Avoid Medical Practice Productivity Loss Due to ICD-10

Some see ICD-10 implementation as an obstacle, but it’s really a chance to improve your healthcare business skills and knowledge. Certainly there will be a learning curve with ICD-10. Codes are very different, guidelines have changed in some spots, and physician documentation needs to be more precise. You will undoubtedly need to learn the new guidelines and coding processes quickly. However, these are manageable tasks, provided you start preparing now. Failure to prepare early enough will result in lost productivity.

There are many ways the ICD-10 implementation will affect productivity. The largest and most obvious area is provider documentation. Whenever documentation lacks certain specific elements, which are required for accurate and precise code selection, a query for additional information will need to go to the provider. If the physician is not immediately available, the service can’t be billed until clarifying information is received.

Another potential productivity challenge with documentation involves charge tickets, or “superbills.” These forms may become obsolete in ICD-10 because there will be more code choices in some fields. If the provider does not understand what is required to differentiate between the new codes, documentation will likely be insufficient.

Medical coders and physicians should begin training now to reduce potential productivity loss. Procrastinating will only result in extensive educational needs right before or immediately following the ICD-10 transition. At the very least, this would result in time away from work during the most stressful part of implementation.

Coders should devote roughly 20 hours to 40 hours of training to ICD-10 education prior to the transition. Physicians should plan on about eight hours to 16 hours of ICD-10 training.

In all likelihood, productivity will not return to normal after implementation. There will be an inevitable delay as assessments are made of how the payers are interpreting the new coding system. Each payment and remittance advice will need to be scrutinized to make sure claims have been correctly processed and, whenever extra information is needed, it should be sent in a timely fashion. Recurring deficiencies must be identified and rectified as soon as possible.

Current diagnosis codes are mostly numeric (V and E codes are the exception), but ICD-10 codes are alphanumeric. Entering new codes will single-handedly slow productivity because a number keypad will not be exclusively used to do so anymore. In addition, distinguishing between letters and numbers will take extra time when a diagnosis code is written (as opposed to a narrative description). Depending on penmanship, which is not stereotypically a common strength for most physicians, the number “2” may be mistaken for the letter “Z,” or the number “0” for the letter “O.”

It is crucial to start raising provider awareness regarding how documentation will be specifically affected by ICD-10, and to encourage providers to quickly become familiar with the specificity of their specialties. Doing so will allow enough time for providers to understand the requirements, so ICD-10 will not feel like a massive change all at once.

Assuming the practice has anticipated, learned, and prepared for the changes and potential setbacks, productivity should return to normal within about four to six months after ICD-10 implementation. In such circumstances, the practice’s bottom line will be only minimally affected.

For any office that waits until the last minute to prepare for the transition, or simply relies too much on outside sources (i.e., EHR vendor, billing company, etc.), the staff will be constantly striving to catch up. Seeing an increase in claim denials, such practices may not be able to remediate the situation because the staff doesn’t understand the guidelines. Awareness and timing are critical to minimizing the negative impact on a practice’s productivity.

Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, AAPC vice president of ICD-10 education and training, has more than 20 years of experience in healthcare, working in the reimbursement, billing, and coding sectors, in addition to being an instructor. She is responsible for all ICD-10 training and curriculum at AAPC. She has authored many articles for healthcare publications and has spoken at conferences across the country. She is co-chair for the WEDI ICD-10 Implementation workgroup and has provided ongoing testimony for ICD-10 and standardization of data for NCVHS. She also sits on the Provider Outreach and Education committee for Novitas Solutions (formerly Highmark Medicare Services).