Q&A with Judy Monestime, expert on the what, when, where, and how of the new medical coding/billing system
For some in the medical field, the delay to the ICD-10 conversion is a welcome deferment, allowing some much-needed extra time for training as well as trial and error of the new medical coding and billing system. For others, the delay could bode as a killer of momentum and a setback to wheels that had already been put into motion. To lessen the impact of the latter, Judy Monestime, MBA, CDIP, CPC, AHIMA Approved ICD-10-CM/PCS Trainer & Ambassador, who is the vice president of ICD-10 Consulting for The CODESMART™ Group, answers vital questions to help your practice be fully prepared for the upcoming conversion.
Monestime has led several ICD-10 assessment and implementation projects as a functional lead for Provider Contracting and Provider Economics/Reimbursement; including evaluating both the business and technical processes and systems for key potential impacts of ICD-10 and confirming ICD-10 impacts by process area, including business rules, training, work effort, business-developed tools, business-managed vendors, and impact to process work efforts. Judy has also led many seminars on ICD-10 transition and clinical documentation impact.
Central Florida Doctor (CFDr): As of April, a recent bill passed into law by President Obama delayed the mandated ICD-10 conversion to at least a year—October 1, 2015. If a physician’s office has had little to no training up to this point for the ICD-10 conversion, what kind of steps should be taken to make sure the practice is prepared come next year?
Judy Monestime: There are 10 steps to put into practice:
- Create a budget
- Conduct ICD-10 Assessment (People, Process, Technology, Claims)
- Conduct ICD-10 Clinical Documentation Readiness
- Educate staff
- Educate physicians
- Talk with your vendors.
- Revise superbills
- Have cash on hand
- Dual Code
- Conduct ICD-10 Testing
CFDr: What are the biggest differences between ICD-9 and ICD-10?
Monestime: Besides the sheer number of codes, there are some other major differences between ICD-9-CM and ICD-10-CM. ICD-10-CM codes are all alphanumeric, starting with an alpha character, as opposed to V and E codes in ICD-9-CM. ICD-10-CM codes include laterality to show right, left, and bilateral conditions. For example, the guidelines state that the right side is designated by a character 1, left side is always designated by a character 2, bilateral is always designated by a character 3, and unspecified is designated by a character 0 or 9, depending on the character placement.
CFDr: What can physicians and office staff do to be best prepared for the conversion
Monestime: Assess ICD-10 training needs! Training will be one of the critical areas impacted by the adoption of ICD-10. Validate and re-assess scale, scope, and customize the educational plan to meet the needs of a diverse workforce during and following the transition.
CFDr: What kind of training and education is sufficient? And how can physicians be sure that their staff has a good grasp on the training they’re receiving?
Monestime: Place emphasis on “Role-Based Training” as opposed to a one-size-fits-all solution. Healthcare practices will need to work with a vendor that will classify the roles into different subgroups. There must be consensus as to the extent of training that needs to be done, who needs to be trained (plus what roles they will have), what level of training is needed, and how training will be delivered. Different levels of training will need to be based on the impact of ICD-10 on roles and functions. Once training has been completed, dual coding should begin.
CFDr: Please tell us a little about CODESMART™ Group, and the types of education and training options available.
Monestime: The CODESMART™ Group is a premiere national subject matter expert for ICD-10 education, compliance and consulting. The company provides solutions in ICD-10 transitions/support, outsource coding, coding audits, improvements in the revenue cycle continuum, and clinical documentation improvement and education.
The CODESMART™ GROUP’s CODESMART™ University, is the leader in ICD-10 education and training as recognized industrywide, and helps healthcare organizations and physicians’ practices to focus on their core mission—providing quality patient care, by making the ICD-10 transition easier and stress free. CODESMART™ University offers the following “best practices” education and training programs for ICD-10:
- ICD-10 for Existing Coding Professionals
- New Coding Professionals
- ICD-10 for Clinicians
- ICD-10 role-based training for various departments throughout the organization
CFDr: What are you hearing are some of the biggest concerns among physicians regarding ICD-10?
Monestime: Productivity loss! Staff productivity will decrease by 30-50 percent as coders and clinicians get up to speed on the new code set. The Canadian’s implementation of ICD-10 CA revealed a dramatic increase of coding backlog due to productivity loss of 50 percent in the first six months.
CFDr: How would your recommend that physicians and medical practices tackle those concerns?
Monestime: A baseline gap analysis provides important data for benchmarking, targeted reviews, and targeted education. A dual coding program can address organizational business goals, such as the ability to rework managed care contracts, identify glitches in billing workflow, and avoid unnecessarily missed reimbursement opportunities before October 1, 2015. Your chosen method for dual coding, concurrent or retrospective, drives cost calculations. Other factors include the types of accounts to be dual coded, volumes of accounts for dual coding, and how much information will be collected, analyzed, and integrated into other initiatives such as testing preparedness.
CFDr: What kind of IT updates and/or upgrades might be necessary for the ICD-10 conversion?
Monestime: Field size expansion, change to alphanumeric composition, and complete redefinition of code values and their interpretation will need to be remediated in the following: EMRs, Practice Management Systems, databases and systems, including access applications used to store, report or update diagnosis codes, crystal reports, and access reports.
CFDr: How will ICD-10 affect the physician’s process of clinical documentation?
Monestime: Since ICD-10 will provide greater detail and more accurate depiction of patient severity, the need for high quality clinical documentation is ever more important. Capturing “severity” can also be an issue. For example, if we know that a patient has a pressure ulcer but we do not know whether it involves only skin or goes all the way down to bone, we will not be able to measure the effectiveness of a wound management program. The number of queries for physician documentation is forecasted to increase. The Advisory Board has estimated that physician productivity will decrease from 10-20 percent due to significant ICD-10 queries. The increase in queries productivity will also affect clinical documentation specialists and coder productivity.