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Claims & Coding: Roundup

Control the accuracy of coding where it matters While the specifi city of ICD-10 codes promises to

improve clinical accuracy, speed, payment cycles and streamline utilization management, realizing these benefi ts will require a deliberate effort to control the accuracy of coding where it matters: at the point of code entry. Traditionally, the root cause of coding errors has been the interpretation made by administrative staff based on encounter documentation provided by the clinician. The clinician does not describe the diagnosis or the procedures in a consistent manner, leaving it up to the staff, with varying levels of experience, to determine the appropriate diagnosis code. The translation of diagnosis as described in the exam room to a code goes through at least three discrete steps

Correct coding begins with thorough documentation

Correct coding begins with

thorough documentation, well before the transition to ICD-10. With the increased code granularity in ICD-10, it’s imperative that providers begin documenting details from each patient encounter so that transactions can be coded accurately.

In addition, all healthcare

Kristine Weinberger, senior healthcare business consultant, Edifecs

organizations need to understand both the differences between and the relationships among the ICD-9 and ICD-10 code sets. In reviewing more than half a billion

ICD-9 codes in healthcare claim transactions, we know that more than 30 percent have complex relationships in ICD-10; meaning it’s not a one-to-one conversion. From a health plan perspective, accurate and thorough knowledge of the differences between ICD-9 and ICD-10 codes will enable the health plan to accurately update its policies to refl ect ICD-10 and to remediate its systems. The key for both providers and health plans is using tools that assist in analyzing and comprehending these differences. Codebooks are always helpful, but more advanced software tools can go beyond what codebooks provide. Comparing the medical concepts that apply in an ICD-9 code to the medical concepts that apply in an ICD-10 code set provides the capability to determine which specifi c codes in ICD-10 are appropriate. Due to the vast increase in the volume of codes available

in ICD-10, a successful and timely implementation will largely be dependent upon an entity’s ability to prioritize and streamline its work.

a t t

in a

and many users/systems, introducing errors along the way. This workfl ow process is complicated by the changed ICD-10 code sets. One approach to eliminate the inaccuracies and ineffi ciency is to eliminate the need to translate and re-key these codes in the clinical workplace. To do so, physicians should consider the use of s

smart/simple data-intake technology on a mobile d

device in the exam room. Using mobile technology w

Kimberly Labow, NaviNet

will ensure that the physician can actually enter the c

codes in the visit notes. Use of various contextual validation aids – such as medical necessity relationships between the problem statements,

diagnosis and procedures – can simplify the selection of codes by physicians.

Need to evaluate CAC systems

It’s no question that coding in the ICD-10 world will be nearly impossible without computer- assisted coding (CAC) – there aren’t enough coders in the world to support and maintain a manual coding process for 155,000 codes. Providers need to closely evaluate CAC systems with an understanding that coding accuracy and consistency can vary widely based on the natural language processing (NLP) technology that powers it. In addition, because one of the biggest obstacles for health systems is consistency of coding across inpatient and outpatient settings, hospitals need to implement CAC systems that can support all venues of care – inpatient, outpatient and even professional – to save time, improve revenue integrity and ensure compliance. Coders will still very much be part of the process, but their lives are going to change dramatically. The use of CAC solutions will elevate the role of the coder to a reviewer or auditor, increasing the overall productivity and accuracy of the coding process. Bringing coders into the process as early as possible, rather than waiting until ICD- 10 is imminent, will ease the transition, promote proper training and reduced errors, and provide fi nancial stability for organizations in the long run. October 2013 may seem far off, but ICD-10 should be a major concern for every hospital CIO now. While every hospital has a number of IT projects currently underway, providers need to prioritize the projects that will ensure profi tability and return on investment – and with ICD- 10 driving every hospital’s reimbursement and fi nancial future, they can’t afford to wait.

Mark Morsch, VP of technology, A-Life Medical (now part of Ingenix)

10 July 2011


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