The type of ICD-10 training needed by clinical staff will depend upon a variety of factors. An advanced level of ICD-10 training will be required for any clinical staff that works directly with patients to provide medical care.
The role of clinical staff has changed over the years. Nurses, therapists and nurse practitioners are now on the forefront of patient care. Many work directly with super bills that may be eliminated and new methods must be learned.
New provisions in HIPAA compliance affects the dissemination of protected patient information. Any clinical staff in a practice that is involved with providing patient care or access to client health information will need a thorough understanding of ICD-10 coding, including staff that provides in-home therapy or care.
Depending upon their level of education, the individual practice, and the laws within the state, clinical staff can conduct exams, make diagnoses, give injections and are authorized to prescribe medications. They can prescribe physical therapy services, make referrals and order testing. These staff members will need specialized training in ICD-10 coding.
Health care coverage is undergoing major changes due to the Affordable Health Care Act. Depending upon the individual practice, clinical staff may be responsible for scheduling referral appointments and obtaining pre-authorizations. Clinical assistants will be affected by changes in health insurance policies and advanced beneficiary notices (ABNs) that will need to updated and reformatted.
One of the responsibilities for non-coding clinical staff will be to educate patients about all of these changes and how they will be affected. Clinical staff may also include technicians for practices that maintain on-site lab and testing facilities. In smaller practices, a single individual may wear many hats and ICD-10 training options must take that into account.
Large, comprehensive practices may encompass case workers, patient advocates and staff that oversee sales of medical products and devices. Clinical personnel in these capacities may need ICD-10 training, but not the intensive level of those who must enter ICD-10 coding. For many non-clinical personnel, the biggest shift with which they may have to adapt is procedural changes.
A byproduct of the Affordable Health Care Act is that patients will have increased access to their health information through patient portals, but it may result in an increased work load for clinical staff. A patient portal allows clients to access test results and other information, but it could result in an influx of calls to which clinical staff must respond.
The patient understanding of what medical personnel told them and subsequent coding may not be an exact terminology match, leading clients to contact the practice for clarification. Any terminology with which patients are unfamiliar or they disagree may result in calls and an additional workload.
Conversely, the greater specificity that coding clinical staff can utilize may be appreciated by older patients. ICD-10 allows clinicians to more accurately describe their level of pain or disability. The in-depth information may result in increased services for chronic conditions and pain management programs.
The bottom line for practitioners is that every member in the practice will need some type of familiarization with ICD-10 coding and/or the procedural changes the transition will engender. A careful analysis must be conducted to identify the level of training and ability each person has to provide effective training for everyone from the front desk and clinical staff to management.
The transition to ICD-10 encompasses much more than simply acquiring the codes and using them. It’s an involved process that requires careful planning, organization, funding and training. With the Oct. 14, 2014 implementation date just a few months away, it’s imperative that clinicians have an action plan in place to meet the deadline. Failure to be ready will result in practices being out of compliance and the denial of reimbursements.
Make A Plan
Planning is key for ICD-10 implementation. The plan must include a timeframe for all the changes and training to be completed, along with a review of the regulations and requirements for transition. ICD-10 can’t be put in place piecemeal. Solicit volunteers or appoint a single individual or team that will be in charge of ensuring each planning step is accomplished.
Break It Down
The transition will include several phases, from the installation of software and hardware to staff training and equipment testing. Break the implementation process into smaller bites to make it more manageable.
Discover if there are any steps or measures that must be completed by a certain time. Clinicians should select a single person or a team to oversee each additional phase of the transition. These individuals will be responsible for ensuring training, IT, software, funding and other associated steps are addressed and completed correctly.
No action plan can be launched without knowing what the impact of ICD-10 will be on the practice. Practices are not the same, even within the same field or specialty. ICD-10 will affect documentation, billing and coding, and the practice’s technology, along with staff education, procedures and funding. An in-depth assessment of the practice and staff will identify areas of concern.
Two of the most critical departments are billing/coding and documentation. Constant and continued communication with vendors, payers and clearinghouses must be maintained to determine compatibility during testing phases. This is also a good time to discover any changes in reimbursements that may be coming in the future. Documentation practices will need evaluation to ascertain if they’ll meet ICD-10 coding requirements.
Implementation is going to be expensive. Funding will need to be secured for a multitude of expenses, many of which may change along the way. There will be costs associated with software upgrades. Practices that opt to maintain their own on-site server will require equipment purchases and advanced security protection.
Until all patient data has been transitioned to the ICD-10 system, clinicians will be utilizing dual coding. The most recent version will be needed in software and printed form. There will be hardware systems to upgrade and software to install. Technical modifications may be required to meet HIPAA standards or meet high-speed data transmission.
Training staff in the use of ICD-10 and new privacy guidelines is necessary, and clinicians should be prepared for a loss of productivity. A wide array of professional organizations and companies offer training in multiple formats. All staff members won’t require the same amount of education and not all people learn the same way.
Training services offer sessions that incorporate eLearning, interactive exercises, and mobile and smartphone applications, along with classroom education, discussion forums, practice tools and simulations. Some customize the training to the individual. Clinicians should ensure that the training entity maintains an appropriate means of ensuring that each staff member is proficient.
