By: Jacqueline Stack, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC,
AAPC Director, ICD-10 Training & Education
The effects of ICD-10 will be felt throughout the entire office. Think of how
your facility runs today. Let's take a look at some of the different areas of
the office and how they will change.
Front Desk: When a patient comes into the office, the front desk staff members
are usually the first people encountered. These employees will need to explain
to the patients, when they make appointments on the phone or show up for visits,
that the status of participation in certain plans may change. HIPAA policies
will need to be revised. The front staff will need to explain the new policies
to the patient and have the patient sign the new forms. Systems will also need
to be updated, which may impact patient encounters. The front desk staff will
need to receive training on any changes that are made to your current systems.
Nurses: The nursing staff may need to learn new pre-authorization formats
and procedure. More Advanced Beneficiary Notices (ABNs) may need to be signed
by the patients under the more specific code set. Every order must be revised
or recreated. Documentation must include increased specificity. The nurses may
be called upon to assist the providers with questions on ICD-10, and they may
need to revise how they perform intake operation for patients. Nurses may also
be affected by systems updates, which would require specific training on these
changes. Nurses would also need training on the ICD-10 code set and the areas
where more specific documentation will be required.
Providers: The need for increased specificity within the physician documentation
will dramatically increase after ICD-10 implementation. ICD-10 codes will require
documentation of laterality, stages of healing, weeks in pregnancy, episodes
of care, and much more. Providers will need to understand all changes to their
specialty resulting from the new code set. They will likely need to adjust their
documentation to meet the new requirements. Since the code set increases from
17,000 codes in ICD-9 to 140,000 codes in ICD-10, provider training may be needed
for on the general code set. They will also likely need training on systems
changes, especially if changes are made to their electronic health records (EHR)
systems.
Clinical: In the clinical area, patient coverage may be affected by elements
such as health plan policies, payment limitations, and new ABN forms. Clinical
staff must be aware of these changes. Revisions will be required on any superbills
in use. Paper superbills may not be a viable option in ICD-10-a one-page family
practice superbill was recently updated to ICD-10, and it became a 10-page superbill.
Health plans will revise all policies linked to local coverage determination
(LCDs) and national coverage determinations (NCDs). ABN forms will need to be
reformatted and the patient will need to be educated on these changes.
Lab: The lab is another area where increased specificity must be used. Health
plans will have new requirements for the ordering and reporting of services.
Coding/Billing: The coding staff will need to evaluate a larger code set to
assign a code, or assess the code assigned by the provider. The codes will increase
from 17,000 possibilities to 140,000 options. As a result, code books and styles
will completely change. The coders may be relied on to educate others about
the new code set-which means they will need extensive training. Medical coders
will also need a more detailed knowledge of anatomy and medical terminology,
given the increased specificity and additional codes. Coders will need to use
ICD-9-CM and ICD-10-CM concurrently for a while, until claims are resolved.
Billers will need to understand the new payer policies that will be revised
and take effect under ICD-10. The billing department must be trained on new
policies and procedures, as well as the ICD-10-CM code set itself. The appeals
processes will likely change. Coders and billers will also be affected by system
upgrades and will require training on the changes.
Managers: The managers will see many changes as well. Any policy or procedure
associated with a diagnosis code, disease management, tracking, or PQRS must
be revised. All vendor and payer contracts must be evaluated and updated. Budgets
will need to be created. Changes to software, training, new contracts, and new
paperwork will have to be paid. Managers will also need to create a training
plan for other staff members, since everyone in the practice will need some
formal training in the area(s) that most directly pertain to them. Considerations
of the best medium of training (in person, online, on-site, etc.) are equally
as important as which departments and individuals need to be trained.
Take the time now to determine how these extensive changes will affect your
facility and how prepared you are for them. Doing so will help you figure out
how to adapt to the new code set in a timely and calculated fashion, causing
as little interruption to the revenue cycle as possible.
Jacqueline Stack, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC,
AAPC Director, ICD-10 Training & Education, is a highly accomplished healthcare
professional with more than 25 years of experience in healthcare administration,
education, and compliance. She holds several AAPC specialty certifications and
has a bachelor's degree in Health Administration. She worked previously at a
large multi-physician family care and occupational health practice with two
locations in northwestern PA. She enjoys sharing her knowledge and experience
as a certified PMCC instructor. She has authored many articles for healthcare
publications and has been a featured speaker at workshops and coding conferences
across the country. She is actively involved with AAPC and has served on the
NAB, various steering committees, and held the offices of president, secretary
treasurer, and president-elect in her local chapter.