Claims Management News

How the ICD-10 Transition Deadline Changed the Nursing Role

By Vera Gruessner

- The October 1st ICD-10 transition deadline has passed and the healthcare industry still seems to be holding steady. However, only time will tell whether healthcare payers and providers were truly ready for the move to the new ICD-10 coding system.

ICD-10 Coding System

Billing coders, insurance specialists, doctors, nurses, and more within the healthcare field have had their workflow affected by the ICD-10 transition deadline. Many have gone through training sessions and implemented new software products to ensure they are properly reimbursed when the new codes are adopted. To learn more about how the ICD-10 transition deadline has affected the nursing profession, HealthPayerIntelligence.com spoke with Dr. Elena Capella, a professor within the school of nursing at the University of San Francisco.

HealthPayerIntelligence.com: What are the biggest challenges for nurses when it comes to the ICD-10 transition deadline? And how is the healthcare industry overcoming these obstacles?

Dr. Elena Capella: “For nurses, the big challenge – which is always a challenge – is documentation and having complete documentation that really tells the patient’s clinical story. Nurses are highly trained right from the beginning about being very careful with their documentation and being very complete and descriptive.”

“Generally, nurses are prepared. What happens with the ICD-10 codes is higher demand as far as descriptive documentation. There will be a lot of analysis of the medical record by medical record coders to make sure all of the elements necessary for the diagnostic code are included in the medical record. For nurses, what that means is that there will be more demand to make sure that nursing is documenting with enough description in the medical record.”

“Nurses are highly trained. They’re used to this. They probably are already documenting enough, but there will be more interest and more demand on making sure the documentation is complete. That will be the big challenge.”

“Every organization has started to prepare for the ICD-10 codes. Generally, organizations will have audits going on. They’ll look at their top diagnoses. They’ll make sure they have enough documentation. They probably already started having meetings on specific diagnoses and the new demands as far as the descriptions and what should be included in the medical record. There already have been efforts to get ready and prepared for the ICD-10 codes. In fact, they’ve been postponed so long, I’m sure healthcare providers have spent years anticipating the new diagnoses codes.”

HPI.com: What steps are providers taking to ensure claims processing and financial analysis stays stable now that the ICD-10 implementation has begun?

EC: “I’m sure among larger physician practices that are part of a healthcare system, there’s been some modeling done as far as looking at those top codes, comparing ICD-9 to ICD-10, and seeing projecting how the payment structures might be different or how documentation shapes up. I imagine that there’s been a lot of modeling particularly among large organizations.”

“For smaller healthcare organizations and smaller physician practices, it’s probably harder to come up with those software systems to do modeling. I imagine though that most healthcare providers are looking at those frequent diagnoses, looking at the differences between the ICD-9 and ICD-10 codes, and looking at how their documentation will shape up as far as these two different systems.”

HPI.com: What software products and technologies are nurses currently being trained to use to keep up to date on ICD-10 codes and billing?

EC: “For the most part, nursing isn’t involved in the technical aspects of the codes. They’re using electronic medical records in order to document clinical findings and interface with the client.”

“They’re using electronic medical records in order to capture the clinical picture for the patient. The real software is in the medical records department where the coders are actually abstracting the data. It’s the coders who are the unsung heroes of the ICD-10 codes because they’ve been prepared for years now for these codes.”

“They’ve been going to workshops. They have updated software to predict and model the different elements of the codes and how the documentation would categorize into the different codes. Usually, the software is used by the medical records personnel who are actually abstracting the medical record and assigning the codes. The nurses are basically documenting in electronic medical records. There have been updates to the electronic medical records. Of course, all of them comply with ICD-10.”

HPI.com: How is the role of the nurse changing now that the healthcare industry has switched over to ICD-10 codes?

EC: “I think nurses can expect to be more involved in discussions about how information is collected and how information is abstracted for the codes. You will see more nursing involvement in committee work where there is discussion about problems with documentation or need for more descriptive documentation.”

“While nurses have generally done their work and documented what they see in the medical record, I think what they will find is that there will be more nurses involved in committee work to actually plan how to improve or change documentation or even change the electronic medical record so that it does collect the kind of description needed for ICD-10.”