Emergency Medicine, is planning articles in the months leading up to October 2015. Written by physicians, for physicians, news about ICD-10 will be specific to EM practice.
ACEP’s home page will include the latest updates, and an ongoing list of resources will be added to the Reimbursement section of the site. Currently, you can find clinical examples, an information paper and an ICD-10-CM manual.
EM Today Newsletter
ACEP partners with Bulletin Health Care to bring the latest health care news each morning from Monday through Friday. Included within EM Today is news and events specific to ACEP. Updates and links to the latest articles on ICD-10 will be included in this newsletter.
Each Saturday, a roundup of the week is delivered with ACEP partner, Multi-View. Also sprinkled throughout the newsletter are briefs specific to ACEP and emergency medicine. ICD-10 news will be included here.
ACEP has an active following on social media. Here are the outlets for information about ICD-10 to be disseminated through ACEP’s membership.