ICD-10 delayed – not canceled!

From CMS: “On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.”

The delay of ICD-10 gives everyone the time needed to apply the principles to clinical documentation improvement. The documentation principles of ICD-10 reflect positive principles that should be applied to ICD-9 today. These principles ensure the appropriate documentation of quality, severity and risk. These are the key elements to incentive initiatives currently being offered by government and third party payers when reported with diagnosis that supports quality, severity and risk. Improved documentation of diagnosis not only supports incentive dollars, but also improved clinical documentation and reporting supports the higher levels of CPT procedure and evaluation and management (E/M) coding that we are currently using.

Gap analysis reveals that we are currently using unspecified coding 38-64% of the time depending on the specialty. Statistics like these help to understand why payers are saying they do not foresee increasing fee schedules because our diagnosis coding reflects that we are not treating very sick people. For example, "diabetes 250.00" does not even tell the payer if the diabetic is controlled or not and yet we want to report that diagnosis with a level 4 or level 5 evaluation and management service CPT. Can you see the relationship between current diagnosis reporting and procedure level?

Training on the use of the tools provided in your system upgrades such as diagnostic calculators, intelligent medical objects (IMO), the new revised CMS 1500 claim form, etc., has already begun and many of your system changes are slated to happen within the next few months. ICDExpert is committed to continuing the education of the documentation concepts that are applicable to improving the quality of documentation in ICD-9 today and ICD-10 of the future.

Recommendation

Complete the activation of your system upgrades early in 2014. Continue to train on the use of the system tools and begin to utilize them in the clinical workflow as planned. Report what you believe to be internal mapping errors as now we have time to fix them prior to the go-live date of October 1, 2015. Align what is being reported with what is documented. Stretch the learning timelines, but focus on documentation and diagnosis improvement around key opportunities that most directly benefit you, the provider.

Pat Schmitter CPC CPC-I
Sr. Healthcare Consultant
Approved AHIMA ICD-10-CM Trainer / Approved AAPC ICD-10-CM Trainer
VEI Consulting Services/Community Health Network
6626 E. 75th Street Ste 500,  Indianapolis, IN 46250-2890
www.veicorp.com/consulting     E-mail: pschmitter@eCommunity.com
Office: (317) 621-7187     Fax: (317) 355-8738    Cell: (317) 956 2152

Call 877-413-ICD-10 to set up an assessment for your practice/provider(s).