ICD-10 Readiness and the CAC Advantage
By Allison Errickson, CPC-H, and Maria Bounos RN, MPM, CPC-H
Computer-assisted coding technology is becoming a critical piece of the ICD-10 readiness equation as hospitals seek the most efficient and effective road to compliance.
As healthcare organizations plan their ICD-10 transition strategy, many are discovering that the effort will touch nearly every area of operations. It’s an overwhelming proposition for many providers in light of the sheer number of regulatory initiatives vying for staff resources and budget line items.
Nevertheless, it’s a coming reality and a necessary step in the right direction to bring the US healthcare coding system into the 21st century. To adequately prepare, hospitals need to consider all the tools at their disposal to minimize the impact to patient care, compliance, workflows, and revenue cycle.
Clinical documentation and HIM professionals certainly will be the heavy lifters when it comes to successfully navigating the transition and learning curve to ICD-10. Most healthcare organizations understand it will be impossible to expect coders to be fully prepared to make the jump from the current 17,000 ICD-9 codes to the 141,000 ICD-10 codes through education alone. That’s why the use of computer-assisted coding (CAC) tools is emerging as a critical component to a successful ICD-10 readiness strategy.
By automating complex coding processes, CAC replaces manual workflows and provides an efficient way for coders to analyze data, diminishing the potential for error and negative impact to productivity. Hospitals trying to make the ICD-10 leap without automated tools can expect to experience a costly drain on resources and severe coding backlogs.
Understanding CAC Methods
Tools that automate medical or surgical code placement generally use one of two approaches for data flow: natural language processing (NLP) and structured input. While both approaches have the potential to streamline and automate coding processes, structured input provides a foundation for ensuring the correct language is used for accurate coding. It also alerts clinicians when further documentation may be needed to capture detail that accurately reflects the complexity of a procedure or severity of diagnosis.
NLP software employs a technological framework that pulls key data from unstructured or free-flowing text to identify the appropriate codes needed for billing. This text may come from physician dictation, speech recognition, or documentation typed directly into an EMR. Once potential codes are identified, a coder edits the results for accuracy.
In the case of structured input, drop-down menus containing clinical terminology associated with a patient’s condition are provided for physician use. Once chosen, these individual menus produce a narrative text phrase that becomes part of the documented record.
While the process of using structured input still may be foreign to many physicians, it is becoming more mainstream as hospitals look for efficient and effective ways to address computerized physician order entry. The overriding benefit to this approach is that the documentation provided through the drop-down menus is coding ready. The preset documentation allows CAC tools to become more accurate in identifying the best codes, requiring less human intervention after the fact.
That’s not to say structured-input eliminates the need for coding professionals. Regardless of the CAC framework, there will always be a need for final review and editing.
In the case of NLP, the need for reviewing and editing becomes even more pronounced because the CAC application relies on clinicians to dictate and document in a way that meets coding criteria. It simply comes down to “garbage in, garbage out.”
When physicians dictate free text, the recorded narrative may or may not say what is needed for CAC tools to accurately identify an appropriate code. When pull-down menus are developed to be coding ready, there is simply less chance for error.
Also, one primary motivator behind hospitals seeking to invest in CAC is the desire to minimize the need for extensive physician education and training. If documentation deficiencies are addressed before there is an opportunity for error, then CAC tools are most effective in helping hospitals achieve this goal.
With structured input in place, physicians are guided to the best documentation paths, enabling CAC tools to accurately identify the best code. With NLP, physicians will still need extensive training that addresses the detailed documentation needs for ICD-10.
Whether a hospital chooses to go the NLP route or use tools based on structured input, CAC remains the best practice to improving manual workflows and accuracy.
What to Look for in a CAC Solution
On a basic level, CAC software should enable coders to review and validate coding output for compliance covering the regulatory landscape, reporting initiatives, and specific policies and rules by payer. This way, before a bill leaves the hospital, there is confidence that there will be minimal effect on revenue cycle and the potential for compliance backlash.
When choosing a CAC vendor, hospitals should verify that ICD-10 code sets will be delivered well in advance of the transition date to allow enough time for training and testing. CAC tools that integrate regulatory and reimbursement information provide an added benefit on top of helping successfully transition to ICD-10.
The availability of a research portal is another important consideration. When research portals accompany CAC tools, coders are armed with an efficient way to identify codes and find the necessary research to support their decisions. Instead of just trying to stay up to speed with ICD-10 changes, coders can move to a more advanced analysis of documentation or aggregate data to stay in compliance with regulatory changes.
Some questions to ask your CAC vendors to assess ICD-10 readiness should include the following:
• What is the schedule and cost associated with providing ICD-10 code sets?
• What is the impact of the new code set on the current system, the end user workflow, and interfaces?
• What training is involved, and will the vendor provide the training?
• Will the vendor provide tools to assist coding professionals’ understanding of the code set transition from ICD-9 to ICD-10?
• How long will the vendor support the ICD-9 code set post transition to ICD-10?
Making the leap to ICD-10 is expected to be one of the most daunting tasks healthcare organizations will face in the near future. With so much activity tugging at hospital resources, the ability to minimize revenue and workflow disruptions during this transition phase will be critical.
Simply put, hospitals that do not have a comprehensive ICD-10 strategy that includes CAC tools are positioning themselves for revenue cycle challenges and coding backlogs. It’s only one piece of the strategy, though, and managers who are approaching ICD-10 preparedness realistically know it will take a solid marriage of both clinical documentation improvement strategies and technology to comply going forward.
— Allison Errickson, CPC-H, is director of coding compliance for ProVation Medical, part of Wolters Kluwer Health.
— Maria Bounos, RN, MPM, CPC-H, is the business development manager at Wolters Kluwer Law and Business.