Where are you now?
Unlike many other healthcare programs, the ICD-10 program is not tied to any incentive program. The cost of implementation are hard costs that have a direct impact on the provider’s bottom line. The change from ICD-9 to ICD-10 represents significant effort and risk. If it is not implemented correctly or completely, the effect on the practice could be significant.
While CPT/HCPCS coding drive provider reimbursement, an incorrect or incomplete diagnosis code will halt reimbursement. Because ICD-10 impacts every part of your clinic, it requires careful management for successful implementation. Physicians face a unique challenge of working to fit a new coding and reimbursement system into their daily clinical work-flow while staying focused on patient care.
The increasing level of detail in the ICD-10 coding requires clinical staff to focus on documentation improvement. Without the correct level of documentation in the medical record it will be impossible to support the new, more specific codes. This will leave the office with unsupported diagnoses for medical necessity or with using only “unspecified” codes. While the jury is still out on how payers will treat these codes, they are expected to deny or delay payment.
For example: ICD-9 Code 722.71 is Cervical disc degeneration with myelopathy. Under ICD-10 you are required to identify the level of the degeneration: Occipito-atlanto-axial, mid-cervical or cervicothoracic region. ICD-10 also requires the indication of radiculopathy or myelopathy. Failure to provide the details needed may require the use of the “unspecified” region or prevent the use of the diagnosis which will impact the medical necessity determination for your claim.
Begin today adding details such as laterality, spinal regions and specific spinal segments to your documentation.
“An ounce of prevention is worth a pound of cure” Benjamin Franklin
One of the key steps toward successful implementation is a Clinical Documentation Improvement Program (CDIP). The goal of a CDIP is to promote clear, concise, complete, accurate and compliant documentation. This is accomplished through analysis and interpretation of medical records. The goal is to identify and rectify situations where documentation is insufficient to accurately support the patient’s severity of condition and care. Suggested improvements may include specificity of principal diagnosis, associated comorbidities or complications.
Due to the increased level of specificity inherent to ICD-10, clinical documentation to support the detailed coding must exist within the medical record. Incomplete documentation will cripple a provider's ability to appropriately assign and support the ICD-10 codes. An insufficiency in this area could impact a provider's revenue cycle in several areas: reimbursement delays, increased records requests and denials. Each error may increase the overall billing cycle time, increase the overall accounts receivable days and may potentially increase denials for medical necessity.
Many physicians feel their EHR system provides protection and insures proper code selection. Recent records reviews from many EHR's show that this is not necessarily the case. EHR software not designed to ensure that the records generated support either CPT or ICD code selection, regardless of sophistication.
The downstream effect of inaccurate or incomplete clinical documentation include:
- Inaccurate or incomplete ICD-10 code assignment which can impact reimbursement and increase compliance risks.
- Failure to meet medical necessity requirement can potentially jeopardize reimbursement
- Inaccurate data used for quality reporting can result in reduced payments
- Increased days in A/R may result from the inability to submit claims timely, decreased claim acceptance and increased claims denials which negatively impact cash-flow
- Increased patient dissatisfaction.
Start with a review of where your records are today. Reviewing current patient examination records and identifying barriers to assigning ICD-10 codes will help in identifying changes to be made. Then, by providing targeted education to each provider to address known deficiencies, improvements can have the greatest impact.
Identifying your practice's top diagnoses and targeting your documentation improvements to those codes first will help your office become prepared for the ICD-10 implementation.
Cornerstone offers a clinical documentation readiness assessment. For details about the program, click here.