Children's Healthcare of Atlanta

SYS 953736 MedClips July.Aug 2013

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The new system will impact Quality, Finance, Patient Access, Revenue Cycle and Compliance and other departments. to say, for example, a patient has mild, intermittent asthma—aligning with terminology used by the NIH Heart, Lung and Blood Institute." The difference between clinical reality and how it is recorded affects the study of medicine and the establishment of a more universal medical home for patients. Creating a more universal experience For even the most common diagnoses, ICD-10 CM will give physicians the ability to more specifically record a patient's pathology, allowing payers, specialists and other pediatricians to better understand the severity of a child's condition—without heavily relying on parent reporting. - Jennifer McCollum Director, Coding and Clinical Documentation "A great example is a parent who is In addition to having access to coding not giving their child the full dose of support provided by employed American medicine because the family can't afford Health Information Management the medicine due to lack of adequate Association (AHIMA)-approved ICD-10 insurance coverage," Linzer said. "In CM/PCS trainers, Children's physicians ICD-9 CM, the only way to demonstrate will have access to learning modules for that is with the code for 'noncompliant additional training based on case studies with care.' In ICD-10 CM, there is a to provide a more hands-on learning unique code to indicate the patient experience. is not receiving the proper dose of medicine due to financial hardship." This detail can prompt physicians "With a condition like otitis media, the to offer referrals for free services or physician may write ROM, for right otitis financial support to ensure that a patient media, but when that gets translated into receives adequate care. ICD-9 CM language, it says nonspecific ear infection," Linzer said. "What isn't recorded is whether it is acute or chronic, and it also doesn't record the presence, or the variety, of fluids behind the ear. The code really doesn't provide much information at all." While ICD-9 CM has codes to show this basic information, There are many benefits to the new system for both patients and physicians, but in the short term, an emphasis on training is critical to receiving timely approvals from payers as well as limiting disruptions in the billing process. The transition to ICD-10 will be felt by practices of all sizes, whether it is a smaller practice or a larger hospital system, such as Children's. It would be misleading to say that the impact will affect only physicians and the medical coding team. "The new system will impact Quality, Finance, Patient Access, Revenue Cycle, Compliance and other departments throughout Children's," McCollum said. Because mistakes or inconsistencies in documentation and coding can potentially A conversion in process affect so many different areas, quality ICD-10 CM will allow for much greater specificity. "Payers will expect better Expanding medical coding and training process. "By conducting internal documentation of the diagnosis documentation requirements will require quality monitoring, our coding staff is regardless of which system we use," administrative and clinical staff to work audited on a monthly basis. We take a Linzer adds. together to ensure a continued level sample of their work and compare it to the of accuracy. With increased reliance on actual documentation in patients' charts to EHR, improperly documented and coded ensure coding assignment accuracy." For patients with recurrent conditions, physicians will now be able to pull from a patient's electronic health record (EHR) the frequency, severity and laterality of conditions. ICD-10 CM will allow checks are an important part of the medical care not only has implications for patients, but it can also carry significant As the October deadline approaches, penalties from the federal government. physicians and administrative staff need to be prepared for a great leap forward physicians to more easily obtain prior "Our staff is undergoing additional in the ability to accurately record the care approval, as in the case of recurrent training in anatomy, physiology, medical provided every day—to the benefit of otitis media, for the escalation of care to terminology, as well as specific ICD-10 research, utilization management and, an otolaryngologist or the insertion of CM and PCS coding training," said ultimately, the patients and families who pressure equalizer (PE) tubes. In addition Jennifer McCollum, Director, Coding and depend on accuracy in medicine. to the escalation of care, ICD-10 CM will Clinical Documentation. "This equates help establish contextual information to to about 70 hours of additional training aid physicians in better understanding per staff member, to prepare them for the compliance and access to care issues. transition to ICD-10." Visit www.choa.org/ICD10 to register for training. July/August 2013 | 9

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