“You will probably have to know not only which insurance company, but the specific insurance product involved,” Tennant said. “Each plan and each product could potentially have a different level of required detail.”
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December 2011Another major change will be in the area of charting.
“Documentation for ICD-10 is a huge issue,” Buckholtz said. “Readiness assessments show there is not enough information to assign a code to the highest level of specificity in 35 percent of the cases. It tends to open a doctor’s eyes when we ask if they are prepared to live on 65 percent of their income.”
The biggest difference will be in the granularity of the codes. There will be codes specific to which side of the body is affected, whether this is a first encounter or ongoing treatment and whether a condition is chronic or acute. Buckholtz pointed to two different injury codes, one for being struck by a turkey and another for being pecked by one, to show how far ICD-10 will drill down in the encounter. To be properly claimed, this much detail must be reflected in charting.
Superbills may be a thing of the past in many practices. Depending on the case mix, a replacement superbill may turn out to be 10 pages or more.
Code sets for ICD-10 are already available through CMS. One suggestion is that providers sit down with the new codes and existing charts to see if their current documentation supports the more in-depth requirements of ICD-10. If not, then they should begin to document patient encounters at the higher levels required so that they can get into the habit before October 2013.
Provider Productivity
Provider productivity issues must also be considered. More documentation time will be required, which may mean that a provider sees fewer patients, especially during the early days. Tennant pointed to a Robert E. Nolan Company report that anticipates that the average doctor will see the equivalent of a four-patient-per-day decrease in productivity. Tennant thinks the reduction could be permanent.
An AAPC white paper describes the experiences of Vancouver General Hospital following Canada’s implementation of a new system in 2000. Initially, the hospital’s average coding time per record doubled, as did its payment turnaround, while its coding backlog went from 64 days to 139. More than 10 years later, productivity has not yet returned to pre-implementation levels.
There may be some parallels with the experiences of practices when their electronic medical records (EMR) systems went online.