Health Information Management

Sufficient documentation a major hurdle for ICD-10

APCs Insider, October 25, 2013

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It’s October 1, 2014, and ICD-10 has finally been implemented. Your coders have been fully trained about the new guidelines and added specificity. You’ve performed end-to-end testing with all of your payers (except CMS) to guarantee seamless claim submission. It still may not be enough to ensure full reimbursement for the services you provided.

Only 63% of providers’ current physician documentation is sufficient to support the more rigorous specifications of ICD-10-CM, according to a 20,000-record audit recently performed by AAPC. This lack of specific enough documentation could have a major negative impact on revenue if not corrected before implementation, with coders relying on less specific default codes.

In fact, AAPC found that insufficient documentation often made up a large percentage of at-risk revenue compared with what was properly documented at facilities. At one facility, the seven most commonly used diagnosis codes accounted for 93% of the facility’s revenue. This means that ensuring proper documentation on just a handful of codes could have a major impact on the bottom line.

How well physicians sufficiently documented for ICD-10 varied widely by specialty. Gastroenterology practices had the lowest percent of complete documentation at just 48%. Plastic surgery, meanwhile, boasted the highest at 98%.

The good news is that providers are well aware of this problem with less than one year before implementation. More than 50% of respondents to a current poll on indicated that physician documentation was their biggest concern about ICD-10.

Providers should have already completed a documentation assessment to understand which conditions and diagnoses will be most important to focus on improving before ICD-10 implementation. They now have less than a year to review their most commonly used codes and make sure that everyone in the revenue cycle, from coders to physicians, is aware of what will be necessary in order to guarantee proper reimbursement. 

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