In the last ICD-10 column’s topic on Organizational Readiness to begin your ICD-10 Transition, I referred to the ICD-10 Project as a “maze.” This reference was a high-level statement about putting a Project Team into place and getting buy-in from all stakeholders. With change management strategy comes the need for education. Everyone must understand both why a change is happening and what it means for them. Author Peter Block eloquently speaks of this notion in his writings on organizational change management and building a communal consensus among everyone in the system.
Two educational points need to be conveyed as your Project gets underway:
Staff at every level do better with change when they are given the context for why they are being asked to do things differently. The context for the ICD-10 transition can be explained in the following manner: The ICD-10 (International Classification of Diseases, Tenth Version) was published by the World Health Organization (WHO) in 1994 and has already been in use by most countries of the world. The USA is one of the last countries to adopt the ICD-10. According to the WHO, the ICD “… is the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups.” Epidemiology tells us that a certain percentage of the population suffers from mood disorders, chemical use, or other conditions. This information is critical to the advancement of how we treat and study mental illness and substance use.
We have no choice but to change in order to keep to our mission and commitment to providing the right treatment, at the right time, in the most effective manner. The ICD-10 accommodates the need to integrate behavioral and physical health across all sectors of healthcare.
The ICD-10 is very detailed and complicated. Most clinicians are not used to thinking twice about a diagnostic code they assign to a consumer, what happens next, or the role of diagnosis codes in the revenue cycle. That is because they are used to using the DSM-IV-TR: that numbering system aligned very nicely with the previous version of the ICD, the ICD-9. ICD-10 coding is very different and everyone will have to learn the new coding system, the alpha-numeric logic, and increased digit capacity of the codes which multiplies the choice of a diagnosis from 1 code to potentially 15 options in the ICD-10.
Getting from the old numeric system to the new, expanded system is no easy task. “Crosswalks” help, but the bottom line will involve clinical judgment in order to support the very specific code assigned. With software programs scanning your claims and audits on the increase as a result, assigning a general diagnosis (“other specified”) will not work anymore. Among the details that will need to be taught and conveyed to staff are: how to get from the DSM-IV-TR code to the new ICD-10 code, how and when the DSM-5 is involved, and choosing a very specific diagnosis that will be required by the ICD-10. For example, one diagnostic code for Primary Insomnia in the DSM IV TR now has an option of 6 different codes and other qualifiers in the ICD-10 (F51.0 section). The ICD-10 Substance Use codes are overwhelmingly complicated.
This will be tedious. Understanding the details will enable your organization to position itself for the Transition, defend your clinical documentation and billing practices, and ultimately, be in compliance with the ICD-10 Transition mandated for October 1, 2014.