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How Might ICD-10 Affect Your Coding Process? Test It and Find Out

By Donna Stewart, CPC, CPC-H, CPC-P, CHCO

Imaging departments performing a high volume of radiological procedures will most likely see their coding productivity impacted by the transition to ICD-10. Diagnosis codes currently total approximately 14,000, but this number will grow to roughly 68,000 on October 1, 2014. ICD-10 codes will increase to as many as seven characters in length and are alphanumeric. The current ICD system is only three to five digits with some alpha characters.

The most effective solution for monitoring the transition from ICD-9 to ICD-10 is to perform an impact analysis. Trace ICD-9-CM codes to see how they currently are chosen and reported. If you understand how you use ICD-9 codes today, you can verify these processes will work in the future and make plans for necessary changes.

Charge capture will certainly be impacted because of the changeover. Test your current charge capture productivity levels. Once your system is ICD-10 ready, test productivity levels again. Continue to monitor results prior to implementation and after go-live. Review workflows, test for ICD-10 productivity, and revise staffing plans as needed. A flow chart is an excellent tool to map the processes impacted by ICD-10 in your organization and allow you to prepare for the transition.

Coders who have direct access to radiologists can conduct concurrent queries and quickly gather additional information required for coding purposes. Ultimately, a coder focused solely in radiology will develop a greater level of expertise and ownership, resulting in greater coding accuracy and improved reimbursement.

Convert your top ICD-9 codes to ICD-10 to see which areas will have the greatest impact. For example, regarding fracture care, ICD-10-CM offers separate codes for an initial fracture, a follow-up of fracture healing normally, a follow-up with fracture in malunion or nonunion, or a follow-up for late effects of a fracture. (The open fracture designations in ICD-10-CM are based on the Gustilo open fracture classification, which is a new concept to most coders.)

Review charts containing your top codes. Is the information needed to code to the required level of specificity currently available to the coder in the documentation? Performing ICD-10 readiness audits now can assist you in determining areas of documentation weakness in your facility.

Pull a random sampling of medical records that represent the diagnoses you currently utilize the most in ICD-9-CM. Do you have enough information to code the diagnosis for these records in ICD-10-CM? Use the results from your analysis to educate your coders and providers. Develop a plan for dealing with insufficient documentation.

If you perform a baseline audit now and again as the transition draws closer, you can monitor your results. If the medical records still do not contain the vital elements needed to code in ICD-10-CM, develop a documentation improvement plan.

— Donna Stewart,CPC, CPC-H, CPC-P, CHCO, is president and CEO of Professional Impact, Inc, and an AAPC-approved instructor, providing training for coders, auditors, physicians, and staff.