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CDI: Just Tell Me What to Say

Something Old, Something New: ICD-10 Survey Uncovers Startling Facts

Published June 5, 2013 2:47 PM by Alice Zentner

According to Ralph Waldo Emerson, society is always taken by surprise by any new example of common sense. Such is the case with the recently released survey of nearly 300 HIM professionals regarding the state of ICD-10.

The survey was conducted jointly by the American Health Information Management Association (AHIMA) and TrustHCS in the fall of 2012. For those who are in-the-know about ICD-10, the survey revealed few surprises. But for society at large, the facts are startling.

According to the report, more than 50 percent of hospitals surveyed are still in the beginning stages of ICD-10, and 25 percent haven't even formed a steering committee to drive the project. These are very scary numbers indeed! The other blatant example of common sense: There will be a 30 percent coder shortage - on top of the 30 percent nationwide coder shortage that already exists. These facts are no surprise to HIM professionals. But what was surprising for us? And what does the survey say about clinical documentation improvement (CDI)?

New Surprises for HIM

The biggest surprise is that hiring spikes for coders will occur in 2013 and early 2014, as hospitals ramp up their dual coding programs and hire for 2014. The number of hospitals already starting to use computer-assisted coding (CAC) was also higher than expected. And more than 75 percent of the hospitals surveyed expect to use CAC for ICD-10.

CAC will certainly help hospitals curb the predicted drop in coder productivity associated with ICD-10, thus easing the coder shortage. The other new surprise involves CDI.

New Surprises for CDI
According to the survey, many hospitals already have a program in place. That's the good news; however, many respondents believe their CDI programs are failing.

Hospitals that employ outside auditors to evaluate their CDI efforts overwhelmingly believe their programs are effective. Those that conduct internal reviews think otherwise. Hospitals conducting their own audits of CDI effectiveness use internal metrics. And when these internal metrics fail to show an increase in revenue, the program is perceived to be ineffective.

Yes, the use of an outside auditor to assess your CDI program is best practice; however, hospitals also should expand their audit metrics. Metrics should include such questions as:

  • Are revenue take-backs by RACs, MACs, and other auditors down or up?
  • Are medical necessity denials on the decline?
  • Has coding accuracy and compliance improved?

Answering "yes" to these three questions also indicates a healthy CDI program.

Still Have CDI Questions?

Still have questions about your CDI program's effectiveness? I suggest that you conduct an outside audit of your CDI program at least annually. Hospitals that have invested in a CDI program must do their homework and assess their efforts.

Finally, a complete CDI assessment must be part of your 2013 ICD-10 plan. Answers will be gleaned and areas for improvement will be uncovered. The future is ICD-10 and clinical documentation is its foundation. A complete CDI audit ensures that your organization won't be caught by surprise when ICD-10 hits your door next year.


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