ICD-10 Readiness

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With the scheduled transition to ICD-10 fast approaching, readiness has become a top priority for all providers. And as most of them know, getting ready has proved to be a major challenge – one that has many scrambling and just as many calling for a delay in the transition schedule.

This problem has not gone unnoticed by stakeholders. Forward-thinking ICD-9 specialists have pointed out that by focusing on clinical documentation improvement (CDI) now, with the current system, many of the anticipated problems with ICD-10 could be mitigated.

For those not in the know, CDI is simply a systematic review process designed to identify errors, inconsistencies, and inefficiencies. The process is not something new, but new approaches to CDI have proved revealing for ICD-9, and could just as easily apply to ICD-10.

For example, a study of traditional CDI processes revealed that the majority of cases reviewed were for inpatient stays of only two to three days. That may not sound particularly relevant, but in practice that leaves up to 40 percent of cases not reviewed. Even more troubling is the mix of cases that get reviewed. Major players like Medicare and Medicade get a lot of attention, but 70 percent of cases still lack review. Finally, the focus is primarily on inpatient visits, ignoring the huge number of patient encounters that happen in an outpatient setting.

What does all this mean? Up to 89 percent of cases are ignored, calling into question the entire CDI process. No one doubts that it can work, and work for the future with ICD-10, but a number of changes need to be implemented. Experts have highlighted these areas for improvement:

  • Review all cases regardless of length of stay
  • Review all cases regardless of payer type
  • Review all cases across care settings
  • Make the process physician driven

If these changes were implemented, advocates suggest, a larger number of mistakes and discrepancies could be identified. And as that data pool accumulated, it would point to systematic problems in the coding process that could be changed or revised to have sweeping effects across systems.

These are compelling ideas, particularly as providers look for meaningful ways to improve ICD-10 readiness. The solution may very well be to CDI processes and using advanced analytic techniques to start gleaning insights. If you’re behind the curve and eager to catch up, find the CDI specialists you need by working with the recruiters at MedPartners.