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Pedal to the Metal for ICD-10 — Maybe not?

Written by: Darlene D'Altorio-Jones (1959-2015) on Thursday, March 27, 2014 Posted in: Inpatient Rehab

Highlights from Mediware’s ICD-10 Webinar Series

Mediware is priviledged to have an ICD-10 expert present a webinar series on the topic as we work toward what we think will be the expected October implentation date. However, hours ago the House approved legislation to delay it by one year. The Senate will still have to vote.

But, since we are preparing and want to stay well ahead of expectations, lets continue to recap the great information from that session, “Buckle Your Seatbelt: IRF Coding for ICD-10.”

Our webinar presenter, Paula Digby, reminds us that despite all evidence in the chart, a physician must either present facts in the order or documentation of their own notes or signed concurrence statements that evidence for all codeable conditions are active and/or being treated/managed. Prior to this late breaking news, ICD-10 was expected to be implemented full force, including IRFs by Oct. 1, 2014.

Should a delay occur, it helps us to work now on getting the correct details and information in the chart to guide appropriate codes for anywhere from three to seven characters in the ICD-10 set. New codes that will take very simplistic prior coding and create location, side, type, (how incurred), type (open, closed etc.), healing process, sequellae (initial, subsequent) and formulate those data elements to one process code for universal understanding of the condition(s).

What will be more important is the education to hospital-based IRFs, as they most likely have coders with very strong acute care episode coding experience but have little understanding of IRF-PAI historical coding directives that can be very different than acute process. A marrying of the knowledge of the IRF-PAI coordinator, the coder and appropriate queries to successfully encode were all suggested.

Dual coding for a short stint was recommended to help practice so that when legislation mandates change, everyone feels very prepared. During Mediware’s first webinar in the four-part ICD-10 series, only 20 percent of the people stated they had started making progress toward coding changes in their facility. Paula felt this was alarmingly low and that NOW is the time to ramp up the processes of education/training.

She stated audit findings of IRF charts revealed the following and those findings were similar to those she has seen in the numerous consults she performs to coach improved documentation/coding.

Existing Audit Findings:

·         Medical Necessity – additional impact may improve with new codes

·         Unclear, ineffective communication

·         Insufficient or missing documentation

·         Incorrect coding

·         Incorrect charge capture data

·         Incorrect patient status and Technical denials

Coding rules will remain unchanged. Therefore, specificity of information is critical to providing the right balance and appropriate tier of information. She gave several examples; instead of a physician stating ‘uncontrolled diabetes’ they should state, ‘uncontrolled with hyper and hypoglycemia’ so then a tier can be captured. Diabetes can be uncontrolled, yet never hit the requirements to gain the tier as in hyperglycemia specifically mentioned.

Are you ICD-10 Ready? Download the Checklist

Paula specifically mentioned the TOP TEN Documentation Problem Areas that are expected. Of those 10 – six specifically are areas that IRF/Us will need to be aware of.

·         Diabetes melliltus (co-morbidity descriptions)

·         Injuries (Etiologic purposes)

·         Cerebral Infarctions (Etiologic purposes – more generally described by artery involvement.

·         AMI (Etiologic purposes)

·         Neoplasms (Etiologic purposes & co-morbid conditions)

·         Musculoskeletal Conditions (Etiologic purposes)

The etiologic diagnosis will need to be discussed so that the correct IGC is selected. That will result in the appropriate HIPPS payment in conjunction with the IRF-PAI assessment data.

What do we need to do? Stay informed, stay educated, practice and when unsure, consult the experts to guide us. But most of all, pay attention to when this regulation will really be in effect! This week’s congressional actions seem to hold that MAJOR KEY to the next steps.