Updated on: March 16, 2016

Clinical Documentation Integrity is the “Heart” of ICD-10 Readiness

Original story posted on: July 8, 2013

Has someone at your facility or practice performed the data analytics needed for the ICD-10 transition? “Yes” is the answer that providers should be giving at this point in the ICD-10 transition, but the poll conducted on ICD-10 Monitor’s July 5 Talk Ten Tuesday broadcast revealed that 50 percent of those responding have not done this analysis yet.


One guest on the broadcast, Bonnie Cassidy, senior director of health information management (HIM) innovation for Nuance Communications, Inc., calls this percentage alarming, saying, “It seems that some folks are paralyzed and don’t know where to begin. Although it’s certainly essential to engage and educate physicians, providers also must focus on clinical documentation integrity (CDI), which is the heart of ICD-10 readiness.” By following the data, she believes, the other needed things will fall into place.

As proof of this importance, Cassidy reports that many organizations are now converting their ICD-10 steering committees to a CDI initiative, which considers changes needed because of ICD-10 as well as electronic health record (EHR) implementation, meaningful use, computer-assisted coding (CAC), and other new technologies.

To convert to ICD-10, providers must know what they expect from their technology and determine where the ICD-9 codes “live today.” They should follow all data that is coming into, and going out of, the organization. Also, know which systems are affected, update them to comply, and make sure there’s a contract for every system that’s going to touch I-9 and I-10. If you don’t have a contract, get one, Cassidy says, and know your contractual obligations as well as the vendor’s.

Initiate Communication

In her portion of the broadcast, Maria Bounos, practice lead coding and reimbursement solutions at Wolters Kluwer Law & Business, reiterated key findings of the June 5–11 survey conducted by the Medical Group Management Association (MGMA), noting that “the picture painted was bleak.” In particular, 71 percent of the 1,200 responders haven’t yet heard from their payers, and 60 percent haven’t heard from their clearinghouses.

Instead of waiting, providers should contact their partners. And, Bounos said, “Folks should be testing now. It takes at least a year, and the survey shows that physicians are behind. If clearinghouses and payers aren’t trading information yet, it’s easy to see that there will be potholes in the transition.” (In fact, Bounos talks about those potholes in her article in today’s ICD10monitor e-News.)

Nicole Harper, revenue cycle director at St. Vincent Health in Indianapolis, appreciates the pothole analogy, saying, “It is best to avoid the potholes as much as possible and look for them ahead of time, which is easier said than done.”

When asked about the status of her facility’s implementation plan, Harper state, “I’ve got to be honest; we’re probably just as far behind as many. As we get into our project plan, there’s still a lot to be addressed. We’re finding several opportunities to change our plan as we move forward.”

Whether there are potholes or not, Harper says, the healthcare industry “definitely needs to stay on the road and keep moving forward. Focus on the completion of your project plan, knowing that things will speed up as we get closer to the implementation date.” 

Currently, St. Vincent’s implementation team is focused on training, providing the anatomy and physiology portion to advanced level coders, basic-awareness training to the hospital staff who need it, and more specific training for CDI nurses, who will aid in the physicians’ transition.

CDI Case Study

As the clinical document specialist for the Hamilton Medical Center in Dalton, GA, Fran Andrews has been busy helping the facility migrate to I-10. The facility’s ICD-10 transition planning began 18 months ago with establishment of a steering committee that now meets monthly. A CDI and ICD-10 team report to the steering committee, and members have a close working relationship with the HIM department. CDI and HIM team members are combining their efforts to reach out and reinforce physician education.

Andrews says, “We rely on each other’s knowledge and skills, and we focus on educating ourselves. We’ve attended a boot camp and will use that information to educate physicians. The hospital also has access to ICD-10 training modules, and two coders have completed the ICD-10 train-the-trainer program. We’re going to team up and hold joint classes.”

Other physician education efforts also are underway. For example, the facility obtained the ICD-9 to ICD-10 crosswalks and will give them to physicians in its community. It also is contracting with a vendor for online education for physicians and hospital staff at all levels through the organization.

Physicians also are receiving ICD-10 education in the facility’s quarterly newsletter. Initially, articles focused on the basic info and various resources available and have now moved on into query-and-documentation changes and issues with both ICD-9 and ICD-10. “We also attend medical staff meetings where good documentation examples are presented plus examples of where documentation is lacking, and this helps physicians know that their words matter.”

One of the most important parts of the facility’s progress has been the support shown by the C-suite. As Andrews says, “Our chief medical officer and chief medical director have helped to champion the clinical development management program,” said Andrews. “They are taking steps to increase physician credibility and make sure that the medical record more accurately reflects patient’s severity of illness and risk of mortality. The support of our medical staff leaders is a key to our successful transition to ICD-10.”


Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.