The ICD-10 coding vacation is over!

Ever been on vacation?  We all have.  The lead up, ripe with excitement and anticipation. The unknowns. The spontaneous confidence that something big is going to happen.  The day finally arrives. Perhaps a plane trip. Activity-filled excursions. The suntan. Mimosas or a Dark-and-Stormy, garnished with some island music.  Good food, a good book, and lots of rest!  But then, before it even starts, you are back home in the grind. The party is over.

And so is the ICD-10 implementation that kicked off October 2015.  Debate about its effectiveness, ability to help control costs, and whether there will be enough qualified coders to do the work was in hyper warp mode.  But finally, right or wrong, the standard was codified and required.

As we approach the 1-year anniversary of ICD-10 in the United States (no one is breaking out the Champagne), there will be another (almost) 6,000 codes released (as if the original amount wasn’t enough!). Along the way, experts in the coding world have been busy auditing and assessing program efficacy, as well as the accuracy and specificity of coders and health-care systems nation-wide.

What have they learned?

According to study conducted by ICD10 Monitor, the overall average accuracy during the 1st quarter 2016 for inpatient, ambulatory, and emergency coding types has dipped to as low as 80%, far lower than the 95% industry standard inherited from the days of ICD-9.  Digging deeper, the study revealed that for some coding categories, the accuracy approached a dismal 50%.  While audits indicate an uptick in accuracy during 2016YTD, the industry effort continue to fall short of the mark and has reduced productivity by as much as 15% (Source: Becker’s ASC Review).  Of course this is clearly on the lower end of the scale when compared to pre-October 2015 estimates (10 to 50 percent productivity impact), it is still a downward trend that has substantial monetized effects.

So, what to do? 

Perform you own internal audits. Do them more often.  Conduct them with greater rigor.  Ask yourself these questions:

1. Does my facility use EMR? Do we dictate?
2. How is my hospital, clinic, or practice entering the codes? By hand? Drop down lists? Are the lists complete and accurate, or do they enable the coder to derive errors through repetition?
3. What are the coder knowledge gaps? What is the mixture of highly trained-and-certified in-house coders versus outsourced coders?
4. Now that ICD-10 is well underway, what are you doing to maintain a robust continuous training program, especially as codes are added, grace periods are depleted, and accuracy thresholds are increased and expected?
5. Is your clinical documentation complete and accurate?
6. Are physicians providing ICD-10 quality notations or are there inherent and systemic quality gaps, requiring several iterations, thereby reducing productivity?

Some proforma and upside considerations: 

1. While you can enter memorized ICD‐9 codes in your search, learning the recommended search strategy for your EHR may yield higher quality results.

1. Take advantage of specific coding when you have sufficient detail or knowledge to assign a more specific code.

1. Codes can be refined to indicate laterality, cause, type and chronicity

1. ICD‐10 codes can now account for disease relationships indicating higher patient acuity (e.g., how many elderly diabetics do you know who actually have no complications?)

Remember that the transition flexibility with the family of code (ICD‐10 three‐character category), is slated to end September 30, 2016.

The upshot? There are a lot of internal, as well as external actions to your medical documentation systems involving accurate transcription and coding.  Doing those things isn’t enough – you must do them accurately and with minimal interference to productivity, maximizing reimbursement and quality of care.

Maybe then we can go on vacation again.  Daiquiris on the house!

For further information about how iData can assist you in the transcription and/or coding space, please contact us at 888-66-IDATA or visit us at www.idatamedical.com to learn more.