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Preparing a Successful ICD-10 Transition

Countdown to ICD-10

Published May 22, 2014 9:19 AM by Elsevier

When it comes to ICD-10 implementation efforts, clinical documentation improvement (CDI) continues to be one of the most pressing concerns on the minds of healthcare providers. For some, the recent ICD-10 delay announcement couldn't come at a better time.  

ICD-10 isn't just a "coder" problem. With industry analysts predicting 50-70% productivity losses due to ICD-10, the development of complete and accurate CDI program will be critical to smooth transition. As reimbursement, revenue, compliance and care management are all at risk, the impact of a quality CDI program within ICD-10 implementation efforts shouldn't be underestimated.

With the increased level of specificity due to ICD-10, provider documentation will need to accurately pinpoint elements such as severity of illness, laterality, complications, episodes and stages, and symptom etiology. This means major impacts to not only coders, but physicians as well.

With this in mind, physician champions can help act as liaisons to help physicians understand their role and impact on reimbursement and patient care. Physicians and coders alike will play a critical role in the accurately capturing DRG data, with the potential to also capture thousands in previously unrealized revenue.

The Essentials

What are the keys to gaining clear, concise documentation through an effective CDI program?

A CDI program will need to:

  • Promote medical necessity documentation to support admission, readmission, and therapies, treatments and procedures.
  • Ensure accurate and complete documentation for accurate coding and reimbursement, including an accurate case mix index (CDI), correct payments and reduced compliance risk, and the correct identification of the principal and/or secondary diagnoses, MCCs and CCs.
  • Align with Joint Commission and Conditions of Participation regulations
  • Support evidence-based care for quality reporting measures

Overall, communication will be key. CDI staff will need to analyze data, formulate physician queries, track CDI program performance, and successfully communicate with physicians, administration, HIM staff and others.

On the road to ICD-10, how does your CDI program measure up?

Resources

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047343.hcsp?dDocName=bok1_047343

http://icd-10online.com/wp-content/uploads/2011/12/The-Why-and-How-of-Clinical-Documentation-Improvement-Programs_V4-ppt.pdf

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posted by Elsevier
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4 comments

I am currently a student at Davenport University getting my BS degree in HIM. I'm currently working on a homework assignment finding different areas of resources pertaining to our area of study. I'm a RN and one of my last jobs was a MDS Coordinator, but this was before MDS 3.0 and of course ICD-10, so I'm familiar with the topic. My question is WHY has it taken so long for the US to transition to ICD-10, especially when the ICD-10 has been being used in other countries for years?? It just seems like, its been such a waste of resources and lose of money not changing sooner than 2015. Especially when I've read they are already working on ICD-11 that's supposed to be available by 2017. It is really sad to think that the USA has all this income and resources and we are usually the last ones to advance in the health care field.....very frustrating!!!

Dawn Parks, HIM - RN, Davenport University September 12, 2015 1:51 PM
Battle Creek MI

I am a student studying Medical Billing and Coding at Palm Beach State College while also working at Boca Raton Regional Hospital. I'm very interested in the ICD-10 transition as I think it will have a huge impact on the future of healthcare and healthcare professions.

Melissa Keehn, Home Health - Administrative Support Coordinator, Boca Raton Regional Hospital May 21, 2015 6:42 PM
Boca Raton FL

Hi Denise,

I am also a student, attending Pam Beach State college for Medical Billing/ Coding. My assignment sounds similar to yours, as it was required that I access these forums and observe. Good luck with your studies.

Christina , , Student PBSC September 2, 2014 10:21 AM
Boca Raton FL

I am currently attending Beal's College for Medical Assisting. I am just about half way through and currently taking Health Insurance: A Guide to Billing and Reimbursement. The homework assignment for that class wants me to post a comment so here I am.

Denise Young, beals college July 14, 2014 1:07 PM
bangor ME

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