By AHIMA Staff
The United States is one of the last countries to switch from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th Revision, Clinical Modification, Procedure Coding System (ICD-10-CM/PCS). The compliance date for implementation of ICD-10-CM/PCS is October 1, 2015.
During an AHIMA Foundation Research Forum session on Sunday, Valerie Watzlaf, PhD, RHIA, FAHIMA, and Patty Thierry Sheridan, MBA, RHIA, FAHIMA, presented findings gathered in their study on physician perceptions of the ICD-10 transition titled “Physicians’ Outlook on the ICD-10-CM/PCS System and its Effect on their Practice.”
The objectives of this research were:
- Evaluate physicians’ perceptions on the change from ICD-9 to ICD-10 and its effect on their practice.
- Determine how health information management (HIM) professionals can assist in this transition.
- Assess what resources are needed to aid in the transition.
Sheridan said she and Watzlaf “wanted to understand what role HIM professionals could play to help transition physicians to HIM.”
Methods and Measurements
Sheridan and Watzlaf developed focus group questions around eight major content areas:
- The impact of ICD-10 and electronic health records (EHRs)
- Billing and reimbursement
- Clinical documentation improvement
- Data mining
- Training and development
- HIM assistance
- Top priorities
- Qualitative data were analyzed using NVivo software and qualitative analysis.
Physician Focus Groups Convened
A total of 20 physicians were asked to participate in one of three focus groups. Twelve physicians representing multiple specialties and geographic areas agreed to participate. The moderator of these virtual focus groups was a physician and an AHIMA-approved ICD-10-CM/PCS trainer.
Three types of questions were posed to the physicians including engagement, exploration, and exit questions. Examples of engagement questions were, “What do you know about ICD-10?” and “How has your office/organization begun preparing for the transition?”
Interestingly, even though the research focus was on ICD-10, physicians instead expressed frustrations with the inefficiency and distracting nature of electronic health records.
A few of the exploration questions surrounded coding training and general concerns about ICD-10. The exit question was “What is your top priority in the transition to ICD-10?”
A common theme that came out of the research, said Watzlaf, was that “most physicians were concerned about how specific our documentation has to be.”
Another was concerns about obtaining accurate reimbursement. Three-quarters of the respondents stated that they do their own coding or oversee coding at their facility, while the rest outsource their coding.
“One physician was thrilled that the codes were more specific to describe high-risk patients,” Watzlaf said.
Another prominent concern for physicians was getting the hospitals they practice in to train them on their inpatient documentation needs. Many thought that hiring an HIM professional to assist with coding in their practice was very important.
A key takeaway was that physicians don’t need to know everything about ICD-10, they just want to know what is specific to them and their practice.
Physicians said HIM professionals could help them with their ICD-10 transition by:
- Creating a crosswalk of codes to convert to ICD-10 by specialty
- Identifying changes in documentation
- Listing the 10 most common diagnoses and documentation needs
- Having an “ICD-10 for dummies” by specialty
- Explaining why claims are being rejected
- Educate billers and coders on how to maximize reimbursement
- Feeding them information and making it more efficient
- Providing training appropriate for physicians
- Developing a crosswalk between DSM and ICD-10
Top priorities for physicians making the transition included EHR software readiness, increasing documentation specificity and time, the ability for healthcare professionals to learn a new language, and overcoming the inadequacy of current training methods and content.
Physicians also discussed advantages of the new system, such as improving data mining and being better able to demonstrate the complexity of patient cases by using more specific codes.
ICD-10 Increases Level of Detail
Respondents reported that ICD-10-CM/PCS will lead to increased specificity and will have a major impact on healthcare services since the level of detail in the documentation will need to increase, according to Sheridan and Watzlaf. ICD-10 will improve the ability to show the complexity of patient cases, which may lead to improvements in the quality of patient care, demonstrated outcomes, and reimbursement.
HIM professionals are needed during the transition to create simple, clear specialty guides and crosswalks as well as education and training tools specific for physicians.
Watch for this full research study in an upcoming issue of Perspectives in Health Information Management.
"How Physicians See ICD-10, and Its Effect on Their Practice"
(Journal of AHIMA website),
September 28, 2014.