I-10 queries

tkreilingtkreiling
in CDI Talk Archive
Anyone have tips or suggestions yet on what is going to be some of the most needed documentation clarifications once we start coding in ICD-10? I have been reviewing coded charts for ICD-10 query opportunities for the last couple of weeks and haven't came up with too many issues besides the ones we know are issues in ICD-9. So wondering if I am missing things, or just haven't came across charts yet that will have I-10 issues.
Thanks,
Tara, RN, CCDS.

Comments

  • jlightfoot@marshallmedical.orgjlightfoot@marshallmedical.org
    edited April 2016
    Thank you in advance for any responses.

    My experience has been the same as Tara's. It seems there are still choices of "unspecified" for the high frequency MCC/CCs. Many of the "linkages" in ICD-10 are also in ICD-9 and although we currently underuse them, I'm not finding significant opportunity for increased DRG, SOI or ROM with the increased specificity.

    We're still waiting for our organization to choose a vendor for data/gap analysis, better late than never, I hope. I'm wondering if our vulnerabilities will be the same in ICD-9 and in ICD-10???


    Jillian Lightfoot RN
    Clinical Documentation Team
    Marshall Medical Center
    Placerville, CA 95667
    (530) 626-2770 Ext. 6203
    jlightfoot@marshallmedical.org

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    MI and sepsis/SIRS are high on our list. Capturing "subsequent" MI's is a new concept and SIRS + Infection will no longer be sepsis (we still have MD's who seem to use SIRS/Sepsis interchangeably). There are lots of little issues as well but in general the more I work in I-10, the less concerned I am about it from just a CDI perspective (there are plenty of other reasons for hospitals to be concerned about I-10 though).
    Another area to be aware of is procedures. I know our team historically has not paid a ton of attention to the detailed procedure documentation, beyond identifying what the procedure is (for DRG assignment) and looking for any complications. But the biggest concern for I-10 is the changes in the PCS system. Coders will be unable to code records at all if the specificity is not available. We are hoping our CDI team can help insure that the documentation is there prior to discharge but this is a relatively new area for us.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • jlightfoot@marshallmedical.orgjlightfoot@marshallmedical.org
    edited April 2016
    Hi Katie,

    Thanks for your feedback.

    As our ICD-10 lead, I'm glad to find that others are feeling the same way (again at least from a CDI view). Sepsis/SIRS and MI, especially demand mediated have been a recurring issue around here for years anyway.

    I agree the PCS seems to pose the biggest threat in loss of revenue, delay of revenue and loss of productivity. Our program is similar to yours in the way we've previously looked at procedures. Any thoughts on who should receive the bulk of education for PCS? Of course, in a perfect world, we'd all receive intensive training, unfortunately that's not our world. We're unsure where to put the most emphasis...on surgeons, our CD staff or the coders??


    Jillian Lightfoot RN
    Clinical Documentation Team
    Marshall Medical Center
    Placerville, CA 95667
    (530) 626-2770 Ext. 6203
    jlightfoot@marshallmedical.org

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Without anyone having performed any gap-analysis, I think I would devote some time to your top procedures. See if the documentation is already in the record. Most of the time it is (at least this is what I am seeing). But when you come across holes, then you can figure out how to fix it. We have had a few things come up that we were able to 'fix' just make adding to a template or auto-populating an order set which is easier that trying to rely on the physicians to document new information every time.
    Also, if your coders are duel coding, they may already have a decent idea about what is missing. Unfortunately, ours are not yet duel coding.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • jschoonhovenjschoonhoven
    edited April 2016
    We will be starting our own 'duel-coding' project next week on our Ortho ward. The usual CDS there will do her full usual load (if possible) in I-10. I have a contract CDS lined up to do the same load in I-9.

    We want to establish both a) what might be missing to code these high volume surgeries right, and b) how much productivity time-loss is there. Is a 'normal load' initially doable in ICD-10? How far off are we likely to be and will it probably improve with time?

    We are going to take up to a month to check this out. I'll let you all know if we learn something!
    Janice

    Janice Schoonhoven RN, MSN, CCDS
    Clinical Documentation Integrity
    Manager- PeaceHealth Oregon West Network

  • jlightfoot@marshallmedical.orgjlightfoot@marshallmedical.org
    edited April 2016
    Again, thank you!

    And again, I agree with your thoughts. Based on our initial reviews, our documentation also appears to be sufficient, we just haven't been coding to that level. I was doubting the validity of what we were finding since we didn't seem to be coming up with much!! Now I'm smiling, thinking we're doing okay.

    We're working on our next phase of meaningful use and the EMR which will include CDI "approved" templates for physician documentation.

    We're ready to begin dual coding, but unfortunately our software isn't. That concerns me more than anything...are all the IT issues going to be resolved in time?? Hoping we can have the coders start soon. Seems it may be the simplest way to start finding our "opportunities".

    Have a great day!


    Jillian Lightfoot RN
    Clinical Documentation Team
    Marshall Medical Center
    Placerville, CA 95667
    (530) 626-2770 Ext. 6203
    jlightfoot@marshallmedical.org

  • paxnerospaxneros
Sign In or Register to comment.