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Clinical Documentation Initiative for ICD-10-CM: There Will Likely Be a Delay!
The American Medical Association continues to exert power to legislative and executive branches to squash the start date of ICD-10-CM. A recent letter was sent by AMA Executive Vice President and CEO, James Madura, MD seeking out the help of Congress and, more specifically, House Leader John Boehner, in this regard.
At this week’s AMA conference in Washington, DC, the Center for Medicare-Medicaid Services (CMS) acting Administrator Marilyn Tavenner indicated that CMS has agreed to “re-examine” the implementation date of October 1, 2013. Some critics believe that a postponement is inevitable based on provider concerns. AHIMA, however, addressed their membership to move forward with the implementation date and warned hospitals and health care providers not to suspend their ICD-10 planning efforts.
Physicians have been using the financial burden for holding ICD-10-CM and PCS in check. The major disagreement is the expense of their office implementation of the ICD-10-CM diagnostic system into their daily operations while also implementing electronic transaction 5010, quality initiatives, e-Prescribing, and EMR simultaneously. Implementation costs for a typical 10-doctor practice are estimated at $285,000 to convert to ICD-10-CM according to a recent study. The software cost associated with the transition would be approximately $25,000. Additional costs would come from claims queries, training, reductions in cash flow and, most importantly, documentation time.
Although there is significant financial overlay for this new system, the bigger issue, in my opinion, is the additional time physicians must absorb in clinical documentation initiatives not yet seen under ICD-9-CM and demonstrated by increasing the actual diagnostic and procedural codes and their descriptions from 13,000 codes to 68,000 codes. These additional codes will require more physician specificity as the system is designed to capture more granular data to be shared with world health organizations while meeting MS-DRG reimbursement demands for hospital inpatients.
As early as 2008, the AMA, their collective subspecialties, and the state Medical Societies all signed a letter to the Secretary of HHS asking for a 60 month hiatus (5 years) from 5010 electronic transaction implementation to the ICD-10-CM implementation. The letter was clear that the provider community could not financially meet the timelines of all government expectations within a very condensed period of time.
As expected, on Wednesday evening, 2/15/12, Secretary Kathleen Sebelius indicated that there would likely be a postponement of ICD-10. With all the dollars already invested by hospitals and other healthcare institutions anticipating an October 1, 2013 start, what impact will this delay have the future of healthcare data?
Only Time will tell.
AHIMA E-Alert, February 9, 2012, pg 1
AHIMA E-Alert, February 16, 2012, pg 1; ASC Review, January 27, 2012, pg 1
Recruiting Certified Coders - A remote coding program may be your answer
Recruiting highly experienced certified coders has been an ongoing challenge for hospitals located in sparsely populated rural settings. Since many credentialed coders aspire to eventually code from home, recruiting and retaining onsite professional coding talent will continue to challenge the HIM industry for a long time. The market shift toward remote, or home-based coding, has left rural hospitals in a recruitment bind.
Fortunately, there are effective solutions to combat this challenge. Clearly, the ultimate goal is to recruit and retain a group of credentialed, highly qualified coders. This can be accomplished by implementing remote coding technology. Whether your facility is paper-based, hybrid or has an electronic health record (EHR), there are practical in-house and outside solutions readily available. With recurring coder recruitment and retention difficulties, HIM administrators should be proactive in their search for coding talent and might consider implementing a remote coding program.
Unless a particular remote facility has already been successful in recruiting and retaining a group of credentialed coders who wish to remain in the hospital setting, HIM administrators may continue to spend valuable time, money and other valuable resources on recruiting credentialed coders who might eventually leave the hospital setting to work from home. This situation is especially problematic for hospitals located in sparsely populated rural settings due to obvious geographic restrictions.
A simple cost-benefit analysis might guide an administrator in making his or her initial decision to implement a remote coding program, as it may be more cost prohibitive to recruit new coding talent on a continuous basis compared to the requisite initial investment to launch a remote coding program. Remote coding technology provides its users with the luxury of year round, continuous access to highly experienced and credentialed coders. Simply put, remote coding is the most effective and efficient means of reaching the most talented coders.
