May 26, 2011

ICD-10 Impact on Clinical Documentation Specialists

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Change is life’s only constant. To that end, the long-anticipated transition to ICD-10 is imminent and preparations are beginning now even though the launch date is Oct. 1, 2013.

If your first inclination to this statement is an autonomic sympathetic response (flight or fight), take a deep breath and commit to an exciting time in the coding and documentation industry. The following questions and answers examine the role and preparation of documentation specialists when it comes to ICD-10.

Does the CDS need to be a professional coder?

Documentation specialists do not need to become coders to achieve success in ICD-10. Having said that, the clinical documentation specialist (CDS) does need to understand coding structure and what documentation is important for coding specificity required by ICD-10.The DRGs will not change initially; that’s a blessing for all since at least something will remain familiar.

The CDS is a key team member who will ensure that the clinical terminology necessary for measuring quality, safety, efficacy of care and compliant reimbursement is documented by providers. And this is true even though the code set will increase to some 155,000 codes in ICD-CM-10.

Is the RN CDS’s clinical expertise and experience advantageous?

Strong clinical and pharmacology knowledge certainly provides the necessary foundation for the RN CDS’s ability to recognize potentially under-documented diagnoses in the medical record. But do not be overconfident or think you are off the hook because of your clinical background. The clinical specificity required for both procedural coding and diagnostic coding is tremendous. When was the last time you reviewed the vascular tree or considered the different large bowel segments, all of which will be necessary for accurate coding specificity? It is anticipated that the majority of documentation strategies will remain the same in ICD-CM-10: the second blessing for all.

Why the big uproar over ICD-CM-10, and what benefits does it bring to patient care and reimbursement?

The recent CMS inpatient hospital mandate for value-based purchasing (VBP) incentive payments largely will be determined by coded data. The mandate and development of accountable care organizations (ACO) focus on clinical integration and management of population health. Population health metrics are derived from coded data. The current ICD-9 code set is outdated and inaccurate. Although CMS will not be adding new codes or DRGs during the first two years of ICD-10 implementation, it is those first two years that will be scrutinized closely. Hopefully the documentation and final coding will mirror accepted clinical practice. Delving into the data should reveal the outcomes.


 

What about physician education?

Physicians will want to know and need to understand why ICD-10 is important to the integrity, accuracy and pertinence of documentation as they get caught up in healthcare reform and all the other mandates being established. They will look to the documentation specialists and coders for support, education, and some tolerance and forgiveness. A steady infusion of ICD-10 education and awareness favors acceptance and retention versus a last-minute, fire-hose approach. The right time to begin ICD-10 physician education and awareness is now.

Next Steps for the CDI Team

  1. 1. Educate yourselves. Take advantage of education from reputable sources. Beef up your anatomy and physiology knowledge; you will need it to be successful in ICD-10.
  2. 2. Update your CDI communication and education plans to include ICD-10. This is a team initiative calling for your involvement. Create a timeline for staging your education.
  3. 3. Consider the challenges facing CDI management when it comes to timely evaluation of benchmarks in ICD-10. It is predicted that coder productivity initially will decrease by 20 to 50 percent. Use concurrent reports to forecast program benefits, monitor benchmarks and manage accordingly. Revisit remittance advice verifying DRG reimbursement.
  4. 4. Request and be apprised of any ICD-9-to-ICD-10 translation assessment findings. This will help you target areas for documentation specificity improvements.
  5. 5. Begin clarifying how ICD-10 will affect documentation for physicians one year prior to the official ICD-10 launch. This will help ease the perceived burden of increased clarifications.

Summary

Your success with documentation improvement in ICD-10 should be similar to your current success with documentation improvement in ICD-9. If you approach ICD-10 transition with the same energy, focus and commitment you invested in your initial CDI implementation and program management, you will get the same results.

About the Author

Melinda Tully, MSN, CCDS, is Senior Vice President of Clinical Services and Education for J.A. Thomas & Associates. Melinda has 25+ years in Acute Care as a Clinical Specialist and Nurse Practitioner. Her area of specialty is clinical documentation education focused on continuous quality improvement.

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Read 70 times Updated on September 23, 2013