Posted in Workflow

ICD-10: What if it stood for 'Improve Clinical Documentation?'

Carl Natale
by Carl Natale

Let's forget about preparing for ICD-10 implementation for a minute. What if healthcare providers focused on improving clinical documentation?

A clinical documentation improvement (CDI) already is regarded as an important step in the ICD-10 transition. There is a discussion in the ICD10Watch Linkedin Group that addresses the best options for dealing with the ICD-10 delay. And documentation is one of the options.

For example, Julie Chicoine, an attorney at Ohio State University, recommends keep working on the ICD-10 transition. Which means:

  • "Code today's records using ICD 10 and identify the documentation gaps."
  • "Use that information for training purposes and also to develop templates."
  • "ICD 10 means "smarter" not more documentation"

While it seems impressive that documentation is mentioned in two of her three bullet points, Gale Scott, Transaction Compliance Administrator at Tampa General Hospital, takes it much farther :

"Our organization has decided to focus on clinical documentation improvement. We are no longer calling this project by the ICD-10 title but rather the CDI title. CDI is so much bigger than just ICD-10. It impacts Medical Necessity and denials, Quality indicators, Cash, value based purchasing, Risk of mortality and severity of illness to name a few. Why would any organization not focus on these things by moving ahead with an upgrade to the expanded ICD-10 terminology. Just because it came with ICD-10 doesn't make it a throwaway. We must continue with the clinical documentation upgrade and begin using it. Then when ICD-10 finally does come along, we will be ready. "

If they can nail documentation, then ICD-10 implementation will be much easier.

And if healthcare providers are wondering how they're going to pay for ICD-10 implementation, they can find quite a bit of revenue in being able to bill for every code that was previously missed. This isn't fraud. This is billing for every medical code legally entitled to submit for reimbursement. To do that, providers need the appropriate, specific documentation.

Without the proper documentation, there can be denials and suspended claims with requests for more information. That's the stick.

But there is a carrot to encourage documenting procedures and diagnoses better.

Physicians don't only get paid for procedure codes. Payment is driven by medical necessity — which is shown by documenting the diagnoses that support the procedure. So by documenting everything they diagnosing, physicians can earn more money.

Otherwise they are letting healthcare payers keep money that physicians are entitled to having.

So CDI strategies will help medical practices capture the specificity for ICD-10 (diagnoses) coding. That means more money using ICD-9 and CPT (procedures) codes now.

The focus needs to be on improving clinical documentation. Then the medical codes become tools for capturing more details and more reimbursement. That's why the increased specificity of ICD-10 codes becomes a feature not a glitch.