With the ICD-10 deadline now only seven months away, concern over the transition is growing. This may be misplaced anxiety relative to the other sea-change transitions occurring in health care, but it is pervasive. So much, in fact, that I think it warrants the following addition to the ICD-10 code set: F41.8XXX – ICD-10 Anxiety Disorder (consider it a new member of the F40 phobic anxiety disorder chapter). This new code proposal requires some justification, so let’s take a look at the symptoms that are driving ICD-10 Anxiety Disorder and some of treatments available to its sufferers.
Symptom #1: Paranoia over coding specificity
Treatment: A dose of reality
While it is true that ICD-10 includes codes with greater specificity, unspecified codes are perfectly valid when clinical documentation supports their use. In fact, here’s a fully adjudicated and paid sample charge using an unspecified code, directly from our ICD-10 testing efforts with a large national commercial payer.
In ICD-10, there are 11 billable acute sinusitis codes. If those codes are clinically appropriate, then they should be used. But, in this case, the distinguishing attributes (maxillary vs. frontal and ethmoidal vs. sphenoidal, for example) that would lead to a more specific ICD-10 code were not available at the time of service—meaning the unspecified code was the most accurate code which could be billed. As this shows, unspecified codes are valid and, when applicable, do not impact claim outcomes.
Symptom #2: Disorientation due to large numbers
Treatment: User-centered technology
There are indeed approximately 56,000 more codes in ICD-10-CM; that makes for a really thick coding book, comparable to the Yellow Pages. And, as with the Yellow Pages, the new code set has developed quite the usability problem when you’re looking for something specific.
In the case of Big Yellow, user-oriented search engines have helped us easily find contact information; similarly, intelligent diagnosis code search tools can make navigating the ICD-10 code set simple.
Here’s how this works for our clients: athenaNet (our cloud-based platform) uses a combination of SNOMED terms, ICD-9, ICD-10, and keywords to dynamically populate relevant codes based on terms that clinicians actually use, along with dynamic filters that rapidly reduce the number of codes presented to the provider as they search for a diagnosis. Additionally, our usability and research teams continually evaluate the performance of this search tool to refine its performance; the more it’s used, the better it gets.
Comparable approaches that focus on user behavior can help address the inherent challenge of designing solutions for complex code sets; deriving simplicity out of complexity.
Symptom #3: Rigidity of business processes
Treatment: Harmonious software, knowledge and work
At the advent of the ICD-10 deadline, old encounters and claims will need to be resolved in ICD-9 and, as I mentioned in a previous post, not all payers must comply with the new code set. Flexibility is important. As such, the recommended treatment for this symptom is the application of a software-enabled service that takes care of the details so providers, billers and coders can focus on the clinical encounter. Solutions that include dynamic workflows by date of service, reflect up-to-date industry knowledge garnered from daily interactions across a national health information network, and keep track of payer readiness allow for flexible and continuous business processes.
Symptom #4: Paralysis of practice managers and project teams
Treatment: Step-by-step guidance specific to your organization
ICD-10 Anxiety Disorder is most commonly associated with teams paralyzed by uncertainty. Urgent care is often required here, starting with assessing the impacts ICD-10 will have on your organization, which can vary from practice to practice. Ideally, practice systems will self-identify where attention is needed; we’ve built a practice-specific step-by-step readiness tool right into athenaNet. In more complicated systems, this can take some work to uncover. Treatment should focus on the major bottlenecks of ICD-10 readiness:
- Readying charge capture tools for ICD-10
Capture solutions (electronic charge capture solutions or paper forms) are where ICD-10 is most apparent to clinicians. Practice managers should look to implement a solution that focuses on ease of use; a 20 page paper super bill is probably not high on the list. (Read “ICD-10: Views from a Practice Manager.”)
- Updating system interfaces
Coordinating multiple vendors and [HL7] message formats can take time; practices should recognize this as a potential bottleneck, and prioritize their interface preparation.
- Prevention of ongoing ICD-9 future orders
If possible, you should start issuing any orders beyond the October 1 date with ICD-10 codes to avoid future workflow issues and call volume.
- People readiness
You should evaluate the readiness of your practice personnel by role (e.g. front desk staff, clinicians, coders/billers, analysts). If this hasn’t yet been completed, assess your needs now and put a plan in place to provide staff the functional knowledge they need prior to the transition date.
Differentials for these symptoms include complicated and rigid software and service models, a lack of agility and change readiness, and solutions that rely only on software. These potential underlying conditions can be exposed by the onset of ICD-10 Anxiety Disorder.
A final note: Good treatment of ICD-10 Anxiety Disorder should target not the symptoms but the cause, the HIPAA-based regulation requiring the code set switch. In this case, the care must be palliative as the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services’ Office of the National Coordinator (ONC) have repeatedly reinforced that the October 1st, 2014 transition date is set. The good news here is that provider organizations undergoing the treatment above will likely overcome ICD-10 Anxiety Disorder this year and move on to other challenges facing health care.
I’ll be presenting at our annual athenahealth User Conference on the topic of ICD-10 so I encourage you to register for my session or feel free to stop me in the exhibit hall to expand on this topic. Hope to see you there.