The saying "the only constant is change" has never been more true than within the realm of health care. Currently, change often comes at such a rapid pace that what is new and improved today is considered passé or outdated tomorrow. While continual improvement is a worthy aim, the process of improvement can often be daunting, if not downright painful. Without an understanding of the value of the improvement or the reason behind wanting to improve, it is difficult to find the motivation to move forward in a concerted effort towards the desired outcome.
Let's take, for example, the change of ICD-10-CM, which is slated for implementation October 1, 2013. Medical Assistants (MA) may pose the questions: "Why does the industry need to make this change?" "How will it be beneficial?" "How will it affect my job?" and "What can I do to prepare?"
If you haven't asked these questions, it's time that you do, because virtually all areas of health care will be affected by ICD-10 implementation. Awareness and proper preparation will be key factors in making a smooth transition. Medical Assistants have always been at the forefront of assisting providers in delivering health care services. Because the role of the medical assistant can be varied and diverse depending on the provider's office methods and procedures, it stands to reason that well informed and prepared medical assistants will prove to be a vital link to assisting physicians in making the transition. Successful implementation will require that all key players are on board to provide effective support as they guide providers through the change in "assisting" them.
During an employer advisory team meeting at our college a few years ago, I recall a medical practice manager making the statement that if two applicants equally trained and skilled in medical assisting were to apply for a position and one had advanced coding skills, he would be more likely to hire the MA with coding skills. As a medical coding program coordinator, this comment piqued my interest and on further questioning, this employer stated that because of the front line involvement of the MA with patient care and front office tasks, this puts the MA in a very unique position. They understand the whole picture and can "connect the dots" in order to assist providers. In addition to clinical skills and knowledge, the cutting edge medical assistant understands that proper coding leads to proper and timely claim submission and payment. This, in turn, leads to a financially sound medical practice. The medical assistant who possesses coding knowledge and skills brings value to their job and builds confidence with their providers.
Why does the industry need to make this change?
Again, change is the thrust behind the need to take the leap to ICD-10-CM. If only medical advances and clinical findings of disease process hadn't been so prolific. If only we didn't have the need for greater reporting ability to track diseases and treatment outcomes to aid in research and developing improved treatment methods. If these changes had not occurred in the health care world, then there would not be a need for ICD-10. But, the advancement of medicine has created the urgent need to increase our capability to capture this data. This has been the catalyst that has catapulted us towards ICD-10. As stated by CMS, "The transition to ICD-10 is occurring because ICD-9 produces limited data about patients' medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full." Yes, the changing face of health care has created the urgent need for expanded reporting. ICD-10 is the answer to meet that need.
How will ICD-10-CM prove to be beneficial?
As humans, we often fear what we don't understand. By coming to a basic understanding of the purpose and value of ICD-10's capabilities, the anxiety can be alleviated. Less anxiety is always a good thing! So let's take a brief look at ICD-10 and what you can expect.
The major purposes of ICD-10 are to elevate the ability to report diagnoses with greater specificity and clinical detail. Consider the value of being able to combine signs and symptoms that accompany a definitive diagnosis with one code. Here are a few examples:
K57.21 - Diverticulitis of large intestine with perforation and abscess with bleeding;
E11.341 - Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema;
I25.110 - Atherosclerotic heart disease of native coronary artery with unstable angina pectoris.
There are combination codes that report poisonings and their associated external cause all rolled into one tidy, concise code: T42.3x2S - Poisoning by barbiturates, intentional self-harm, sequela.
With ICD-10, Obstetric codes will now be reported to identify the trimester, rather than the episode of care as reported with this code: O26.02 - Excessive weight gain in pregnancy, second trimester.
ICD-10 codes will allow for future expansion because of the improved structure of the new system.
Take a look at this helpful feature that allows us to report laterality with one code as illustrated in the following examples:
C50.511 - Malignant neoplasm of lower-outer quadrant of right female breast;
H16.013 - Central corneal ulcer, bilateral;
L89.012 - Pressure ulcer of right elbow, stage II.
From the documentation and coding standpoint, this makes so much more sense to report this way. It makes you wonder why we haven't made the change sooner!
Many of the students who are enrolled in the Health Information Technology courses at our local technical college readily agree that when learning ICD-9 and ICD-10 coding, they find ICD-10 to be easier and more logical than ICD-9. They prefer the clear and full descriptions listed next to each code. No more following indentations that trace back to the category code or having to remember to check for fifth digits!
How will ICD-10 affect my job responsibilities as a medical assistant?
While we don't have a crystal ball that allows us to clearly see all that the future holds with the transition to ICD-10, one thing is certain that wherever the ICD-9 codes are utilized in a medical practice, ICD-10 codes will take their place. Think about where you currently see and use diagnostic codes: When ordering labs or x-rays, scheduling and obtaining pre-authorizations for procedures, reporting to government health agencies, maintaining EMR databases and super bills with annual updates. While this list is not exhaustive, it does help to sketch a picture of some areas that will be affected.
As a medical assistant, much of what you bring to the table is to offer support wherever needed to promote the efficiency and effectiveness of a medical practice. Because of the unique vantage point of the medical assistant, there are some real opportunities for job growth and expansion of responsibilities.
I recently met a very well trained medical assistant who had been working with a growing family practice clinic for a number of years. As is the trend today among medical practices, and what is positioned to be the mandatory wave of the future, the practice where she was employed made the decision to transition to an electronic medical record. Without even formally applying for the position (because frankly there was not a "job description" for what this MA was about to undertake), this medical assistant found herself jumping in to make sure that the functionality, process flows, and operability of this system worked for the providers and staff. This medical assistant saw a need and without hesitation stepped up to the plate and hit a home run! Over time, this MA became the "go-to" person for any questions or issues that surrounded the EMR. She became invaluable to her providers and office staff. Now, picture this same scenario, only replace the EMR implementation with ICD-10-CM implementation. Are you beginning to form a vision?
Defining Your Fate
A few lines from William Ernest Henley's Invictus offers a grand perspective:
It matters not how strait the gate,
How charged with punishments the scroll.
I am the master of my fate:
I am the captain of my soul.
As medical assistants embrace the changes that lie ahead with confidence based on an understanding of the purposes and benefits of ICD-10-CM, they will no longer fear the implementation, but see it as an opportunity to be part of a dynamic era in the history of health care. Medical assistants will see that they are the "masters of their fate" and envision tremendous opportunities that lie ahead.
Marilyn Holley, CPC, CPC-I, RHIT
Marilyn earned her degree in Health Information Management from Weber State University in 1992. She was a coding/data/medical records manager for a multispecialty clinic in Ogden, UT, and has over 15 years of experience in ED provider/facility coding. She has also been an AAPC (www.aapc.com) workshop presenter on diverse coding and practice management topics over the last 5 years.
