Whether your answer is an emphatic ‘YES’ or a resounding ‘NO’, you’re likely to have strong feelings about it one way or the other. For a moment, let’s look at the current legislative landscape as it relates to another (potential) delay.

With the SGR fix passing just days ago, the best chance for another delay just evaporated.

In 1979, this country adopted ICD-9. That’s nearly 35 years of utilization and tweaking for the current code set. You might expect that after nearly 35 years we’d have complete confidence in our data – as much as it is possible to glean from the code set. But if you’ve been involved in any data review (especially in the most recent decade), you’ll know that is not the case. After nearly 35 years, there are still big gaps in the foundation for ICD-9. I’ll tell you what some of those gaps are in a few paragraphs.

Before I get to that, I’d like to mention something that may not seem related to the question at hand. Have you heard the story of the young farm hand whose resume’ simply stated, “I can sleep in a storm.”? If you already know this one, skip the next paragraph. For those who haven’t heard it, read on.

A young farm worker applied to the farmer for a job. His resume’ was short. “I can sleep in a storm,” was all it said. But he passed the interview and the farmer liked him so he got the job. The farmer was pleased with himself for gaining a likeable helper, until one night when he awoke to the sound of a terrible storm. The farmer was distraught and hurriedly went about checking all the animals, crops, buildings, and equipment. He found the animals safe and calm inside the barns, the hay covered with tarps, the buildings were locked against the wind and rain, and the equipment was secured in the storage areas. The farmer finally understood what the young hand meant by “sleeping in a storm”. He had done the work while there was no crisis. When the storm came, he could rest because of his earlier preparation.

By looking ahead to the potential changes and implementing them into the day-to-day operations, the healthcare organization, like the young farm hand, will be able to calmly meet the next crisis head-on. The payers have done their work, so that piece is ready. Now for the most important changes I’d like to recommend.

Identify coding issues. Training for coders is the second most important piece in the data puzzle, regardless of the code set. Train your coders in the basics and then retrain them. Those ‘basics’, when overlooked, cause a high percentage of the errors. But what’s the most important piece of the data puzzle?

Documentation by the physician is the single most important piece in the data puzzle. All coding is based on the physician’s documentation. While the ICD-10 set is designed to be more in tune to the way doctor’s document, there is still a deficit in that area. We can’t expect improvement in this area without specific clarification. There’s a difference in the way doctor’s speak and the way coders are allowed to translate. This fact is one of the main reasons for the ‘disconnect’ between these two. For your physicians I use two methods to get the point home:

1. Documenting for ICD-10 is like documenting as a resident – DETAILS MATTER! TELL THE WHOLE STORY! STATE THE OBVIOUS! Associate ALL treatments to their conditions and provide relevance of ALL test results. This alone will do wonders for appropriate capture of the patient’s severity of illness and for telling the story of why treatment was needed (supporting medical necessity). Yes, sometimes treatment of the specific condition is not based on the laterality or location but it helps us to provide data that may support invention of new treatments in the future based on learned information from the more specific data provided.

2. ICD-10 is like real-estate! LOCATION MATTERS! Any disease illness or injury on any body part can be reported so it is important to identify the specific body part, laterality of that part (which is most commonly stated even now) and the specific part of the body part (i.e. specific part of a fractured bone: not just “femur fracture” but “left intertrochanteric femur fracture”). The type of fracture displaced/nondisplaced; type of healing: routine healing, nonhealing or residual of a fracture; and, encounter: initial/subsequent are also important to documenting fracture care. Each condition has different specifics needed for appropriate reporting to paint the picture of the patient’s true severity of illness and to support the care provided.

Since you wouldn’t buy, sight unseen, a water front lot described as “just steps to toes in the sand and water” and expect beach front on a beautiful blue ocean, payers will begin not accepting our non-specific description of the patient and reimbursement may be impacted.

How can a healthcare entity ‘sleep in a storm’? By consistent, constant, clarification to all staff, both clinical and coding. Make sure your coders are well trained in ICD-9 and in ICD-10. Don’t stop reinforcing the basics. Remember, after nearly 35 years there are still difficulties in ‘getting it right’ with ICD-9!

Also, don’t stop reinforcing to the clinical staff the documentation concerns that are holding you back. (If you don’t know what those are – ask your HIM Director. If that person doesn’t know, we can recommend some excellent consultants!) When a physician identifies the diagnosis as “pneumonia” or “CHF”, many other details are blatantly obvious to that physician. But some of those details are not obvious to the coding staff. To add another caveat, even IF those details WERE obvious, the coding staff would NOT be able to utilize them. Those “obvious” details, such as relationships between diagnoses and treatments or the relationships between disease processes within the body must be clearly stated in the documentation or they are useless to your reimbursement potential.

When October 1, 2015 dawns, will our organizations be ready to submit claims utilizing the code set in place on that date? Maybe. Those who are prepared will not have to worry.