After spending a week training clinicians at two free-standing psychiatric hospitals, it remains clear to me that the state of readiness for DSM-5 and ICD-10 in our industry is concerning. In addition to the weeks work, I saw a number of items crossing the newswires that worry me.
The first has to do with the EHR's in our industry and the way the codes are displayed. As an EHR system administrator, I also have hands-on experience with the way ICD-10 and DSM-5 tables, descriptions, and codes appear. For the End User, ICD-10 will not be friendly or fun. For example, some systems “search” feature produces very awkward results, including physical health diagnoses with names you cannot begin to pronounce. Many people are still saying “My EHR will take care of ICD-10.” This is simply not true. As the clinician, you must choose the correct diagnosis, keeping in mind that “cross walking” or converting DSM-ICD is not easy. What should you do? At a minimum, figure out how the codes and descriptors work in your system and train your staff well before October 1, 2015.
The second item has to do with most organizations top diagnoses. NOS is a favorite for some organizations. For others, a general diagnosis such as PTSD will disappear from the radar and clinicians will have to choose one of three flavors moving forward: Acute, Chronic, or Unspecified. I am concerned that auditors will have a heyday with us when they see all of our NOS diagnoses, especially after we have treated someone for any extended period of time. What should you do? Run a report, learn the corresponding ICD-10 codes, and figure out the documentation requirements to support the diagnosis.
The third item is regarding ICD-10 training in our industry. Sadly, it is virtually non-existent. Organizations are hiring “trainers” that do not fully grasp what is happening in our industry. AHIMA ICD-10 trainers, certified coders, Health Information Technology Project Managers, RN’s are all very qualified in the healthcare arena to train on ICD-10, without question. However, organizations do not realize that the trainers will not be clinicians in our industry or have the background and knowledge of the DSM. Unless you pay attention to who you are hiring, you may end up doing a second training of your staff just to address the clinical issues pertinent to us. What should you do? Ask proposed trainers for evaluations from previous ICD-DSM trainings and ask them to show you the curriculum they will teach. That will help you determine if the potential trainer "gets it" or not.
If you would like to hear more about the state of readiness in our industry, come to the 15th Annual Behavioral Health Information Management Conference and Exposition in Long Beach, CA on April 15th and attend, “Transitioning to ICD-10 and DSM-5: How Treatment Organizations, EHR Vendors, Health Plans, and Others Have Mobilized to Address the Challenges.” Good luck with your readiness planning!