Remote coding can be successfully implemented and managed by even the smallest of facilities. Prior to implementing a remote coding program, it is imperative that HIM administrators fully discuss remote coding solutions with various departments. For example, the IT department will need to be heavily involved in implementing and managing the technology (software and scanning) that will be utilized to securely transfer the medical records. Along these lines, facilities that still utilize a paper chart will need to devise a scanning program. Whether the decision is made to implement an in-house remote coding program or to outsource this function, the individual(s) or company must be very familiar with HIPAA (and state-specific) privacy and security regulations, as well as all aspects of IT that tie into an efficient remote coding operation. Now more than ever, with the recent HITECH Act and renewed focus on privacy and security of protected health information (PHI), facilities must be cognizant of how their PHI is being handled. If utilizing an outside vendor, be sure to inquire about the privacy and security controls that are in place.
While remote coding may be a viable alternative to traditional onsite coding, as with any other solution, the advantages and disadvantages should be thoroughly assessed on a department-wide basis. The continued quest for in-house credentialed coding staff should not be abandoned and HIM administrators should always strive to recruit a team of superb coding talent. If, however, coder recruitment and retention have plagued your department for quite some time, considering a remote coding program will at the very least provide an alternate and effective means of enlisting national coding talent.
ICD-10-CM/PCS: Are Hospitals and Physician Offices on Schedule for the 10/1/2013 Implementation Date?
Since our last ICD-10-CM blog, I have successfully completed the two required AHIMA courses, attended an on-site Nashville, TN grueling three day session, and successfully wrote the final exam. I am now the proud recipient of the AHIMA Approved Instructor for ICD-10 CM/PCS and an AHIMA Coding Ambassador. This four month experience was an eye-opener to me professionally as an HIM administrator but also as a member of the health care team. Prior to initiating these studies, I had little familiarity as to how two code-based diagnostic and procedural systems would have the degree of monumental impact on the US health care industry as a whole.
From my background in Clinical Documentation Improvement Systems, I questioned which major health care leaders were engaged in the advancement of these coding systems. My research suggests that the principals were the Center for Medicare Services (CMS), National Center for Vital Statistics (NCVS) , American Hospital Association (AHA), and the American Health Information Management Association (AHIMA), all of whom have fully engaged this huge overhaul, a refit of an old and tiring code-based system which has been used for over thirty years.
Surprisingly the preliminary years, beginning in the early nineties, were spent in the design, testing, and restructuring of two new and completely unique code sets that could optimally meet the challenges of US health care practices. I suspect that these years did not go without many sleepless nights for the principals. Some say that a saving grace is that the diagnostic system, ICD-10-CM, did not require a complete overhaul since many of the coding guidelines and rules were compatible with the old ICD-9-CM diagnostic system.
As with the development of any new documentation system and more specifically where medical terminology, medical nomenclature and classification systems will affect the documentation of the medical practitioner, one key player, the American Medical Association (AMA) has rarely been mentioned. Through the evolution of DRG's in 1980-83, we recognize that not bringing the physicians into the new case mix system was a huge mistake and caused many hospital organizations to fail. We need to take heed from our past experiences if we have any chance for these coding systems to be successful from the onset. As we all know, these systems are predicated on capturing physician documentation and converting these diagnostic and procedural terms to ICD-10 alpha-numeric language.
To add insult to injury so near the implementation phase, the American Medical Association delegates, at their Annual Meeting in November, 2011, voted against the start date of October 1, 2013 for ICD-10-CM/PCS. Although they admit that their disagreement is not in the actual ICD-10-C/PCS code structures, they object to the timing, physician financial constraint and staff preparation. They questioned the efficacy of implementing systems that would require much more physician time in clarifying documentation while adding more financial woes for implementing required manual and computerized system changes into their practices.
The American Health Information Management Association has responded in full disagreement to the American Medical Association's position. They contend that the current ICD-9-CM system cannot meet the demands of the emerging knowledge and technology in American health care and can only survive through broader, more flexible systems that can keep up with the health care changes.
