Transitioning the Medical staff to ICD-10-CM/PCS in Partnership with the Revenue Cycle Team: The Medical staff in most Hospitals or even in busy Practices are probably not going to sit down for a didactic session on ICD-10-CM/PCS. Yet you must have their attention if for no other reason that they will have a profound impact on Revenue. You may have implemented the Electronic Record which will embed the new codes, but they will not have created the Clinical Documentation needed to support the Coding.
Coders, unless, they have an intimate working knowledge of the clinical practice/procedures of their Physicians (despite the training they may have received on ICD-10-CM/PCS) may not be able to construct an appropriate Procedure Code or correctly assess the codes for the MS-DRG assignment.
In over 27 years of operation, Health Systems Management Network, Inc. (HSMN) has helped transition many Medical and Revenue Cycle staffs through each iteration of the DRG and APC reimbursement methodologies through a very thoughtful process whose main core is combining clinical/technical knowledge with critical thinking skills.
HSMN has used the advice of the many Physicians with whom it has worked on all of the transitions. From the advice and from the practical work of spending time with the Attending staff, House Officers, Nurse Practitioners, Primary Care and Specialty Nurses and the Revenue Cycle staff, for over 27 years, HSMN has learned that the Clinical and Coding staff must have training that reflects the reality.
The reality faced each day by the Clinical staff is that no two patients are the same clinically and demographically. Therefore, HSMN’s approach to this new transitioning is to test where the staffs are, and where they need to go. At the core of this transition is the Physician’s documentation. ICD-10- CM/PCS compels greater specificity in documentation practices. The Coder can only be as good as the documentation is!
HSMN has introduced a very successful technique that we have called Case Deconstruction and then ICD-9-CM Reconstruction in ICD-10-CM/PCS. The concept is simple and elegant. HSMN reviews current cases in ICD-9-CM and parses them to see whether the Clinical Documentation and the Coding/MS-DRG match perfectly. Based on the Case’s existing Documentation and Coding, HSMN begins analyzing the problems which may lie in either the Clinical Documentation or the Coder’s judgment or skill level. The “Case” is then reconstructed into the ICD-10-CM/PCS and presented to the Medical staff. While HSMN works closely with Coders, it also confers with the Medical staff member who was the lead Physician/Clinician on the “Case”. We then encourage and model a partnership in which both Clinician and Coder are asked to present the entire ”Case” to the Clinical staff of that particular discipline and to the Coders who will work with them.
Deconstruction and Reconstruction are the key elements along with Clinical Documentation and Coder Critical Thinking Skills for the success of the ICD-10-CM/PCS Transition! CMS in its pronouncements speaks of “Conversion”. In our many years of experience there can be no “Conversion” without internalizing an understanding of the differences between ICD-9-CM and ICD-10-CM. The understanding can only come about through a process that takes some time and energy. Clearly the Medical staff bare a burden of specificity never envisioned in Medical school and for the Coders it is the weight of judgment in the PCS assignment.
Medical staff often asks “What is the incentive for me to improve my clinical documentation with this level of specificity?” Good question. The obvious answer for the Physician is that better Clinical Documentation leads to improved quality of care. Another answer is that Physicians are more intimately involved in coding then they assume. Consider the Physician’s productivity for example. Physician productivity is expected to take a 10% to 20% hit due to an anticipated significant increase in Coder’s queries. At HSMN, we think that the Physician’s time is better spent providing care, not answering coding queries.
The new coding scheme is about specificity; it is not about being paid more for procedures or visits. Changing documentation to meet the greater level of specificity called for in ICD-10-CM/PCS will help the Physician not hinder him. HSMN has found that when Clinical staffs are challenged, they will respond.
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