Getting Physician Attention, Buy-in for the ICD-10 Transition

April 25, 2014

Whether you have one physician or 17,000 to prepare for the ICD-10 transition, here's how to get them invested in implementing the new coding system.

"If you can order coffee at Starbucks, you can do coding," said James M. Taylor. "That's what we tell our doctors."

And with that statement, Taylor, the physician director of coding and revenue cycle for Kaiser Permanente, made understanding, adopting, and using more than 70,000 codes under the ICD-10 coding system a little more palatable for your average doctor.

Taylor was a keynote speaker at the American Health Information Management Association's ICD-10 and Computer-assisted Coding Summit, held in Washington, D.C., April 22 and 23.

Taylor played a key role in preparing Kaiser's 17,000 physicians for the ICD-10 transition, originally slated for Oct. 1, 2014, but now in limbo.  No matter the volume of physicians your practice needs to prepare, Taylor said the first key step to make ICD-10 more accepted is to get physicians engaged in the transition from the start.

"You need to get physicians involved early on," he said. "Change is always easier with you than to you … And ICD-10 is not that big of a deal for a majority of your physicians." 

Kaiser enlisted physicians as part of its ICD-10 work groups to help ensure it made reasonable ICD-10-related decisions and that the messaging coming from the top down came from the physicians' peers in plain language.

"I can turn coding speak to physician speak," Taylor, a former private family physician in Ohio, said. "Find a doctor [in your practice] to talk to the others."

The work groups came up with 10 guiding principles for diagnosis documentation and coding for ICD-10, including that physicians "tell us what they know," and be sure they are making diagnoses relevant and consistent with their level of clinical expertise. So primary-care physicians would rely on their referring specialists to get to the root of the issue versus guessing on the proper diagnosis and code.

From Coffee to Coding

But what about getting physicians to understand the new codes in ICD-10 when they've been using ICD-9 for years? How do you get them to essentially adopt a whole new language?

That, Taylor said, is where Starbucks comes into play. "At Starbucks, the customers have learned their jargon; it's usually vice versa," he said. "[Customers] just want a cup of coffee … but there are too many variables."

So if you know what you want - coffee - you just need help with the rest: Is it venti or grande? Whole milk or skim? Hazelnut or caramel?  It's the same with ICD-10 codes, said Taylor.  Physicians know what they want - to code a hip fracture, for example - but need help with the rest to complete the code: What type of fracture? What's the encounter type? What's the laterality?

The answer for Kaiser was to create an ICD-10 calculator tool that would help fill in the blanks to move from the ICD-9 code to its ICD-10 successor. "We said, give me what you got [for the purpose of the visit] and we'll get you the rest of the way [to get to the right ICD-10 code]," he said. "[Physicians] don't need to know the lingo [in this case, the code number], it's spelled out for them."

And what began as a coding tool quickly became an educational one, noted Taylor.

"Like Starbucks, after a while, you know how to order," he said. "And it became the same with our doctors and codes. Later on, when they went to enter [diagnoses], they didn't need the calculator. It turned into a teaching tool."

The ICD-10 calculator tool was only one part of ICD-10 education, said Taylor.  At Kaiser, on top of the 17,000 physicians, there are 49,000 nurses, and thousands of others who play a part in getting to the right ICD-10 codes.  So Kaiser split its training into three groups: those who see the diagnosis, those who use the diagnosis, and those who make the diagnosis.

For physicians - those who make the diagnosis - training time and detail largely depended on specialty. Primary-care physicians trained for a shorter period of time and mostly online, whereas OB/GYNs and those in orthopedics, just two specialties where the ICD-10 codes are more numerous and the changes greater, trained longer and had more face-to-face sessions.

"One size does not fit all …and dividing the training made sense so everyone doesn't sit through things that don't apply to them," Taylor said.