Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

AHIMA Reviews Top ICD-10 Implementation, Coding Challenges

In an analysis of ICD-10 implementation, AHIMA identified the top five coding errors and potential challenges that providers may face with updates to the system in October.

By Jacqueline LaPointe

- In the days leading up to the go-live of ICD-10 implementation, many healthcare providers feared that the new system would decrease productivity and cause more claim denials.

AHIMA identified the top ICD-10 implementation and coding challenges from the past eight months

However, in the eight months since the launch, most healthcare providers and coders are encountering only a few common errors with the system that have minimally affected hospital revenue cycles.

“There are some surveys that showed some [claim] denials, and some [providers] were having issues,” said Sue Bowman, AHIMA’s Senior Director of Coding Policy and Compliance.

“I don’t think we can say nobody had any problems, that would be a stretch, but I think we can say the scale of them and the significance of the problems was much less than many people predicted.”

AHIMA reported that the most common recurring ICD-10 coding errors were the following:

READ MORE: PQRS Medicare Payment Adjustments Waived After ICD-10 Update

• Inaccurately applying the seventh characters for trauma and fracture codes, especially with specifying if it is an initial or subsequent visit, in the acute hospital setting

• Improperly using procedure codes that drive the diagnostic related group, particularly with specifying if the service was therapeutic or diagnostic

• Misidentifying respiratory failure as a principal diagnosis and sepsis codes

• Mistaking the use of guidance tools, including fluoroscopy, ultrasound, and whether dye was used

• Insufficient documentation of devices, components, and grafting materials used during a procedure, such as bone or synthetics.

The article also pinpointed the top five specific coding weaknesses since the beginning of ICD-10 implementation, including external causes of morbidity (V00-Y99), symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), injury, poisoning, and certain other consequences of external causes (S00-T88), congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99), and diseases of the blood and blood-forming organs, and certain disorders involving the immune mechanism (D50-D89).

Despite some challenges with ICD-10 coding, AHIMA found that healthcare organizations had general success with properly coding for some procedures, such as endocrine, nutritional, and metabolic diseases (E00-E89), disease of the genitourinary system (N00-N99), diseases of the circulatory system (I00-I99), mental, behavioral, and neurodevelopmental disorders (F01-F99), and diseases of the eye and adnexa (H00-H59).

While healthcare providers experienced some hiccups with ICD-10 implementation, these challenges have barely impacted healthcare revenue cycles.

“When we went live with ICD-10 we saw a shift of coder productivity of about 30 percent the first couple of weeks,” said Chloe Phillips, MHA, RHIA, Director of HIM and Clinical Revenue at Brookwood Baptist Health to AHIMA. “We have maintained at 10 percent or less loss in productivity since ICD-10 went live, so the productivity loss has been minimal.”

The transition to ICD-10 had not impacted the revenue cycle at Brookwood Baptist Health, Phillips added.

However, AHIMA explained that some healthcare organizations may face new ICD-10 challenges in the coming months as CMS updates the code set in October. The industry group reported that CMS plans to lift the ban on adding new ICD-10 codes and eliminate the unspecified code provisions for Medicare Part B claims.

The end of the unspecified code period could spell significant trouble for providers since many physicians have defaulted their EHR systems to assign unspecified codes and providers will have to be more specific come October 1, explained AHIMA. This could lead to more Medicare claim denials.

Some healthcare organizations are also finding that their case mix index has dropped in the last eight months since ICD-10 implementation, reported the article. Since the case mix index is used to calculate the allocation of resources to care for patients in a specific group, healthcare revenue cycles have also decreased.

AHIMA explained that providers and vendors are attempting to discover why case mix indexes have been impacted, but many do not have the data to accurately pinpoint the cause. Some auditing vendors have hypothesized that inaccurate quality documentation or improper coding may be the driving force behind the decrease.

Even though providers still have to prepare for ICD-10 implementation updates, AHIMA stated that the system should help providers collect quality data on their patients and physician habits, which could influence value-based payments.

“As we shift to value-based payment, and more of that patient-centric view—a longitudinal view versus a look at a patient walking in the door—I think you’ll find that coding becomes less of the basis of pure payment, and becomes more of the basis of tracking accurate information for the purposes of better patient management,” stated Jared Sorenson, Vice President of Revenue Cycle for 3M Health Information Systems. “I think that shift, ICD-10, enables it.”

Dig Deeper:

How to Manage ICD-10 Implementation Updates, Maximize Revenue

3 Key Steps to Continue ICD-10 Implementation Progress

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