Planning for ICD-10 at the University of Utah Hospitals and Clinics

By Connie S. Tohara for Computerworld

When October 1, 2014 arrives, there are a number of potential disasters that await if we’re not fully prepared for the new clinical coding classification, ICD-10. Federal regulators have proposed a Fall 2014 deadline to comply, and we’re taking the initiative head-on at the University of Utah Hospitals and Clinics (UUHC).

We want to take advantage of everything that ICD-10 offers. This means having clear, specific and detailed information about our patients captured within our electronic health records (EHRs) so we can not only store information, but can access it to support research activities, improve medical education programs and fuel evidence-based patient care moving forward.

Documentation is Key

As the healthcare industry becomes more electronic, many organizations find themselves moving away from traditional dictated patient records toward the keyboard and mouse to capture patient-care data in structured, discrete formats (often within templates). However, that may not be enough. The patients’ narrative holds the key to accurate medical coding, reimbursement and ongoing high-quality care. Without complete, detailed records, medical coders have a more difficult time matching the appropriate codes to the service delivered, resulting in under-representation of the patient encounter and losing the ability to receive the appropriate level of reimbursement.

Capturing high levels of specificity is going to be critical. With ICD-10, the number of medical codes jump dramatically. While this code explosion certainly makes documentation and billing more complex, there is great value in it. As an academic healthcare facility, we see very sick patients. Highly specific coding options allow us to clearly and accurately communicate the degree of sickness through not only our medical notes, but through the codes that identify important details including severity of illness and risk of mortality.

We must provide our clinicians with the best tools to document care. To support the process, we’ve implemented back- and front-end speech recognition technologies to enable quick, easy and accurate data input into the EHR.

Assistive Technology is Your Friend

Another key technology piece is extending medical coders’ toolkits by introducing automated, ICD-10-enabling technologies that promote accuracy and efficiency across the coding process.

• Computer Assisted Coding (CAC) – Experts anticipate coder productivity losses of up to 50 percent in the first 6-9 months following the transition to ICD-10, with the expectation that they will never regain full productivity because of the permanent increased number of codes involved in their day-to-day workflow. Assistive technologies, such as CAC, will help us regain lost productivity so that we can continue to provide quality coding. And, anything we can do to improve their work environment is a strong retention strategy.
• Clinical Documentation Improvement (CDI) – UUHC has had a CDI program in place for the past five years. This group has been invaluable in enhancing provider understanding of documentation requirements. As they’ve worked with residents, mid-levels, and attending physicians, the quality of documentation of patient care has improved dramatically. Their daily presence on the nursing units provides a timely and increasingly respected resource to providers when they have questions about queries and other documentation concerns.
• Computer-Assisted Physician Documentation (CAPD) – We are also using new understanding technology to support their efforts as well. One such leading Clinical Language Understanding (CLU) technology is CAPD; it monitors physician documentation continuously and, when necessary, will prompt for additional information to ensure that what is captured complies with the level of specificity needed to correlate the appropriate ICD-10 medical code. For example, if a doctor describes a patient with a broken arm, the CAPD system will inquire for more information: laterality of the fracture, the specific fracture type, location, type of encounter, etc.

Training

At UUHC we also recognize the need to soundly prepare our coding staff for ICD-10. In addition to providing specific and detailed ICD-10 education, our plan includes extensive anatomy and physiology training, ICD-9 to ICD-10 comparison discussions, and online software with use cases to allow practical application of coding principles and an environment in which to practice their skills.

There is no one-size-fits-all approach, but a variety of options will be critical in order to have a staff become as comfortable in ICD-10 as they’ve been in ICD-9. Physicians, coders, billers, IT, and many others will need to coordinate resources. Ongoing training and communication between and across groups is critical.

Outside Vendors

ICD-10 preparations will stretch our already busy coding staff. Consider bringing in contract coders to cover the additional workload. Start talking to outside coding vendors early because everyone will be looking for coders. Lock in their price and commitment to you early–cost for these services can and will rise the closer we get to ICD-10. Find out what they’re doing to prepare their coders for ICD-10 so you can ensure you’re receiving quality ICD-10 coding from them.

UUHC is also planning to begin “dual coding” one year early, which means we will code inpatient patient records in ICD-9 and ICD-10 at the same time. Doing so separates any problems related to getting our coders up to speed using ICD-10 from potential technological issues related to implementation–issues such as vendor failure to completely remediate their software or problems with payer systems being able to process our claims appropriately.

The Bottom Line

The planning for various components associated with ICD-10 is critical. Our top priority in this transition period is making sure documentation processes are optimized, customized to clinician needs, and appropriately detailed. By taking advantage of currently available coding and CLU technologies, working strategically with key vendor partners, and maximizing the knowledge within your organization around patient information capture and use as UUHC has done, your opportunities to be successful in your ICD-10 transition are not only good; they’re likely to position your organization for greater success than ever before.