Who will win and who will lose in this recent dispute over classification systems and time frames? Stay tuned. 2012 will be an exciting year!
ICD-10-CM Diagnosis Coding and ICD-10-PCS: An Introduction
This is the first of a series of educational articles to introduce two (2) new coding and classification systems that the American Health Information Management Association (AHIMA) anticipates their implementation on October 1, 2013. These two systems will have a major impact on how we, as diagnostic and procedural coders, will assign appropriate codes to inpatient and outpatient records. These systems will also have long term implications for medical decision making and medical documentation practices.
These systems will be similar to those currently in use by other countries, such as Canada, Sweden, Korea, Thailand, Australia, France and Germany under the auspices of the World Health Organization (WHO); yet our systems are unique to the United States because they will encompass both major morbidity and mortality diagnoses code sets and a specific inpatient procedure code set unique for our medical and surgical care delivery systems. Ultimately data obtained from these systems will be used nationally and internationally to report, compile, use, and compare healthcare information.
International Classification of Diseases-10th revision-Clinical Modification (ICD-10-CM) and International Classification/Procedure Coding System (ICD-10-PCS), have been in the works since 1985, yet their final code sets have yet to be published in electronic or printed media. Delays in implementing both systems have been experienced due to many issues such as electronic transactions (EDI) and HIPAA covered entities to name a few. Scheduled for implementation in January 2009, the systems have been pushed back by four years and are now on target for October 1, 2013.
Grouping of the new diagnostic classification system has changed drastically. Unlike ICD-9-CM where body systems designed chapter disease groupings, the new ICD-10-CM will now categorize their code sets according to the following: 1)communicable diseases; 2)general diseases affecting the entire body; 3)local diseases arranged by body site; 4)developmental diseases; 5)injuries; and 6)external causes of illness. Therefore, as we start this journey together we must recognize that another paradigm shift in our technical coding knowledge will evolve. Let us embrace these new systems and learn how our impact will assist in improving disease management and health care delivery for future generations.
In the next part of the series, we will be discussing the formatting of both the tabular and alphabetical index of the diagnostic and procedural classification systems.
Sepsis and Septic Shock: Increased Presence in General Surgery Patients
The two top physician concerns in general surgery patients post-operatively have been about pulmonary emboli (PE) and myocardial infarction (MI) with therapeutic measures for each of these potential conditions. Interestingly, a recent study by Laurie Barclay, MD, from Methodist Hospital Research Institute of Houston, Texas reported that sepsis and septic shock are more likely to occur post-operatively.
The study compared incidence, mortality, and risk factors for sepsis and septic shock with those for PE and MI in a patient population of 363,897 general surgery patients included from the 2005-2007 National Surgical Quality Improvement Program (NSQIP) data set. Sepsis occurred in 2.3% of patients, septic shock in 1.6% of patients while pulmonary embolism occurred 0.3%, and myocardial infarction in 0.2% . The greatest proportion of patients were 60 years of age or greater in the septic shock group (70.3%) compared with 40.2% of those with no sepsis and 51.7% of those with sepsis alone.
Comparatively speaking, patients entering the hospital for emergency surgery had a higher incidence of sepsis (4.5% versus 2.0% in the elective admit population). Risk of sepsis and septic shock were 6-fold higher in patients with other comorbid conditions and they had increased risks of mortality.
The study conclusions, based on record review of 363,897 patients, demonstrated that sepsis needed to be screened more acutely by general surgeons in order to prevent sepsis-associated morbidity and mortality in the their inpatient populations.
1. Sepsis in General Surgery
The 2005-2007 National Surgical Quality Improvement Program Perspective
Laura J. Moore, MD; Frederick A. Moore, MD; S. Rob Todd, MD; Stephen L. Jones, MD; Krista L. Turner, MD; Barbara L. Bass, MD
Arch Surg. 2010;145(7):695-700.
2. Archives of Surgery, Vol. 145, No. 7, July 2010
Sepsis in General Surgery: The 2005-2007 National Surgical Quality Improvement Program Perspective