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ICD-10 QUICK TIPS: Addressing The Need For Increased Specificity

Posted by National Compliance and Quality Audit Team on Nov 23, 2015 10:00:00 AM


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As the largest outsource coding provider in the country we have identified trends and gained unique insights from our coders throughout the transition to ICD-10. We are sharing these insights with the broader HIM Community through our bi-weekly blog series "ICD-10 Quick Tips." 

The subject matter for this series is currated based on the trending topics in our online question and answer system which services over 1200 of our HIM professionals.  Our Subject Mater Experts have an average of 20 years of experience and are considered an experts in the field. 

This week's post comes from National Compliance Manager, Melissa McLeod-Seyfert, CDIP, CCDS, CCS, CPC, CPC-I and AHIMA Approced ICD-10 Trainer. 

Well…we survived the I-10 transition! All of our ICD-10 preparation, studying and practice has paid off.   As we begin to compile ICD-10 data there are a few areas that still need our continued diligence.  With the increased specificity of the ICD-10 codes it is critical to compliant coding and accurate reimbursement that physician documentation is precise enough to support the new codes.  As HIM Professionals, it is our responsibility to write queries when documentation is not specific enough to support coding to the highest level of specificity. Here are a few areas where the need for more specific documentation has been impacted by ICD-10.

Cause and Effect Etiology

Many diagnoses in ICD-10-CM are combination codes, requiring the provider to document a cause and effect relationship.  The increased volume of combination codes, which require the provider to “link” diagnoses by documenting “with” or similar terminology, can negatively impact CC/MCC capture rates and/or case-mix index if the organization is unable to assign these combination codes.

Heart Failure

Specificity in heart failure documentation is critical.  One of the most often written queries is requesting further details regarding heart failure.  Is it acute? acute on chronic? diastolic? systolic or a combination of all? Acuity and specificity impacts CC/MCC capture.

Atrial Fibrillation and Atrial Flutter

Persistent atrial fibrillation, typical atrial flutter, atypical atrial flutter and atrial flutter unspecified, qualifies as a CC code (in most instances) and has the potential of resulting in the assignment of a higher weight MS-DRG Depression

In ICD-9, there is a specific code for major depression, unspecified (296.20), and this is a CC.  In ICD-10, the coding system the documentation of major depression, unspecified (F32.9) is no longer a CC.  If the major depression is documented as single or recurrent, mild, moderate, severe without psychotic features or severe with psychotic features then it remains a CC in ICD-10.

Just a few pearls to boost compliant coding and maximize appropriate reimbursement!

 If you have specific questions about ICD-10 or would like to propose a topic for our Subject Matter Experts, we encourage you to leave your comments below. 

Topics: Education