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ICD-10 and DSM-5 Preparedness: Lessons learned from one FQHC

August 21, 2014
by Lisette Wright
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I recently returned from a two-day training where the audience was from the behavioral health and substance use departments of a Federally Qualified Health Center (FQHC). The recently published “ICD-10/DSM-5: Coding, Documentation, and Clinical Diagnostic Training©" course was presented to a very advanced audience of clinicians. During the discussion periods throughout both days, I learned a number of interesting items from the clinicians that (again) validated my perception:

  1. No one in the audience had learned the ICD in graduate school except the physicians;
  2. No one in the audience knew that the ICD-10 Coding Rules and Guidelines are HIPAA-mandated;
  3. Very few, if any, have ever had formal coding and documentation training;
  4. Many have attended ICD-10 trainings or separate DSM-5 trainings sponsored by their state associations or similiar;
  5. None of the trainings covered the combined content in the same manner nor did the ICD-10 training prepare them for the new Rules;
  6. The FQHC compliance officer was concerned about the upcoming regulations;
  7. This particular FQHC happens to have a very large, sophisticated, medical EHR. All EHRs with ICD-10 tables loaded will present significant problems for BH/SU clinicians due to terminology, the granularity of certain categories, and the language differences.

This was a very sophisticated, innovative and leading organization with exceptional senior leadership and a great IT staff. Given the points above, how many of you are truly prepared for the ICD-10/DSM-5 transition? Even if you do not have an EHR yet, the challenges remain. The unpreparedness in the industry is concerning. The good news: there is still time to get up to speed!

Presenting at AHIMA’s 2014 Annual Convention next month on the dual code sets, I will help professionals with understanding the devotion to the DSM. I will also address the delicate balance of approaching clinicians when their documentation is insufficient. A blog here talks of this challenge for all of us in the healthcare industry. If our coding and documentation are insufficient (or not in line with the regulations) to support the more granular and specific ICD-10 codes, then we run a risk at audit-time should we not utilize coders on the front end of the revenue cycle.

This FQHC sets a good example of how to prepare. Learn from them and engage in the following activities sooner rather than later:

  1. Do not delay understanding this transition and the implications for clinical processes. Educate your staff;
  2. Practice dual coding and improved clinical documentation with continual feedback loops;
  3. Develop internal policies and procedures for handling the discrepancies;
  4. Treat the ICD-10 transition just like you would an EHR Implementation: it is a project that will take months, time, effort, resources, and a solid commitment if you are to be ready by the go-live date.

Lisette Wright

IT Consulting for Health and Human Services

Lisette Wright



Lisette Wright, M.A., LP has over 20 years of experience in the healthcare...

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