Health Information Management

ICD-10 as time saver?

HIM-HIPAA Insider, August 25, 2014

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We hear a lot about the projected productivity declines after ICD-10 implementation. And coders will be less productive initially. That only makes sense because ICD-10 is new, coders will need to look for additional information, they (or their clinical documentation improvement specialist coworkers) may be sending more queries.
 
That’s the short term. What about the long term?
 
ICD-10 should actually speed up claims processing, according to Donna Smith, RHIA, project manager and senior consultant with 3M Health Information Systems in Salt Lake City.
 
For one thing, ICD-10-CM codes will better support medical necessity because they include more information, Donna points out. Right now, hospitals spend a lot of time copying records and shipping them off to payers because the ICD-9-CM codes are just so vague.
 
ICD-10 will also tell a better patient story. With the seventh character, you can actually follow a patient’s injury all the way through and see what kind of outcome the patient experienced.
 
A better, more complete picture of the patient’s severity of illness should also help reduce denials, Donna says. If Dr. Adams says her patients are really sicker than Dr. Smith’s, ICD-10 will allow her to show it. And if you don’t have to appeal denials, you get paid faster and you spend less time fighting with the payers.
Let’s not forget laterality. Joe comes in with a lacerated left index finger with injury to the nail. We have one code in ICD-9-CM (883.2). We’re reporting that same code for all 10 fingers.
 
In ICD-10-CM, we have separate codes for every finger, plus codes that specify whether the nail is involved and whether any foreign bodies remain in the wound. For our lacerated left index finger, we would choose between:
  • S61.311-, laceration without foreign body of left index finger with damage to nail
  • S61.321-, laceration with foreign body of left index finger with damage to nail
Both codes require a seventh character to denote the encounter.
 
The next day, Joe comes in with another finger laceration, this time of the left ring finger. In ICD-9-CM, we’re still reporting 883.2 and the insurance company may think we’re double billing or we did something wrong.
 
However, in ICD-10-CM, we will report one of these codes:
  • S61.215-, laceration without foreign body of left ring finger without damage to nail
  • S61.225-, laceration with foreign body of left ring finger without damage to nail
  • S61.315-, laceration without foreign body of left ring finger with damage to nail
  • S61.325-, laceration with foreign body of left ring finger with damage to nail
Again, we need a seventh character for encounter.
 
The payer can see that Joe injured a different finger, so we should be quickly reimbursed, which will save time (and aggravation).
 
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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