The impacts of the transition to ICD-10 are still being felt by all, and many organizations are looking for an effective way to gauge their aptitude with the new system. Industry expert Deborah Grider addressed this query in a recent article in which she laid out a simple and accessible method for ICD-10 assessment. It breaks down to a three-pronged approach.
It’s obviously impossible to audit every record. But organizations can get a representative sample of performance by identifying the codes that have been used most frequently since the Oct 1 ICD-10 deadline. Between 10 and 20 records using those codes should be pulled and audited. The selection of diagnosis code should be considered, along with whether there was adequate data to support that diagnosis code. If either the code or the data supporting that code have issues, the entire record should be considered a failure.
According to Grider, an audit that shows 95 percent of records are correct should be considered successful. Providers that fall below that figure should be made aware of the issue and given additional training and education. It’s important, however, not to take punitive steps. Keep in mind that ICD-10 is still fresh for everyone, and some providers made more of an effort than others to prepare for the transition. The goal is to improve processes, not punish failures. In any case, auditing should continue for all providers. Since this methodology relies on representative sampling, there is the chance that systemic mistakes fall outside the focus on any single audit.
The results of the ICD-10 assessment should be used to inform the long-term clinical documentation improvement program. At the very least, training and education should be delivered to all providers annually, regardless of performance. If persistent problems arise, these should be the focus of the training. Grider recommends performing audits at least every six months, and more frequently for providers that regularly fall below the 95 percent threshold. She points out that the frequency of performing these audits can put a significant burden on existing staff, and that it may be necessary to add to the ranks or bring in a consultant. She stresses in her conclusion, however, that regular assessment is essential, and that it’s a mistake to wait until you get a request from a payer to start evaluating the effectiveness of your ICD-10 program.
Do you have the staff necessary to perform the auditing, monitoring, training, and education necessary to use ICD-10 correctly and in full? If not, let MedPartners help you find expert professionals.