Sample high-value claims before ICD-10 implementation date

With the heat on physician practices to prepare for the impending ICD-10 implementation date, two analysts discuss how best to avoid negative outcomes.

The ICD-10 implementation date is coming and there’s no avoiding it. As healthcare organizations try to prepare themselves the best they can, physician practices in particular may be feeling the pressure. Two experts weigh in on how physician practices can ensure readiness and offer some ideas for ways to prepare.

Clinical documentation improvement (CDI) is critical to being prepared for ICD-10 and avoiding potentially troublesome outcomes.

“If insufficient [information] is gathered at the time of service, then the granular ICD-10 code cannot be assigned,” said Robert Tennant, a senior policy advisor of government affairs at the Medical Group Management Association (MGMA) based in Englewood, Colo. “So what we suggest to folks … even if your software has not been upgraded yet, you can still do what I would call CDI testing.”

Physician practices can accomplish such testing in two ways: sampling and creating code subsets.

In the first approach, take a sample of 25 to 30 claims — “usually the high-dollar, high-volume claims that the practice traditionally submits to health plans,” Tennant said — or 50 to 100 claims if it is a bigger practice or you’re dealing with claims that have already been adjudicated and paid.

Then look at the documentation and see if the appropriate level of granularity for an ICD-10 code can be assigned. Note any mistakes, and from there educate physicians and clinicians about these missteps, Tennant said.

“For example, let’s say that a claim was paid for a sprained wrist but you notice that in the documentation, the physicians never wrote down whether it was the left wrist or right wrist,” Tennant said. “[That’s] an opportunity then to educate clinicians and say, ‘OK, everything looks good but you forgot to put laterality. So let’s start to incorporate laterality into all our clinical documentation’.”


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