Creating a roadmap for ICD-10 success

CMS’s recent announcement that ICD-10 will go into full effect on October 1, 2015 has revived discussions about the appropriate next steps in the minds healthcare stakeholders, from both clinical and administrative teams. Taking the time now to evaluate your organization's strategy for ICD-10 education, will help your teams stay ahead of the curve and protect both data and financial integrity.
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Based on personal experience with learning, teaching, and analyzing ICD-10 from both a clinical documentation opportunity and coding perspective, I offer the following suggestions to assist with structuring education plans for the upcoming year:

  • Leverage data analytics
  • Conduct an ICD-10 recode
  • Utilize dual-coding efforts

Start with data analytics
Data analytics is a great method for identifying areas for coding improvement and targeting opportunities for further ICD-10 education.  Leveraging data analytics for current claims can assist organizations with identifying high-risk areas, including potential Medicare Severity Diagnosis-Related Group (MS-DRG) shifts and the associated case mix index (CMI) change.  In the data analytics process, current claims data is translated into ICD-10 data utilizing General Equivalence Mappings (GEMS).  The outcome is typically reported with all potential code mappings and associated MS-DRG shifts with potential financial implications.   The mappings will show all potential ICD-10 code possibilities for each ICD-9 code, which directly impacts the MS-DRG movement (either positively or negatively) depending upon which ICD-10 code is selected.  Armed with this insight, organizations should use data analytics as a roadmap, selecting a record sample to audit for actual movement based on the current clinical documentation found in health records to support ICD-10 code assignment.

Time to recode
Once the potential shifts have been identified at the MS-DRG level, the next step is conducting an ICD-10 recode within the targeted MS-DRGs.  The recode will show any actual movement found within the audit record sample that had potential to shift based upon GEMs mapping results. This step also provides your organization with valuable information needed to assess the real CMI impact based on the ICD-10 codes and subsequent conversion to the corresponding MS-DRG within ICD-10.  In my experience, there are multiple MS-DRG shifts within the grouper logic that one would not expect to occur.  The selected sample recode should highlight if any of these changes could be impacted by more complete documentation, allowing the CDI staff to focus education efforts for physicians and providers.

Translating information into action
The next step is to utilize dual coding efforts as an organization.  There are multiple methods for dual coding and each facility should consider the process and staffing currently available to determine the best method for their organization.  It is here that the coders will take any ICD-10 theory they have learned and put it to practical use.  The dual-coding process will quickly assist organizations with identifying the more difficult types of cases, how productivity is being impacted, and what type of knowledge within ICD-10 still needs improvement.  Future ICD-10 education can then be structured around those deficits.

By utilizing these three steps and taking the time now to proactively approach ICD-10 education, your organization can stay ahead of the curve and protect both data and financial integrity.

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Lisa Roat

About Lisa Roat

This was a contributed post by Lisa Roat, manager for HIM consulting at Nuance. If you’re interested in more content like this, visit the Healthcare section of the blog.