Clinical Documentation Excellence Program: Tackling ICD-10 Challenges

In October 2013, the University of Mississippi Medical Center (UMMC) launched its clinical go-live of ICD-10 with a focus on data-driven priority setting and physician engagement. An external audit of diagnosis codes found that documentation yielded unspecified diagnosis codes 4% more often than the national benchmark of 18% and predicted a 1% increase for unspecified codes in ICD-10.

This posed a risk, as we expect issues with reimbursement for unspecified codes to increase in ICD-10 and inaccuracies in our case mix index (CMI) with the high volume of unspecified codes in both ICD-9 and ICD-10.

While the overall number of diagnosis codes did not increase substantially from ICD-9-CM to ICD-10-CM, incomplete procedure codes grew from zero percent in ICD-9-CM vol. 3 to 8.8% in ICD-10-PCS, marking an increase in non-specific documentation a major risk for facility procedural coding.

To address these concerns, UMMC launched a Clinical Documentation Excellence (CDE) program aimed at educating providers on core professional and hospital billing concepts, establishing clinical documentation and revenue cycle improvement metrics for each academic department and creating a collaborative environment for tackling challenges in the ICD-10 transition and beyond.

Leaders from the high-risk focus areas of neurosurgery, orthopedics and family medicine initiated CDE programs in fall 2013 to serve as pilot groups for the organization.

By early 2015, all three pilot programs had demonstrated a substantial decrease in unspecified code usage and a corresponding increase in overall diagnosis code capture, leading the two surgical specialties to a 9% increase in the capture of complexities and comorbidities. The CMI for neurosurgery has improved 21% from program initiation while orthopedics has seen a 23% increase.

Family medicine has decreased their unspecified ICD-9 code usage for professional fee billing by more than 5% taking it under the target threshold established for the ICD-10 implementation date in October 2015. By integrating education and documentation support tools into the provider’s existing work flows, the program is seen as minimal work on the medical staff while providing improved information for patient care.

A physician recently shared, “The additional specificity we have on the problem list is really helping my care in clinic. We need to never go back to the generic documentation.”

Early work into educating providers on business basics such as how and where ICD and CPT codes are used, what ICD-10 means for DRGs and the CMI and how physician documentation directly impacts the accuracy and completeness of claims data yielded well informed physician partners ready to face the ICD-10 challenge.

Ongoing efforts have demonstrated that priorities and tactics shift over time, making an adaptable program following data-driven priorities important during this era of shifting to performance-based reimbursement. Working by specialty to focus on the diagnoses relevant to the providers at the table helped gain traction and engagement from the physicians at unprecedented levels.

For UMMC, the work in 2015-2016 will continue by deploying the program to more than 50 pediatric and adult specialties—and adjusting to the realities of living within an ICD-10 system.

John Showalter, MD, MSIS, is an influential thought leader on the innovative use of health information technology to drive improvements in healthcare. A practicing physician, Dr. Showalter is dual board certified in internal medicine and clinical informatics and currently serves as the Chief Health Information Officer for the University of Mississippi Medical Center.

Leigh Williams, MHIIM, RHIA, CPC, CPHIMS, AHIMA Approved ICD-10 Ambassador, is an innovative leader of information and technology initiatives. She has served since 2013 as the University of Mississippi Medical Center’s executive director for ICD-10 implementation and director of revenue cycle overseeing their clinical documentation excellence program and HIM functions.

——————————————————

Photo courtesy of: HIMSS

Originally published on: HIMSS