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CDI: Just Tell Me What to Say

Unspecified

Published May 25, 2011 12:06 PM by Alice Zentner
Blog titles are supposed to be catchy to get your attention and make you want to read further. At least, that is what I was told. A blog titled "unspecified" is not something most people would understand and be drawn to. But, if you work in the world of HIM coding, or clinical documentation improvement, then you know that ‘unspecified" has ramifications. 

The transition to ICD-10 has the potential to greatly increase the number of unspecified codes. This could cause many problems for your institution. For starters, unspecified typically drives lower reimbursement to your facility. Lowering your revenue in a time of increased expenses driven by healthcare changes is not a formula for job security. Secondly, unspecified will decrease your severity of illness. This takes the wind out of your sails when you try to make the case that your "patients are sicker". This may drive denials at pre-authorization based on severity. Third, unspecified is an immediate red flag for conducting more internal coding and documentation audits. Bottom line...you need to try and eliminate unspecified before 2013.

Solving the problem of "unspecified" is simple in concept. That is, simply "specify." The problem, of course, is that you need to get the physicians to specify the particulars required by ICD-10. Getting to the documentation granularity required by ICD-10 is going to require clinical documentation improvement (CDI) and, in most cases, a lot of it.

How much CDI do you need? Well, the best practice would say do an audit of your high volume, high revenue cases and code them to ICD-10 and see where they fall. This will tell you how much change you need and give you a wealth of information to help drive your CDI program. The I-9 codes tell you where you are, the gap analysis will steer you organization successfully towards ICD-10.  For more information on making your CDI program ICD-10 ready, visit my ICD-10 blog.

posted by Alice Zentner
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