Health Information Management

Associate Director's Note: Much ado about ICD-10

CDI Strategies, October 29, 2015

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After three years’ worth of frustration and postponements ICD-10-CM/PCS implementation seems to have been much ado about nothing (to quote Shakespeare). The October 1, 2015, implementation date has come and nearly a month has passed wherein the United States healthcare system lumbered on pretty much as it had under the ICD-9-CM/PCS code set.

There were rumblings still, grumblings between the bickering Benedict and Beatrice (in our circumstance CMS and the physician practice world) as the two parties pretended to hate and then reconcile with each other. In fact, at AHIMA’s national conference earlier this month, AMA president Steven J. Stack, MD, joked with the crowd about previous comments he’d made indicating he and his fellow physicians didn’t want to delay ICD-10-CM/PCS’ implementation, they wanted to kill it. While that memorable quote once made headlines, its sentiment is now all in the past, Stack intoned from the stage, on eve of implementation.

Indeed it may be. Much of the pre-implementation banter and negativity seems less of late. Most facilities seem to be handing the transition well, with 70% indicating that implementation was going “fine” or “okay” with “a couple of documentation/coding bumps,” according to a recent ACDIS poll.

The ACDIS CDI Talk networking group also seems relatively sanguine so far, with a few discussion items related to software or encoder problems and a few reviews and cases seeking ICD-10-CM/PCS documentation guidance. Such discussions included PICC [peripherally inserted central catheter]-line placement, gastrointestinal bleed, and general PCS assistance, among other items.

Another 13% of respondents to the ACDIS poll, are waiting for claims denials to start arriving to really determine whether ICD-10-CM/PCS disruption has occurred. Additionally, CDI departments need to watch for any MS-DRG shifts.

Various assessments by CMS, Milliman, and 3M found that the MS-DRG assigned to an ICD-10 claim did not always match the MS-DRG assigned to an ICD-9-CM source claim. While only 1% of claims are expected to be affected, 41% of those will shift to a higher-paying MS-DRG, while 66% will move to a lower-paying MS-DRG, according to a CMS study quoted in a recent Briefings on Coding Compliance Strategies article.

Still, as Laurie L. Prescott, MSN, RN, CCDS, CDIP, CDI Education Coordinator and lead CDI Boot Camp instructor with HCPro Inc., in Danvers, Massachusetts, told listeners of the October 14 ACDIS Radio show “it’s not the zombie apocalypse” and CDI specialists simply need to continuing performing their core responsibilities of:

  • ensuring the completeness and accuracy of the medical record
  • identifying documentation improvement opportunities and trends
  • working across disciplines (coders, physicians, nurses, etc.) to provide education about those opportunities

“Nothing is perfect but the big thing is that we are going live,” Gloryanne Bryant told listeners of a the September 30th ACDIS Radio show. “If there [are] problems there will be solutions, too.” 

Even Shakespeare’s characters can agree with that. After all “Much Ado About Nothing” was a comedy, not a tragedy. 



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