PIVOT Points

ICD-10: Save your clinicians’ time spent gathering documentation

Give your doctors documentation tip cards or checklists for common home health diagnoses. Doing so will save home health coders and nurses time.
Having your marketers offer such educational material to office managers and discharge planners will help limit productivity delays your agency’s nurses and coders will face in ICD-10, starting Oct. 1, says consultant Arlene Maxim of A.D. Maxim Consulting in Troy, Mich.
The need for agencies to guide doctors about ICD-10 becomes even more crucial now that CMS and the AMA announced that a lack of code specificity under ICD-10 will not necessarily cause claims denials for Part B providers until Oct. 1, 2016.
Contractors will be instructed not to deny practices’ claims based solely on the specificity of the ICD-10 diagnosis code as long as the physician used a valid code “from the right family.”
In certain circumstances, however, claims may be denied because codes aren’t consistent with applicable policies such as Local Coverage Determinations or National Coverage Determinations. Plus, any break doctors might get from Medicare doesn’t apply to Medicaid or private payers.
Under ICD-10, a home health coder might be coding an episode and realize that based on the documentation available to her it’s unclear whether the myocardial infarction (MI) was acute or when the MI occurred, says Trish Twombly, senior director for DecisionHealth in Gaithersburg, Md. Depending upon the agency, that coder might ask the nurse to call the doctor’s office and gather the necessary information.
It might slow a nurse’s productivity 30 minutes per patient to go back and track down such information, Twombly says.
An ICD-10 documentation checklist could be a simple form you can hand doctors. It would ensure doctors provide the patient paperwork your agency will need to code in ICD-10 without clinicians being tasked with making multiple follow-up calls, Maxim says.
Maxim says a general checklist should include: Most recent history and physical; most recent progress note; list of current medications; most recent laboratory report; most recent X-ray report; most recent EKG summary; and immunization dates for the flu and pneumonia. She suggests you take that general list and modify it to add the details you’d need doctors to provide when referring patients with the diagnoses most common at your agency.

Survey shows agencies’ ICD-10 prep

Most agencies expect their clinicians’ productivity to decline due to ICD-10, but they aren’t certain just how long declines will last.
About 59% of agencies expect productivity decreases from their clinicians, according to the 142 respondents to a question in HHL’s 2015 Productivity Survey. (See chart )
About 20% of agencies expect productivity to return to normal within weeks, 18% believe productivity will return to normal within a few months and 13% believe productivity will to normal within several months.
While most agencies do believe there will be a productivity decline, few agencies plan to adjust visit productivity standards during the transition to ICD-10. Only 17% of agencies plan to adjust standards while 37% aren’t sure.

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