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The Top 4 Clinical Documentation Considerations for ICD-10

Posted by Pamela Hess on Jul 14, 2015 12:23:33 PM

purple-4-handsThe ultimate goal of clinical documentation is to improve the healthcare delivery system by ensuring that proper coding paints the most complete picture of patient care.  With such a lofty goal, clinical documentation is a key factor in the upcoming ICD-10 transition.

 With October 1st quickly approaching, you may be wondering where to prioritize your training and education plans.  When it comes to CDI, here are the four key areas of focus for the transition to ICD-10:

1. CDI/Coder training

CDI and coder training should not only include ICD-10 coding instruction, but also specific case review from the dual coded data to show DRG changes for cases coded in ICD-9 vs. ICD-10.  This information allows the staff to focus on, not only the code variations, but how they affect the reimbursement for the facility.

2. Physician education

Virtual meetings, web based tutorials and efficient query processes can provide ongoing education as new ICD-10 documentation deficiencies are identified. Provider ICD-10 education is an on-going process.

Physician education has evolved from one-on-one conversations and queries at the nursing station to remote communication and technology solutions.  The volume of email alone makes practitioners more selective in which communications will be answered.  The EHR with drop down menus, smart prompts, and templates allow for routine queries to be built into the documentation process itself.  This can be used to educate the physician and prompts can be turned off when no longer needed.

3. Data Analytics

The data captured with the dual coding process will provide a comparison of not only the payment variation for ICD-9 vs. ICD-10 DRG change due to a grouper variation, but will also include information on missing specificity that can change the code and possibly the DRG.  Reports generated from the facility claims database can provide lists with corresponding account volume for:

1) Cases without MCC/CC

2) Service line and physician specific DRG volume change for ICD-9 vs. ICD-10,

3) Case Mix Index trends, post go-live ICD-10, and

4) Coder specific CMI by service line.

Trend analytics on DRG validation and medical necessity denials by payer are also important.  Remember that the NCD (National Coverage Determination) and LCD (Local Coverage Determinations) covered code lists for specific diagnoses and treatments will change post ICD-10.  Medical necessity denials can be reduced with an effective CDI program.

4. Technology

“Rapidly changing technology offers a variety of options for maximizing clinical documentation improvement (CDI) program efficiency and capture of ICD-10 specific data . . .The advent of the electronic health record (EHR) encouraged the latest technology using NLP to identify key words and phrases making it easier for the CDI specialist and coders to determine query opportunities.  Considering that half of the target CDI cases reviewed concurrently require no further action, CDI teams can leverage technology for rapid analysis to determine cases needing further clarification.  The CDI practitioner can use this saved time to clarify complex concurrent cases directly with providers, expand the program to include other payers, and for critical one-on-one education with providers” (Hess, 2015).

As you can see, redesigned CDI processes can impact the accuracy of ICD-10 data and effectiveness of its use through data analytics used for critical thinking and transformational change management.  I’ve included more information on Clinical Documentation Improvement in my book, available HERE.

ICD-10 requires more significant and rapid change in our provider education, data collection, and strategic planning based on focused analytics.  Clinical Documentation Improvement change will ensure that ICD-10 benefits are realized.  Stay tuned for more information on this exciting transition to ICD-10!

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Topics: Outsourcing