Becker's Hospital Review

37 Executive Briefing: ICD-10 Presented by: Coding Crunch: 7 ICD-10 Lessons From Cedars-Sinai By Bob Herman I n 2011, Cedars-Sinai Medical Center in Los Angeles did what many providers were hesitant to do: It decided to tackle ICD-10 as an inevitable change and began its work to transition to the new system. By contrast, only about 20 percent of pro- viders believe they will complete or expect to complete all ICD-10 business changes by the third quarter of 2014 — the quar- ter before ICD-10 goes live, according to a survey from the Workgroup for Electronic Data Interchange. Thea Campbell, director of health informa- tion and ICD-10 coordinator at Cedars- Sinai, said senior leaders saw the need to conduct a risk analysis and determine how ICD-10 would ultimately affect the aca- demic medical center. Cedars-Sinai executives expect the orga- nization will be ready by the Oct. 1 dead- line, thanks in part to the proactive plan- ning approach. Ms. Campbell explains what she and her colleagues have learned during their ICD-10 planning process. 1. Ensure all it systems will be ready. Electronic health records have usurped hospitals' capital resources during the past few years, and ICD-10 represents anoth- er costly IT endeavor. For Cedars-Sinai, which runs on an Epic platform, the price tag for the preparatory stages of ICD-10 will run into the millions, which is in line with cost estimates provided by various healthcare organizations. But that does not mean hospitals have any extra space to afford it. Ms. Campbell says hospitals have to spend the capital to ensure all IT systems are in sync. ICD-10 will go live in October regardless if hospitals are ready, and the coding system will be the lifeline for hospi- tals to continue receiving reimbursements from payers. "That's a very crucial step," Ms. Campbell says. "You can have everything done, but if you can't bill out the door to payers, you can't get paid." 2. don't assume revenue cycle sys- tems are the only systems that will be affected. iCD-10 is often associated with finance and revenue cycle systems. How- ever, it will affect far more than those back office functions. EHRs, lab systems and numerous other platforms transmit codes, and those similar- ly have to be updated, Ms. Campbell says. 3. unconditionally support the coding staff. Coders are the last line of defense between a hospital claim and reimburse- ment, making their training paramount. Because Cedars-Sinai planned for ICD- 10 early, the organization implemented a dual coding strategy. This means that Cedars Sinai coders ensure all visits and discharges are coded in both ICD-9 and ICD-10. "The reason for two separate work streams is two-fold," Ms. Campbell says. "First, to allow our revenue cycle to prog- ress in a normal and consistent manner in ICD-9, and secondly, it allows our trainees to focus on the needs of ICD-10 from a documentation specificity and guideline perspective." Dual coding, on top of intense re-education of basic coding and science principles, will allow hospital coders to feel more at ease once ICD-10 goes live. In addition, it will help the hospital spot potential problems. 4. View physician education and train- ing as one of the highest priorities. Coders are the last stop for all claims pro- cesses, but a claim isn't a claim without physician documentation. Ed Hock, a senior director at The Advisory Board Company, says physicians are the foundational pieces of a successful ICD- 10 implementation because ICD-10 is a documentation issue as much as it is a coding issue. Ms. Campbell strongly agrees. She says Cedars-Sinai kicked off a "fairly aggres- sive" physician education strategy. The system has 2,100 physicians on staff, and it is holding sessions with physicians by specialty to identify their issues and docu- mentation concerns. Proactively reaching out to physicians can result in multiple benefits, Ms. Campbell says. Aside from clearer documentation and less confusion, ICD-10 gives hospitals a chance to align with other community pro- viders who may need help along the way. "I think administrators have a real opportu- nity to be educating physicians and help- ing physicians," Ms. Campbell says, not- ing that many community physicians don't have the resources to manage ICD-10 on their own. "There could be an incredible amount of goodwill, especially when a lot could be said about physician-hospital re- lationships." 5. Conduct comparative data analyses to find out where money will be lost and gained. Cedars-Sinai has rigorously analyzed the financial ramifications of ICD-10. This includes analyses of payer reimbursements, costly coding mistakes and service lines. Ms. Campbell says the organization will also develop pertinent indicators to monitor, like A/R days, after ICD-10 goes live.

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