EMS providers keep hearing that better documentation will be needed in order to bill for ambulance claims once ICD-10 arrives in 63 days. It’s true; documentation will need to change to reflect the needs of ICD-10. But what does that mean to the average emergency provider? And is this new system only about the money? With a better understanding about the goals of ICD-10, emergency providers will soon see that the quality of their documentation has the potential to make a tremendous impact on public health and safety. Below we will look at how ICD-10 approaches the mechanism of injury in two scenarios so that we can understand what will be needed in field provider documentation of emergency calls. First, however, we’ll review the goals of ICD-10 to appreciate why this change is concerns much more than the just the money.

The International Classification of Diseases (ICD) is the coding system by which every medical service is designated on a claim for reimbursement purposes. Though ICD coding is a mechanism for payment, the system was designed to promote international compatibility and comparability in the presentation of statistics regarding healthcare services and to allow for a smooth claims processing system for payment. Every type of healthcare service rendered by physicians, hospitals, healthcare practitioners and EMS providers can be classified and grouped for statistical analysis. ICD-9 is the system that has been in use since the 70’s; healthcare long ago ran out of ways to describe what happens today in medical settings. We graduate in October to ICD-10 going from the 13,000 codes available now under ICD-9 to over 68,000 codes under ICD-10. The change allows more in-depth description of the type of healthcare service we provide. The goals of gathering better information about emergencies via the use of ICD-10 is to help us prevent injuries and deaths.

For EMS, this means that there will be a better way to track the external cause of injuries. Therefore, we need to do a good job of documenting the mechanism of injury. In so doing, the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), and the National Center for Injury Prevention and Control (NCIPC) can analyze the data and disseminate the findings to help prevent injuries and death. Let’s look at two types of emergency and how the documentation will need to change to enable collection of quality data.

Take the patient who nearly drowned. Under ICD-9, the emphasis was on the activity that occurred at the time of the event, for example, swimming or diving. If the provider responded to a near-drowning victim who had been swimming or diving, there was no way to code information about where an event occurred or how it happened. Yet information about where an event occurred could help prevent a future tragedy. Under ICD-10 coding, details will be needed about the type of water involved (for example, swimming pool, natural water or bathtub). Having statistics on where near-drowning events transpire may lead to better safety measures and education that prevent drowning accidents. In this case, emergency providers’ documentation about the mechanism of injury can make a difference to public health and safety….as well as enabling the claim for emergency service to be properly designated and filed for reimbursement.

Under ICD-9, accidents involving transportation were grouped by the type of vehicle involved in the accident. For ICD-10, we need to understand not only the mechanism of injury (motor vehicle accident involving an SUV engaged with a school bus on a highway overpass) but also the characteristics of the person who was injured (passenger in an auto, pedestrian or a two-wheeled or three-wheeled cyclist). Again, gathering data about the types of transportation that lead to injury as well as data about the characteristics of the person injured can help us develop methods to avoid certain types of accidents in the future.

EMS has always been about patient care and community response. The beauty of ICD-10 is that there will be greater emphasis on documentation about the patient, the history of the present incident and the impact the event had on the patient’s body – in essence, the “where, what and how” of the mechanism of injury. These were always the basics of good EMS response and care. Now we will finally have a method to better track what EMS does…and hopefully the feedback from that information gathering will eventually improve the health and safety of our communities.  That’s a very good thing!

If you need help preparing your crews to document for ICD-10, check our website for online documentation training for field providers which you can easily access repeatedly for crews and new hires.

About the author:  Maggie Adams is the president of EMS Financial Services, with over 20 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. Check out our newest documentation training webinars and billing webinars on our website. Friend EMS Financial on Facebook, or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com