According to CMS Trusted Sources – ICD-10-CM and PCS are Moving Forward

ICD-10-CM implementation is moving forward despite the AMA’s objection; it supports a bill introduced last month by Republican Ted Poe (TX) that would block implementation of the new codes and requires a search for a less disruptive alternative code set.  CMS maintains that ICD-10-CM is better organized than ICD-9-CM and logical, and therefore, will not postpone the implementation.

Health Systems Management Network, Inc. recently posed a question to both a large Medical Center, and a large Group Practice, “Is it important to know if the patient has been bitten by a parrot vs. a duck?” In ICD-10-CM terms this would be W61.0100A vs. W61.6100A. The answer from the physicians group was that it didn’t help and in fact made billing more difficult. They will put in more time and not receive adequate compensation in this new system of coding. On the other hand, the Medical Center to whom we posed the same question answered that this is definitely the way to go.

Health Systems Management Network believes, along with its Medical Center Clients that the implementation of ICD-10-CM/PCS presents an opportunity to connect with the Medical staff in a way it was never able to do before.  For the Medical Centers it means having to create a real connection to the Medical staff in order to achieve a level of quality in both the Clinical documentation and the resulting Claim.

In our almost thirty years of implementing the various iterations of inpatient, outpatient and professional fee coding our approach to the implementation has not changed. Our approach to implementing ICD-10-CM is to begin working with the Medical staff and create a Confluencebetween the Clinical Decision making and its supporting Clinical Documentation.

While some believe that having Coders Certified in ICD-10-CM or purchasing the best new software will be the answer to the transition, HSMN believes that a truly successful implementation must begin by creating a Bridge between the documentation, the reporting of the encounter and submitting the claim.

For almost 30 years HSMN has maintained and has been privileged to have had a Physician/Clinical Advisory Team with whom we have worked to help Clinicians through each iteration of the Coding Scenarios. Our advisory team encompasses each and every discipline in Medicine and Surgery and each type of Physician extenders.  Our Team of Advisors believes that ICD-10-CM provides a much more logical extension of the clinical mind in all aspects of its Clinical Documentation.

Of course it requires an incredible addition of Specificity. So HSMN begins its consultation first and foremost, with discussions with the Leaders of each of the disciplines or Practice heads to identify some champions who are willing to have their “live cases” subjected to “Analytical”or “Extreme Parsing” to better understand the link between what they are thinking as they review data to make a diagnosis and their medical decision making that supports the interventions.  While the ICD-10-CM screams Specificity in clinical documentation, it also reflects the clinician’s thinking about where, what and how of the diagnosis and treatment. Of course one can make the case that it doesn’t matter that the patient was bitten by a rabbit or a parrot except that in the actual clinical decision making there is thinking about potential parasites or diseases these critters may carry.

HSMN works with a model Clinical Team to “Deconstruct” an active case in order to see what is missing in the ICD-9-CM world that would make it impossible to transition easily to the ICD-10-CM/PCS scenario.  Working with the Clinical Team the “Live Cases” or “Active Cases” are then reconstructed into ICD-10-CM using clinical decision making bridges.

In this process HSMN also works with the Medical staff on its own Professional Fee billing with exactly the same kind of transition.  Our team calls this the “Quid Pro Quo Strategy”. The reconstruction of “active” cases is done by including a senior/experienced Coder from the hospital who becomes part of the Clinical Team for the entire exercise of Deconstruction and Reconstruction.  While it is important for the Coders to have had ICD-10-CM training, it is equally important that they interact with the Clinicians to better understand what is going on in the clinical decision making process.

HSMN models these roles so that the Hospital or Practice can then take over the process until each and every discipline has had the opportunity to participate and become comfortable with the new Coding.   In Academic Medical Centers and those large Hospitals with Residency programs it becomes crucial that Residents internalize this process before July 1st rolls around when thenew House staff arrive.

After working for 30 years with House officers, we know that the patient handoff in the age of the demand for them to work fewer hours is going to result in more handoffs and potential missing documentation.  We have focused heavily on the house officers because they are very involved in the clinical documentation while the attending staffs oversee them.  We know the reality.  Thus early on work with the house officers is important.

The methodology of “Active Case” Deconstruction and Reconstruction works well with very busy house officers because it serves to support clinical decision making and diagnosis as part of their duties instead of another didactic exercise for which they have so little time

We invite you to experience our process to help make your transition a logical extension of the clinical mind. Please contact our offices by calling 866-908-4226 or email for a consultation on how HSMN can be of service to your organization. This initial teleconference consultation is without cost.