Clinicians should be aware that the ICD-10 transition requires new knowledge, skill sets and procedures. Not every staff member may be able to make the transition successfully. New staff may need to be hired to replace those unable to cope with the changes. Training should begin with coders, clinicians, clinical staff and other staff, in that order. Everyone should be aware of the training schedule.
Practices should begin internal testing of their new hardware and software systems to address the inevitable problems that come with such a major undertaking. IT professionals will be a common sight in practices as they perform upgrades, test systems and address problems, all of which can result in productivity losses. Be prepared.
When internal testing is complete, practices should begin testing their systems with clearinghouses, insurance companies, payers and vendors as soon as possible. Staff should know when testing is scheduled and be prepared for interruptions. Conduct simulations and test runs to ensure communication with critical entities and develop a contingency plan for any potential problems.
HIPAA compliance standards must be met for the secure transmission of data. Clinicians work with a host of pharmacies, labs, hospitals and other physicians and they’ll also need to communicate securely and seamlessly with those entities. This is also the time when clinicians should determine which ICD-9 codes they use most often and map them to the ICD-10 version.
Once all system software is working in concert with critical entities, begin dual coding as needed. Create an ongoing plan for determining the source of any errors or problems. Identify any staff members that may need additional training. Additional staff may need to be hired to address back-logs and loss of productivity in the first few months of ICD-10 implementation.
Coding and billing activities deserve special monitoring to ensure continued productivity. In-house billing/coding departments could require additional personnel to maintain a steady workload. The alpha-numeric composition of ICD-10 coding requires billers/coders to switch between their keyboard and numeric pad. It will take extra time to complete the billing process. Any denied claims will need careful tracking to determine where documentation or coding errors may be occurring.
Auditing The Process
There are sure to be glitches along the way, even after several months of ICD-10 use. Processes and procedures throughout the practice have changed. The new codes should be audited to ensure the latest versions are being employed and communication with essential entities monitored for any undetected problems that may have crept in. Most importantly, monitor reimbursements to ensure that pre-ICD-10 implementation amounts have remained the same.
The ICD-10 changeover will be many things – exciting, expensive and frustrating. Creating an action plan will alleviate many of the potential problems. Appropriate training and education is essential and ongoing monitoring of revenues, procedures and processes will ensure a successful transition.
Clinicians preparing and training for implementation of the ICD-10 code set have encountered some unusual results. In an effort to be more specific, eliminate waste, reduce fraud and save money, the ICD-10 codes are very specific, sometimes to the point of being humorous.
Practitioners can now provide coding that may leave insurance companies wondering about their clients and the activities in which they’ve been engaging. Every clinician remembers a strange or unique situation for which they’ve billed – and the difficulty they had explaining it to the patient’s insurance company. The following are some examples of the unusual and sometimes humorous coding available with ICD-10.
Members of the animal kingdom can be unpredictable, but ICD-10 coding points out just how unanticipated some situations can really be, from fast moving turtles to equine collisions. In the animal category, practitioners will find some interesting injuries to be noted and places where the event took place.
- W59.22XA – Struck by a turtle
- W611.2XS – Struck by a macaw, initial encounter
- S30.867A – Anal insect bite, non-poisonous
- V80.730A – Animal-rider injured in collision with a trolley
- Y92.72 – Injury obtained in a chicken coop
All families have problems, but it seems that some clichéd situations are eternal. When families have problems, there’s a code for that.
- Z63.1 – Problem with in-laws
- Z62.891 – Sibling rivalry
- W21.31XS – Struck with footwear
- Z62.1 – Parental overprotection
- Z73.4 – Inadequate social skills, not elsewhere classified
- R46.1 – Bizarre personal appearance
- G44.82 – Headache associated with sexual activity
- R45.2 – Unhappiness
- The arts can be dangerous and that’s amply demonstrated by ICD-10 codes that identify the supposedly safe venues in which to enjoy entertainment, but may not be as protected as individuals might think.
- Y92.253 – Injured in an opera house
- Y9250 – Injured at an art gallery
- Y92.26 – Movie house or cinema
- Y92.251 – Museum
Work-related accidents and injuries are a common complaint for medical professionals and the new codes reflect such injuries. It would appear that some individuals are at high risk of being injured is some unique ways, and some return for an encore performance.
- V97.33XD – sucked into a jet engine, subsequent encounter
- X52 – Prolonged stay in weightless environment
- V95.41XA – Spacecraft crash injuring occupant
- Z89.419 – Acquired absence of unspecified great toe
Leisure time activities account for a large portion of injuries. Sports-related injuries top the list, but there are some lesser known activities that can be just as dangerous. When it comes to leisure time activities, clients are presented with multiple opportunities for injuries.
- V91.07XA – Burn due to water skis on fire
- Y93.D1 – Stabbed while knitting or crocheting.
- Y92.146 – Hurt at prison swimming pool
- T63 – Unspecified event, undetermined intent (to be specific)
Some of the ICD-10 codes bring to mind weird and wacky laws that have outlived their usefulness, but have never been removed from the books. It bears remembering that while some codes were developed to address potential problems and injuries of the future as technology advances, many of the codes currently exist because a particular situation actually happened to someone, somewhere, sometime…