Physicians can use the following tips to keep their revenue cycles humming now that ICD-10 has arrived.

The train has been on the tracks a long time—and even got sidetracked a few times—but now it has pulled into the station. ICD-10 is underway, and physicians are finding out whether they are prepared to deal with it.  

“What’s happening in the world of ICD-10 is a sea change from ICD-9,” says Anthony Oliva, DO, MMM, FACPE, national medical director of Nuance Communications, a clinical documentation consulting firm. “In the ICD-9 world, getting a specific and complete diagnosis was never a substantial part of the physician’s role. I was paid based on the time I spent with a patient, how complex my decision making was, and how complex my evaluation was. That’s what it was all about, not a diagnosis.”

With ICD-10, that situation has changed. Physicians are expected to provide substantially more specific information about patient encounters. The increased complexity of ICD-10 may be best expressed by numbers: There are 68,000 ICD-10 codes, compared with 13,000 ICD-9 codes, and each code has increased from five digits to seven.

Although the challenges of ICD-10 may seem daunting, many physicians and systems are prepared for the change, and extensive resources exist for smoothing the transition. And the “big picture” advantages of the new system—such as reams of new epidemiological data—may improve the delivery of health care in the years ahead.

“We’re really at an exciting point in the history of medicine in the United States,” says Crystal Clack, MS, RHIA, CCS, director of coding and data standards at the American Health Information Management Association. “Remember the ‘Chicken Little’ scenarios about Y2K? We’re at a similar crossroads.  We have prepared for this change for many years, and now it’s time to enter into this new era of health care.  There will be the inevitable heartburn at first that comes with any change, but people will adapt, and we will see many wins with the use of ICD-10.  I’m confident that in a year or two we will be able to look back and say, ‘We made it.’”

Whether physicians feel prepared for ICD-10 or are dreading it, the following tips can help them adjust to the new reality.  

Tip 1: Pick Your 25 Top Diagnoses

The most common diagnoses deserve the most attention. “At this stage in the game, physicians should look at the top 25 diagnoses for the practice,” says Kimberly Hopey, PhD, RN, director of professional services at Nuance. “Usually a physician’s diagnoses follow the 80/20 rule, so those top 25 diagnoses will represent 80 percent of their work. If they learn the new requirements for those diagnoses, that will gain them the most benefit.”  

Tip 2: Talk to Your Staff

Whether in a hospital setting or a private practice, a coder or clinical documentation improvement (CDI) specialist is paying close attention to the ICD-10 coding guidelines and learning the new system. Physicians should ask questions about the specific ICD-10 requirements for coding. Feedback on documentation for coding should be encouraged as a relationship is built between the physician and coding expert. “Providers should feel comfortable  working closely with the coder or CDI specialist to identify opportunities for improvement,” Clack says.  

Tip 3: Remember Your Clinical Predisposition

Although the ICD-10 requirements are more detailed, the codes do not require any sort of new clinical approach. “The fact is, when someone comes in with a broken leg, you don’t just say ‘broken leg’ in the record,” says Marion Kruse, BSN, RN, MBA, senior managing director of clinical services for Precyse Solutions, a health information management consulting firm. “You also say how the patient broke his leg, which leg was broken, etc. Recording the proper codes for that injury is not really that different—you’re already putting that specificity into your notes.”  

Tip 4: Use Your EHR Narrative

Whether electronic health records (EHRs) help physicians adapt to ICD-10 better depends on how well the systems are designed and kept up to date. However, nearly all EHRs include a space for narrative in the physician record. This space can be used to include the specificity needed to properly code the encounter.  

Tip 5: Lean on Your Associations

Professional associations know which codes physicians are most likely to need, and probably have prepared ICD-10 tools of some sort. For example, the Radiology Business Management Association offers an ICD-10 toolkit that “contains a customizable model implementation plan & educational materials to help document the info needed for ICD-10 coding & a full range of staff training,” according to the organization’s website. “It’s important to see what your specialty society has,” Oliva says. “I think that’s an overlooked place that can provide good information at no cost, because you’re probably already a member.”  

Tip 6: Consider an App

Oliva also notes that quality smartphone apps can help physicians quickly figure out ICD-10 codes. “On these apps you type in a preliminary diagnosis, and it will open up with all the things you need to look at,” he says. These apps, for example, allow a physician to enter terms related to conditions or diagnoses and then refine the search to narrow it down to the exact code.  

Tip 7: Measure Your Progress

Measuring how well you’re doing will keep you moving forward. Obviously, the ultimate measure is payment. “The big three metrics are the number of claim denials, the A/R [accounts receivable] days, and the medical necessity denials,” Hopey says. Another potential metric, particularly for physicians who care for hospital patients, is the case mix index, notes Mel Tully, MSN, CCDS, CDIP, vice president of clinical services and education at Nuance. If a hospital’s case mix index is dropping, it begs careful analysis. It may be because documentation does not support final coding for the complications and comorbidities that put accounts in higher DRGs.  

Tip 8: Relax and Learn

Physicians do not need to be ICD-10 experts from day one. “I think the nuts and bolts of learning this will be on the ground,” Oliva says. “As time goes on, interaction with patients is how I’m going to learn.” Hopey agrees: “I think one thing to emphasize is that Oct. 1 is not the end point—you have to continue your education after that. I recommend physician practices and offices conduct chart audits to find where they have gaps in the documentation, and work on those areas.”  

The data gathered from detailed ICD-10 coding will, hopefully, help improve health care in the long run. Complying with ICD-10 today will require some extra time, but that additional effort should shrink over time and pay off with higher-quality care.  


Ed Avis is a freelance writer based in the Chicago area.

Interviewed for this article: Anthony Oliva, DO, MMM, FACPE, national medical director, Nuance Communications; Crystal Clack, MS, RHIA, CCS, director of coding and data standards, American Health Information Management Association; Kimberly Hopey, PhD, RN, director of professional services, Nuance Communications; Marion Kruse, BSN, RN, MBA, senior managing director, clinical services, Precyse Solutions; Mel Tully, MSN, CCDS, CDIP, vice president, clinical services and education, Nuance Communications.

Publication Date: Tuesday, September 29, 2015