J.A. Thomas & Associates Blog Building an ICD-10 Solution � From the Physician Perspective

Accurate DRG assignment under either ICD-9 or ICD-10 requires accurate and complete clinical documentation by treating physicians (including residents, fellows and non-physician practitioners working under a collaborative physician agreement).� To protect the revenue cycle under ICD-10 it is necessary to engage physicians in the process, leverage appropriate IT solutions, and collaborate throughout the process.Engaging PhysiciansFrom an epidemiologic and quality perspective, ICD-10 is a significant improvement over ICD-9.� Physicians need to understand the benefits to clinical care of more accurate and complete documentation, bringing the United States into the community of developed nations using ICD-10.� Many perceive ICD-10 as another potential source of conflict with hospitals, yet most hospitals are working collaboratively to assist physicians through the transition.� Providing this basic �orientation� of physicians to ICD-10 can dispel many myths, fears, and concerns, as well as building the foundation for collaboration with their hospital partners. The above-described engagement is not so much education as orientation to a system that can enhance the quality of clinical documentation.� Physicians need to learn early what efforts are being undertaken at the hospital to develop and implement practical solutions through information systems, HIM solutions, CDI enhancements, and process interventions, and participate in those development processes.Educating PhysiciansThere is a role, however, for direct physician education.� The challenges, however, are substantial.� Few physicians want to go through the extensive didactic education required for ICD-10 proficiency.� Yet all will have to provide ICD-10 diagnoses to the proper level of specificity to submit professional billing.� A logical solution, then, is to provide all physicians with specialty-specific information regarding accurate documentation.� This education must be clinically driven.� Coders readily acknowledge that physicians simply will not listen to coder-delivered education.� This is not due to lack of knowledge on the part of coders but rather the neuro-linguistic differences in approach of a physician and a coder.� Physicians learn best from physicians on a peer-to-peer basis.� That is why physician education for ICD-10 must be clinically delivered. Each subspecialty must understand the specific documentation necessities for their specialty.� This can be efficiently accomplished in a surprisingly limited amount of time. However, there is one other substantial challenge facing revenue cycle leaders.� That is, even with excellent coder, documentation specialist and physician training, a collaborative approach, and excellent planning there is one more key link - IT.Innovative IT SolutionsIn addition to the overall electronic medical record transition, system re-writes for ICD-10, computer assisted coding, meaningful use, and a myriad of other IT challenges, one additional solution would greatly enhance revenue cycle function under ICD-10.� Both ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) are structured in a clinically logical, hierarchical manner.� Since there are 576 codes for hip fractures, one can eliminate over half the possibilities by simply identifying right or left.� Additionally, the physician should identify initial or subsequent encounter, whether the initial fracture was displaced or non-displaced, whether the subsequent encounter was for non-union, mal-union, etc.� The actual number of parameters to be specified is small and the physician knows the detail at time of care (but likely not at the time of subsequent coding query). To avoid a massive revenue cycle log-jam, hospitals will require an integrated approach between coding, documentation specialists, nursing, and other clinical department education, appropriate IT solutions, and physician education (and motivation) to achieve complete documentation at the time care is delivered.