2. ICD-10 Impact
Coder
Productivity
Physician
Productivity
Rework
Change in Charts
Coded per Hour
3-12 Mos. post
transition
Long Term
Increase in Queries
DNFB / DNFC
Increase in Inquiries,
Claims Adjustments
& Rejections
-5% to -
10%*
Coder: -20%
• Inpatient: ~5 charts/day
• Outpatient: ~8 charts/day
• ER: ~24 charts/day
Coding Manager:
-35% to -50%
-10% to -20%
+45 to +90 min/day -10% to -25%
Source: Advisory Board Research & Analysis,
recent Precyse customer data
3. ICD-10-CM Impact
ICD-10-CM is manageable as the documentation
impacts fall in 8 to 10 core impact areas:
Axis of Classification
Possible 7-digit codes
Laterality
Trimester Specificity
Drug and Alcohol Code Expansion
7th Digit Expansion Codes
Complication Codes
Combination Codes
Increased Specificity
4. An Example of Impact
ICD-10 often combines disease specificity, common
sites/locations, and manifestations of the disease into
one code
Non-specific documentation (such as Regional
Enteritis) will result in significant increases in queries
and increases in denials
Regional enteritis of
the large intestine
Unspecified
intestinal
obstruction 560.9
555.1 K50.112
Crohn’s Disease of
the large intestine
with intestinal
obstruction
5. An Example of Impact
ICD-10-CM is a much more clinically-based system
Allows physicians to truly show severity of a
patient’s illness
ICD-9-CM ICD-10-CM
455.- 10 Hemorrhoid codes
• External
• Internal
• Unspecified
K64.- 8 Hemorrhoid codes
• Degree of severity
(First to Fourth)
6. ICD-10-PCS Impact
All diagnostic information is excluded
Standardized and self-contained (No Latin, terms have one
definition, etc)
No more Eponyms
No more unspecified procedures
Will require use by coders of far more specific anatomical and
pathophysiological concepts
7. The Big ‘Holes’ to Fill
Avoiding umbrella/non-specific codes
Specific documentation of underlying conditions
and manifestations
ICD-10 ready templates/prompts
Telling the ‘whole’ clinical story
Drive severity of illness/medical necessity
9. • Determine severity of illness and prove medical necessity.
• Grow compensation and reimbursement.
• Address technology and healthcare reform initiatives.
• Ensure strong reputation.
- Physician profiling/national registries
- Quality reporting
- Consumer health sites
• Avoid the risk of audits.
How to ‘Sell’ the ICD-10 Message?
10. The ICD-10 Tree
ICD-10 is similar to a tree
Physicians
Ancillary Departments
Coders
Finance
HIM
IT/IS
11. Best Practices: Get Physician Buy-In
Make it practical
Make it convenient and mobile
Use a combination approach eLearning,
peer-to-peer, and internal programs
Communicate the ‘What’s In It For Me’
effectively
12. Best Practices: Tiger Team
Create a Tiger Team that takes the education
before everyone else
Allows you to develop ‘super users’ who will be
able to help others, answer questions, and
provide potential training
Comprised of individuals from all major
education groups, such as coders, CDIS,
physicians, and others
13. Best Practices: Collaborate with CDIS
View the Clinical Documentation Improvement
Specialist role as the most critical to success
Use them as your ‘champion’ to:
• Do face-to-face education
• Integrate documentation education into current
practices
• Rework queries/forms
• Develop additional education collateral and printable
documents
14. Best Practices:
Strong Communication Plan
Essential to look at ICD-10 as an Education and
Communication event
Should try to use:
Posters/Collaterals for awareness
E-mail Blasts
Organization Newsletters
Mailbox Stuffers
Organization Webinars
ICD-10 Website on Intranet