The Importance of Having an ICD-10 Champion on Your Team


2818462063 05f06b31b8 Medical care providers all know that beginning in 2015, claims for reimbursement must use ICD-10 billing codes. Claims using the old ICD-9 codes for any services provided after the change takes place will be rejected.

There is a lot of concern within the healthcare industry about the costs that will be incurred in the transition process. Use of the wrong code may result in reduced reimbursement or total rejection of the claim. Some have referred to this change as the biggest challenge facing health care providers since Medicare came into being in the 1960s.

Much is being written about how to prepare for ICD-10. The emphasis is on training the medical billing and coders on how to make the transition from the 13,000 ICD-9 codes to the 69,000 ICD-10 codes. The World Health Organization (WHO) has training tools available for billers and coders as does the Healthcare Information and Management Systems Society (HIMSS).

Unfortunately, very little is written and few resources provided on physician education as an important factor in how to prepare for ICD-10. Physicians need to learn how important it is for them to properly document their care in order for coders and billers to be able to fulfill their important role in the new billing scheme.

Selecting an ICD-10 champion.

Hospitals and medical practice groups of all sizes are now focusing on physicians and their documentation of patient care as a major aspect of how to prepare for ICD-10. Experts recommend that each healthcare entity select an ICD-10 champion from within their current staff. There should be a champion from each specialty area in multi-specialty practices in order to concentrate on how to prepare for ICD-10 within that specific area of practice. 

Champions are trained in the codes for their specialty area and documentation required to support the billing codes. They need to be willing to convey to their peers the value of the documentation and how it relates to proper reimbursement.

Why physician champions are needed.

·         Physicians respond best when other physicians are the ones educating them on how they need to improve their documentation.  They are not interested in codes, but are interested in providing a high level of patient care.

·         Champions can convey to their peers the connection between ICD-10 codes and improved patient care requiring more specific documentation. With emphasis on patient care instead of coding, physicians will be more receptive to the change.

·         For some practices, not much has changed. For other specialties, thousands of codes have been added.  Physician champions for a specialty area can focus on the documentation of care specific to their specialty. For example, for orthopedists treating a fracture, new codes require specificity as to location of the fracture, whether it is an initial encounter or some type of follow-up appointment and the level of healing at the time of each appointment. While this specificity is required for ICD-10 billing, it also enhances the management of patient care.

·         Champions can increase motivation of providers by emphasizing the positives of the new system, including more timely and accurate payments, fewer claim denials or returns for more information and improved patient care based on the documentation.

·         Champions engage their peers into viewing the codes as management tools for improving patient care instead of simply a burdensome bureaucratic requirement for getting paid.

For more information on ICD-10 coding feel free to visit us at Healthcare Information Services.