The ICD-10 compliance date of October 1, 2014 draws nearer every day. While many individuals in healthcare believe this initiative to impact only coders and billing staff, that misconception will certainly prove detrimental on many levels. All involved in the patient care experience will be impacted, even the patient (as introduced in ICD-10: Ignorance is Not Bliss – Part 1.) In Part 2 of this 4 part series, we will continue to follow our patient through her post-ICD-10 experience. When we last left off, Doris Jones was waiting for an exorbitant amount of time in the clinic waiting room to see her doctor. After an hour, she is finally checked in and called back by the Medical Assistant.

Scenario: Please Visit Ignorance is Not Bliss – Part 1 for Mrs. Jones’ situation.

Now let’s see just how this change really can affect everyone…

Nurse/Medical Assistant: Decreased productivity due slower patient throughput. Increased need to monitor documentation and supportive information to assist physician documentation. Patient expectation and satisfaction management.

Specifically, in the example above, Nicole greets Doris and escorts her to the exam room. Nicole apologizes to Doris for the wait, but Doris is visibly upset. Nicole explains to Doris that there is a new government initiative in place that everyone in the office is getting used to, and apologizes again for the slowness. Nicole asks Doris for her Reason for Visit, takes her vital signs, gathers her medical and surgical history, allergies, etc. As she does so, she asks further questions about how Doris obtained the bruise and subsequent headaches. Doris sheepishly explains what happened. Nicole includes this information in her note as a cue for the physician. (Note: This time spent by the MA to gather and document the information exemplifies how/why it is important that all staff are trained – working collaboratively can reduce the burden on the physician.)
Physician: Greater need for specificity in documentation. Clear designation of medical necessity of visit, procedures, etc. Awareness of impact of detail in documentation as it relates to Level of billing (e.g. inclusion of more detail may yield higher level billing.) Forced to deal with Patient dissatisfaction due longer wait times.

In the scenario above, Dr. Smith enters the exam room and greets Doris. He briefly reviews the patient’s chart and initiates the physical exam. He confirms with Doris that she attained her head injury by accidentally bumping into a lamppost, thanks to the cue Nicole had written in her note. While Doris is still in the room, Dr. Smith clicks/types through his template-driven documentation, making certain he specifically mentions the way that the injury was acquired. Concerned about the residual headaches and massive bruising, Dr. Smith orders a CT Scan for Doris, and he links this order to Chronic post-traumatic headache, intractable – G44.321, which he has listed as the Primary diagnosis. He also lists Contusion of Other Part of Head- S00.83, specified Forehead as a secondary diagnosis. Because of his dialog with the patient, in conjunction with MA Nicole’s copious documentation, he is able to include a further diagnosis: Walked into Lamppost, Initial Encounter W22.02XA. True, it may take a bit longer to document what led up to the headaches and massive bruising, but the importance of this information should not be underestimated. For instance, if there are additional tests needed or a Neurology referral required, this last diagnosis could prove imperative to expediting the billing process (e.g. inhibiting payors from claim rejections due lack of information/improper coding.) Dr. Smith sends Doris home with educational materials on concussions and headache treatment, and he awaits the results of her CT Scan.
***Please continue to follow this scenario in ICD-10: Ignorance is NOT Bliss – Part 3, where the story of Doris, along with the far-reaching impact of ICD-10 will be explored in its impact on Coders, Billers, and, again, Physicians.

As Doris’ story progresses, you begin to see a microcosmic (and simple patient visit) representation of the paradigm shift ICD-10 will bring. Again, the critical nature of education, not just for Coders/Billers, but for staff, clinicians, physicians, and beyond will certainly prove critical through the implementation of the new code set and beyond. Thankfully, there are resources to assist you through this change. Precyse offers a true strategy and solution for these various roles. Precyse University has developed an incredibly robust ICD-10 online training program, and now you can gain access to the entire training program, for your non-clinical and clinical staff, medical billing staff, and yourself, and receive a 10% discount off of the entire order, by using coupon code SAVE10EHR, when visiting Precyse University ICD-10 Online Training Program

Rebecca Wiedmeyer
Chief Communications Officer
EHR Scope, LLC
Eric Fishman, MD
Founder and Managing Member,
EHR Scope, LLC