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DEPARTMENTS: PRACTICE POINTS

Reminder

ICD-10-CM Workflow and Audit Processes

Hess, Cathy Thomas BSN, RN, CWOCN

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Advances in Skin & Wound Care: August 2015 - Volume 28 - Issue 8 - p 384
doi: 10.1097/01.ASW.0000469398.62814.68
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October 1, 2015, is our International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) implementation go-live date. As you ramp up for your transition from ICD-9-CM to ICD-10-CM in the wound care department, there are a number of key documentation strategies and processes to review.

1. According to Healthcare Information and Managements Systems (HIMSS) (www.healthcareitnews.com/directory/icd-10-coding), “The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is a revision of the ICD-9-CM system, which physicians and other providers currently use to code all diagnoses, symptoms, and procedures recorded in hospitals and physician practices. The ICD-10-CM revision has more than 68,000 diagnostic codes, compared with the 13,000 found in ICD-9-CM. The revision also includes twice as many categories and is more specific in identifying treatment. For example, ICD-10 provides codes to distinguish between a left or right leg; ICD-9 does not. The US Department of Health and Human Services [HHS] had intended to require implementation by October 1, 2014. However, on April 1, 2014, President Obama signed into law HR 3402, which prevents HHS from establishing ICD-10 as the standard code set before October 1, 2015.”

Important note: The transition to ICD-10-CM/PCS does not affect Current Procedural Terminology (CPT®*) codes, which will continue to be used for outpatient services.

2. The American Health Information Management Association (www.ahima.org/topics/icd10/faqs) states the value of ICD-10-CM is the improved clinical detail, better capture of medical technology, up-to-date terminology, and more flexible structure resulting in

  • higher-quality information for measuring healthcare service quality, safety, and efficiency;
  • greater coding accuracy and specificity;
  • recognition of advances in clinical practice and technology;
  • improved ability to measure outcomes, efficacy, and costs of new medical technology;
  • enhanced review of medical necessity and fewer claims denials;
  • improved ability to determine disease severity for risk and severity adjustment;
  • global healthcare data comparability;
  • improved ability to track and respond to public health threats;
  • reduced need for manual review of health records to perform research and data mining and adjudicate reimbursement claims;
  • reduced need for supporting documentations to support information reported on claims;
  • reduced opportunities for fraud and improved fraud detection capabilities;
  • development of expanded computer-assisted coding technologies that will facilitate more accurate and efficient coding and alleviate the coder shortage; and
  • space to accommodate future code expansion.

In addition, the specificity and granularity of the key data elements will improve your outcome data.

3. At this time, we should remember that change brings opportunity to review and refine processes. To get started in reviewing your processes for wound care documentation and coding, review your Clinical, Operational, Regulatory, and Economic (CORE) drivers supporting the work performed in your department. Each of these processes brings a different action that supports the specificity of key wound care documentation. Once you understand the changes impacting your CORE drivers, strategically redesign your workflows to optimize your documentation.

One important addition to the ICD-10-CM documentation is laterality. This new documentation feature will reflect codes for right, left, and bilateral. The codes will also detail the tissue structures exposed.

The Table provides you with an example crosswalk of an ICD-9 code versus the comparison ICD-10 code set.

Table. SAMPLE
Table. SAMPLE:
ICD-10 CROSSWALK

*CPT is a registered trademark of the American Medical Association.
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