It has been suggested by some that the ICD-10 coding changeover will cause chaos because of the significant changes in the number of codes added to create specificity to a degree no one could have imagined. The number of diagnoses codes will increase from 14,567 to 69,833 and inpatient procedure codes will increase from 4,000 to 71,918. HSMN has developed a Program that makes that transition meaningful and effective. We call it the “HSMN 9-10 Bridge”. In HSMN’s 27 years of working with Medical Staff, we have learned what is effective in helping them. Diagnostic Coding for the Professional fee and Procedure Coding are going to be difficult transitions, but HSMN has guided Medical Staff in every setting through every iteration of Coding since 1985.

Some have suggested that automated systems will help Medical Staff, but HSMN has talked to a number of organizations who disagree because the systems work best when there are fewer source documents to review. ICD-10 entirely changes the view of clinical documentation to something that may be beyond the grasp of many coders and physicians. According to clinical leaders, “Physicians do not typically document to the highest level of specificity required by ICD-9-CM” and so it can be inferred that ICD-10-CM will be a far greater challenge. So many of HSMN’s clients have turned to us for a solution that fits their culture, history and Practice values. We have the solution in what we call the Deconstruction and Mapping Methodology.

Over many years HSMN has trained both Coders and Physicians and we know that for ICD-10-PCS (Procedure Coding), Coders must have intense training, advanced clinical understanding of what physicians do and expanded medical terminology vocabulary. Not to mention of course, anatomy, physiology, pathophysiology and a working knowledge of pharmacology. Coders and Physicians will need close collaboration on appropriately describing specificity through the new Coding scenario.

HSMN’s Hospital, private practice and clinic clients are faced with a grave problem. As Coders and Physicians prepare for the upcoming changes, KLAS, a highly regarded research firm, has found that almost half of all hospitals will purchase a computer assisted coding product in the next several years in hopes of avoiding kinks in cash flow. Vendors will be pitching their coder-assisted products to hospitals as the new paradigm for success in this new environment. While they can be helpful, the truth is that hospitals and Physician practices need to work with the Medical Staff and Coders on the basics. The first thing to determine is how well they are doing with ICD-9 coding and clinical documentation now. A review of the quality of the clinical documentation as it relates to the coding outcome is essential to understand the current state. The results of this documentation audit using HSMN’s Deconstruction Mapping Process (DMP), will establish current state conditions, and help set the stage for introducing ICD-10 coding and clinical documentation requirements.

HSMN has found over the course of 26 years of working with Coders and Medical Staff that most professionals agree that no matter what tool is used to assist in coding, the outcome is only as good as the documentation in the patient records and the coders understanding of what has taken place in the patient encounters. Without a Clinical Documentation Improvement Program in place, not only will cash flow slow down but denials will increase and chaos will ensue. For over 26 years we have worked with Hospitals and physicians in every setting using the Deconstruction Mapping techniques to achieve a very high level of Clinical Documentation improvement among members of the Medical Staffs.

HSMN has incorporated the best practices from its clients and worked with the best clinical minds in the industry in order to develop the specific steps for a successful program improvement transition. Using HSMN tools the best Health Care Delivery organizations are conducting thorough reviews of the current quality of clinical documentation across all disciplines in the current coding requirements of ICD-9-CM. Then they are mapping such findings to the core group of Physicians in each discipline to get their input on the best way of achieving a higher quality.

HSMN has advised its clients to use current cases and applying the ICD-10-CM requirements and testing the quality of the documentation and coding. These findings begin the process of using live cases deconstructed to create the substance of the training process. Physicians generally don’t have time for lectures but they enjoy the challenge of diagnosing and recommending treatments in the context of actual patient encounters. Coders and Physicians should work closely to advance their mutual understanding of each other’s knowledge.

In using HSMN’s Mapping and Deconstruction Methodology we have found that in the subsequent stages of the transition most senior coders, who have excellent critical thinking skills, can round with Physicians in each discipline so they can learn what the Physicians do and the Physicians can begin to learn the new language/descriptions that drive the ICD-10 System. Lastly, HSMN encourages those efforts to identify the champions on the Medical Staff who will pair up with colleagues to help teach and become models in the transition process. The HSMN team models the Rounding techniques for the in-house coders until they are comfortable assuming this role.

In our opinion until the basics are done, the introduction of automated systems will only serve to confuse the Medical Staff and the Coders unless a Program of Clinical Documentation Improvement, Mapping and Deconstruction are put into place. HSMN has been among the industry leaders for over 26 years and has the experience of jump starting the entire transition. HSMN first introduced the “Bridging Technology” in a number of Medical Centers in the late 90’s and through present. The Bridging means that Medical Staff will see a connection between their own professional fee documentation and coding and that which will provide the Hospital with the appropriate revenue for the services provided.

Email us at theo@hsmn.com or send us a note about your current situation. HSMN has a breadth of experience and a very deep client list of successful practice outcomes.